First, immediately report your injury to your employer even if you do not believe you need medical treatment. Next, file a claim for benefits. If your employer has done what they are supposed to do after you report your injury, your employer files a first report of accident. This form is mailed to their workers’ compensation insurance carrier and they in turn will mail notice to the Virginia Workers’ Compensation Commission that an injury has been reported and they will also call you to get a tape-recorded statement as to what occurred and to attempt to make a decision whether or not to accept your claim. The recorded statement is the insurance adjuster’s opportunity to find any grounds to deny your claim. I usually advise my clients not to give a recorded statement because there are certain things that they could be led into answering that could destroy their case. However, sometimes, to speed the process along, it could be an option to give your recorded statement quickly. You would need to speak to a lawyer to get advice as to which would be the best option for you, given the circumstances that you are in at the time. Assuming that the insurance adjuster accepts your claim, they usually begin making voluntary payments of two-thirds of your average weekly wage within a few weeks and they will give you a panel of physicians for you to pick one to become your workers’ compensation treating physician. Many times, the insurance company continues to make voluntary payments and does not mail the First Report of Injury to the Virginia Workers’ Compensation Commission. At this point, it’s important to note that if you have not received a claim for benefits form from the Workers’ Compensation Commission, you request one; either online or in person at the Commission. A sample copy is in the appendix. Filing this claim for benefits is very important. At that point, the Virginia Workers’ Compensation Commission generates documents to the insurance carrier that are called the 20 day order. This 20 day order is a form that the insurance adjuster has to return to the Virginia Workers’ Compensation Commission within 20 days advising the Commission whether they are accepting the claim or if they are denying it and, if so, why. You would then get a copy of this document.
If they accept the claim, an Award order would be entered. This is the document that you are looking for when there is any change in your case. You want Award orders entered so that you’re under what’s called an open Award, as opposed to not having an Award and the employer just making voluntary payments. This is important for several reasons. One reason is that if you’re being voluntarily paid with no Award order and a conflict comes up six months to a year later, you will still have to prove your case: that the injury by accident occurred. Many witnesses may be gone and, at the very least, memories faded. The conflict may be whether or not you should have surgery and now you also have to fight and prove whether an actual accident occurred. Once an order is entered, the insurance company is legally responsible for that injury by accident and you would never have to go back and try to prove it. The second reason why Award orders are so important is, once you’re under an Award order you can ask, under some circumstances, for an expedited hearing if an issue arises. This would mean you would have your hearing more quickly than waiting with all the other individuals whose claims are being denied. Usually, this would cut the time before your case is heard by three to four months. Cutting the time by three of four months, during which time the insurance company has cut your check off, may mean a lot to you financially. Don’t forget that your bills, like electric, rent, and mortgage are not going to go away because you are hurt on the job.