Claims Process: What Should an Employee Do When They Are Hurt?

Step 1: Report Your Injury

As soon as you are hurt on the job, report your injury to your employer. The law gives you thirty days to report, and the sooner you do it, the better.

A lot of very serious injuries start as nothing more than what feels like a pulled or strained muscle – the sort of thing that you think will just go away. Don’t ignore this small pain. Report it, in case it grows into something bigger, or is symptomatic of a much larger problem that has yet to fully show itself.

Step 2: File A Claim Form

Once you’ve reported your work injury to your employer, the next thing to do is file a Claim Form with the Virginia Workers’ Compensation Commission. We have the forms here on our website, as does the Commission. If your employer has already reported your injury to their carrier and to the Commission, the Commission may also have sent you a Claim Form in the mail.

The claim form has two parts: a top part, Part A, and a bottom part, Part B.  Part A is where you describe the accident and identify which body parts you injured. Part B is where you tell the Commission what benefits you are seeking.  

The form says that Part B is optional, but it’s the part you need to fill out to receive an award for any lost wages. If you only fill out Part A, you risk only getting an award for medical treatment for the body parts you listed on the form but not any lost wages.

What types of benefits are available to you as an injured worker?

The first and perhaps most important is your lifetime medical benefits. An award for lifetime medical benefits will mean that, for the rest of your life, all medical treatment that is reasonable, necessary, and causally related to your work injury must be paid for by your employer’s workers’ compensation carrier.

Temporary Total Disability and Temporary Partial Disability

There are a few other types of benefits. Two deal with lost wages – Temporary Total Disability and Temporary Partial Disability.

Temporary Total benefits are for when you are out of work entirely due to your work accident, either because the doctor tells you that you cannot work, or because the doctor tells you that you have restrictions that prevent you from doing the job you were doing before you were hurt and the employer does not have work for you.  If it is the latter, you will need to look for a job. 

Temporary Partial benefits are for when you are able to work, but not as much, or at a lower paying job, to make up the difference.

Step 3: Record a Statement

At any point in this process, your employer’s workers’ compensation carrier might call you. The person on the phone will probably be an investigator or an adjuster assigned to your claim.

The adjuster may ask you:

• if they can record your conversation
• how the injury happened
• what medical treatment you received
• any prior medical treatment you have had

This is called a recorded statement and what you say in the recording will be used against you if it can be. You do not have to agree to the recorded statement, but the adjuster may deny your benefits if you refuse.

Physician Panel

The adjuster might also offer you a panel of physicians to choose from so that you can begin your medical treatment. If the panel includes three doctors from three separate practices and all of them will agree to treat workers compensation clients and are a reasonable distance from you, then this will probably be considered a valid panel.  

You need to go to a doctor from that panel if you want the insurance company to pay for your medical treatment. They will claim that any other treatment is not authorized and you might end up paying the bill.

Once you have filed your Claim Form with the Commission, the Commission will order the workers’ compensation carrier to let them know if they are accepting or denying your claim. If your claim is accepted by the adjuster, that’s wonderful! You will probably get a document called an Award Agreement and once everyone signs this and returns it to the Commission, then the Commission will enter an Award Order.

Step 4: If Your Claim is Denied

If your claim is denied, then the Commission will schedule a hearing to figure out whether your injury is a compensable work injury. If you have a hearing scheduled, and need help, or, have any questions about the claims process, reach out to us at the Injured Worker’s Law Firm to receive a free consultation with one of our attorneys as well as a free copy of our lead attorney, Michele Lewane’s book Workers Compensation in Virginia, which is full of great, helpful information for you as you move through the Workers Compensation process.