- DO NOT give a recorded statement about your case to the insurance adjuster or anyone else.
- If a nurse employed by the workers’ compensation carrier contacts you, DO NOT discuss your medical condition, employment, employment prospects, personal life or anything else with him/her. DO call your attorney to discuss the event.
- If any person other than your treating doctor directs you to see any other doctor, DO NOT go until you have discussed the situation with your attorney.
- DO NOT sign any papers presented to you by any employee or agent of the insurance company until your attorney has reviewed them.
- If you are presently receiving or have a claim pending for weekly benefits, DO be aware that insurance companies often hire investigators to watch and record your activities. DO act accordingly.
- DO report any change in your medical condition or employment status to your attorney.
- DO NOT show this paper or any other papers you receive from your attorney to anyone.
- If a vocational counselor hired by the insurance company contacts you about locating work, DO NOT discuss anything with the counselor until you have spoken to your attorney.
- DO NOT discuss any aspect of your workers’ compensation case with the insurance adjustor with two exceptions:
- If you have not received reimbursement for prescriptions or mileage, you should speak directly to the adjustor; and/or
- If you have not received your check, you should speak directly to the adjustor. DO NOT call your attorney regarding your checks unless your checks are two weeks late or if the adjustor will not speak with you regarding this information. The Virginia Workers’ Compensation Act allows us to file for a 20% penalty on all amounts owed to you if your checks are more than two weeks late.
- DO NOT write letters to the adjuster, the Virginia Workers’ Compensation Commission, or anyone else handling your case.
- If you are placed on light duty, DO contact your employer to see if light duty work is available. If they do not have light duty work, DO start looking for light duty work immediately. DO contact at least 10 employers per week, register with the Virginia Employment Commission, and keep a list of all job contacts including: name, address, date, telephone number, and contact person.
- EVERY time your see your doctor, DO get a disability slip and send our office a photocopy of it. DO keep the originals of the disability slips.
When you’re struggling with job-related injuries, it can be very frustrating when the insurance company accuses you of some form of Workers’ Compensation fraud, such as willful misconduct. If your Virginia Workers’ Comp claim has been denied, you could always speak to a lawyer and petition the Workers’ Comp Appeals Board.
The insurance company isn’t out for your best interests; it will look for loopholes in your case and take advantage of any opportunity they can find to deny your claim.
What is willful misconduct?
In a Virginia Workers’ Comp case, willful misconduct is best defined as any intentional act that led to job-related injuries. In other words, the employee knew the rules and the consequences and broke them.
Legitimate willful misconduct is a form of Workers’ Compensation fraud, a serious offense, and will result in a denial of a Workers’ Compensation.
Some forms of willful misconduct include:
- violating a statutory rule (like speeding); and
- violating a work safety rule.
There are some employees who engage in willful misconduct, and it’s only fair and just for their claim to be denied. For example, if workers drink on the job, they shouldn’t be “rewarded” with Workers’ Compensation.
When a Claim Is Wrongly Denied
However, insurers will oftentimes try to stretch the evidence and then wrongly deny a claim. For example, what if you’re injured while making a delivery on the job while driving 2 miles an hour over the speed limit? The insurance company could exploit that and try to deny your claim.
If you’ve been injured at work, especially when it’s a serious injury that prevents you from continuing to earn a living, it’s important to see your claim through to the end and try to get the compensation you deserve.
If your claim has been denied, you and your VA attorney can submit your case to the Workers’ Comp Appeals Board. Just because your employer has said you engaged in willful misconduct doesn’t mean that you still can’t get your benefits if you fight for them.
One of the tactics insurance companies use to deny Virginia Workers’ Comp claims is to claim that because an employee broke a safety rule, he or she is guilty of willful misconduct, a form of Workers’ Compensation fraud.
No matter what your job-related injuries are or what your case entails, you should consult with a Virginia Workers’ Compensation attorney so you can make sure your rights are protected. Even if your claim has been denied, an attorney can help you petition the Workers’ Comp Appeals Board and help you fight for your benefits.
Understanding Work Safety Laws
In Virginia Workers’ Comp cases, the law states that it’s the employer’s responsibility to show:
- they had a reasonable rule that the worker knew about;
- it was for the worker’s benefit;
- the worker knew the probable serious results of violating the rule; and
- the worker purposefully broke the rule.
It can be tragic when employees break important safety rules and get serious job-related injuries as a result. If workers blatantly ignore and refuse to adhere to safety rules, it’s only natural that their claim should be denied.
However, sometimes there are legitimate reasons for breaking a rule, which the Workers’ Comp Appeals Board would take into consideration, such as:
- fear or injury;
- an actual, physical inability to comply with the rule;
- an emergency;
- ignorance of the rule; or
- vagueness of the rule.
There are extenuating circumstances that might have caused the employee to break a company rule, and the claim shouldn’t necessarily be denied just because the employer accuses the employee of Workers’ Compensation fraud.
If you’ve found yourself in this unfortunate situation, don’t give up on your benefits yet. First, speak to a Workers’ Comp attorney who’s familiar with the insurance company’s tactics and knows how to deal with cases like yours.
Contact an Attorney about Your Work Related Injury Claim
When you have difficulties with your work-related injury claim, a Virginia Workers’ Comp attorney can bear some of the burden you’ve been placed under. To get back on your feet, whether it means getting back to work or getting the benefits you deserve, order a copy of our free book, the Ultimate Guide to Workers’ Compensation in Virginia, and contact a Workers’ Comp attorney at the Injured Workers Law Firm for a no-cost consultation – 1-877-755-7744 or 1-866-608-5893.
About the Author: Injured Workers Law Firm
The Injured Workers Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers' compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia Workers’ Compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia” , or call our office today (804) 755-7755.