worker in hard hat with shoulder injury being helped by coworkerAn employee hurt on the job in Virginia generally may file a claim for workers’ compensation benefits. Workers’ comp is no-fault insurance that covers medical expenses and lost wages for employees injured in the course of performing their job duties. Nearly every business with three or more workers on the payroll is required to carry workers’ comp. You don’t have to prove any negligence on the part of your employer to file a claim, and you can’t be fired or penalized for doing so.

There are workers’ compensation claims that do not require the services of an attorney. Some work-related injuries are minor and don’t lead to expensive medical treatment or more than a week off work. If you suffer such a minor injury, you have no pre-existing medical conditions, and neither your employer nor the insurance company disputes your claim, you might handle the workers’ comp process on your own as long as you meet all deadlines and procedural requirements.

Workers’ Comp Claims That Require an Attorney

Successful workers’ comp claims are paid by the insurance company from which your employer purchases coverage. That insurer, which is in business to make a profit for its shareholders, does so by collecting as much money as possible in premiums and paying out as little as possible in claims. For this reason, the insurer employs tactics to dispute, delay, or deny expensive claims resulting from serious injuries that require costly treatments and lead to significant time off work.

Today, injured workers with expensive or complicated claims are more likely than ever to face a fight with the insurance company over fair benefits. Going up against the insurer’s adjusters and attorneys, who are well-trained to avoid paying expensive claims, is very difficult for the average person, especially after a serious injury. Such a claimant is likely to require legal representation in order to receive fair benefits for a work-related injury.   

The Workers’ Comp Claims Process

The Virginia Workers’ Compensation Commission (VWCC) allows you 30 days to report a work-related injury to your supervisor, but you should do so immediately after your accident. Your employer should file a First Report of Injury (FROI) with the VWCC within ten days. You may then submit a Claim for Benefits form from the VWCC website. You actually have two years to file, but it’s best to do so as soon as you’re physically able. Waiting to report your injury or file your claim can only work against you. The insurance company will cite your delay as evidence that your injury is not serious or not work-related. You don’t want to give the insurer any ammunition to use against you.

You should seek a medical diagnosis and treatment as soon as possible. You’ll probably be directed to a doctor recommended by the insurance company, but your attorney can help you to seek an independent diagnosis from a doctor not affiliated with the insurer. Keep all your medical appointments, follow the doctor’s treatment plan, take medication exactly as it’s prescribed, and retain documentation of all your treatments. If your claim is accepted, you’ll receive an Awards Agreement. If your claim is denied or you find yourself in any of the situations described below, contact a workers’ comp lawyer right away.

When to Contact a Workers’ Comp Lawyer

As soon as you become aware that one or more of the circumstances below apply to your case, you’re well-advised to consult a workers’ comp attorney:

  • You’ve reported your injury and filed your Claim for Benefits but have received no response from the VWCC or the insurance company within a reasonable period of time.
  • You’re already receiving Social Security Disability Insurance (SSDI) or other disability benefits that might be reduced when your workers’ comp claim for benefits is accepted. Your lawyer can work to minimize the offset between the two sources of benefits.
  • Your employer terminates you or retaliates against you in any other way after you’ve filed a claim.
  • The insurance company’s adjuster requests a recorded statement from you about your accidental injury. Do not provide such a statement without your lawyer present.
  • You have any pre-existing injury or health condition that the insurance company can blame for your current medical issues. Your attorney can gather evidence to prove that your work accident caused your current injury or aggravated a pre-existing condition.
  • Your current doctor is not providing satisfactory treatment of your injury, you’re not getting timely approval for treatments, or your employer sends you to a doctor who tries to minimize your claim. Your attorney can petition for an independent medical exam by the doctor of your choice.
  • A third party not employed by your company is fully or partially responsible for your work-related injury. Although you may not sue your employer, you may sue the third party. A civil suit could win you extra compensation to make up the one-third of your wages that workers’ comp does not cover. You can also seek compensation in civil court for your pain and suffering, which worker’s comp does not address.
  • You’ve scheduled or want to schedule a hearing before the VWCC. Your employer and insurer will definitely have a team of lawyers present, so you want your own attorney there to level the playing field.
  • Your claim is denied for any reason. Your attorney can gather further evidence, call in expert witnesses, and start the appeals process.
  • Your employer forces you back to work before you’re sufficiently recovered or refuses to honor your impairment rating or medical restrictions by offering a light-duty position.
  • You’ve reached the stage of maximum medical improvement (MMI) but are left with a total or partial permanent disability that prevents you from returning to your job. Permanent disability claims are very expensive for the insurer and are likely to be disputed.

If you know that your injury is serious, it’s a good idea to consult an attorney immediately after your accident for guidance throughout the claims process. Once your claim has been accepted and paid, you can never ask for more compensation, so you want to be sure to seek benefits sufficient to cover all your losses before your case is closed.

Your lawyer can make sure you complete every step correctly, meet all deadlines, and observe all other procedural requirements. Most law firms will offer you a free first consultation and charge no attorney fees until the case is won, so you have nothing to lose and a lot to gain by talking to a lawyer as soon as possible.

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