6 Things you Need to Know When Your Virginia Workers’ Compensation Claim is ACCEPTED

When your workers’ compensation claim is accepted and your medical care is being covered by the insurance company, there are still things you need to do:

1. You still need to file a Claim Form form with the Virginia Workers’ Compensation Commission to have your benefits formally recognized by the Commission. This is also to protect you against the 2 year statute of limitations set forth by the State of Virginia. Until you have an AWARD ORDER entered by the Commission, you are not protected and all you benefits could stop at any time for no reason at all.  Without an Award Order, the insurance company is voluntarily paying your benefits with nothing to hold them to it if they feel like they don’t want to any more.
2. You need to make sure you are getting treatment through the approved workers’ compensation doctor. If you go outside of the insurance company’s network of providers, your treatment might not be covered.
3. All treatment and testing the workers’ compensation doctor orders for you has to be pre-approved by the insurance company.
4. A claim can go from being accepted to being DENIED at any moment. Even if your claim is approved and you have been given a lifetime medical award by an Award Order, you (and your doctor) still have the burden of proof to show that your ongoing treatment is reasonable, necessary, and related to the work injury.  This standard has to be met every step of the way throughout the workers’ compensation process.
5. Always get a work status slip from your doctor at every visit. Anyone who has spoken with my office knows that we are constantly telling injured workers’ YOU MUST HAVE A SLIP FROM YOUR DOCTOR HIGHLIGHTING YOUR WORK STATUS. Whether it is off of work completely or restricted duty, workers’ comp will not honor anything that is not in writing from your doctor. Also, workers’ comp will not accept back dated work slips, even if it is obvious that you cannot work, you MUST have clear, current instructions in writing from the doctor. I cannot stress this enough! Even if every bone in your body is broken and you can’t get out of bed, workers’ comp WILL NOT PAY you without a work status slip from your doctor.
6. You may or may not get a settlement. Settlement is a mutual agreement by both parties – it is not a guarantee. Bottom line – if both parties can’t reach an agreement then there is no settlement. You would just continue to receive your benefits. If the insurance company offers you a settlement or if you are contemplating settling your claim, I always recommend speaking with an experienced workers’ compensation attorney to ensure you are getting a fair settlement. Also, if you have an accepted claim and are receiving any benefits in addition to workers’ compensation (ex: Medicare, Medicaid, or Social Security) you should talk to a workers’ compensation attorney because additional steps in the settlement process may be required.

If you have questions about your workers’ compensation benefits or if you would like more information on the Virginia workers’ compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia” or call our office today (804) 755-7755.