Who’s Who in a Virginia Workers’ Compensation Case
If you have been injured on the job and are pursuing Virginia workers’ compensation benefits, you are going to be coming into contact with a lot of people who are involved in the administration of your benefits.
Make sure you know who is who, and what role each person or agency plays in the path to getting your benefits. I have compiled a small list of people and agencies you will likely come into contact with during the course of your claim, and hopefully this will help you have a better understanding as to who you are communicating with, what their role in your claim is, and what is going on with your case.
- Insurance Company – The Insurance Company is to whom your employer pays the workers’ comp insurance monthly premium (like you might pay your car insurance) so when an injury is reported, the insurance company can step in and take over management of the claim. If you are receiving benefits, payment for medical care, and/or pay for lost wages, the money would come from the insurance company.
- Insurance Adjuster – The Insurance Adjuster is an agent of the insurance company. Their job is to investigate and determine what, based on their information, should or should not be covered under workers’ compensation. Insurance Adjusters work for the Insurance Company and will often times contact injured workers and take recorded statements (beware of recorded statements, they can be used against you!). This person will likely be your first point of contact for your claim (unless you have hired an attorney to assist you) and will also be the person who makes the initial determination as to whether your claim is approved or denied and if medical care and/or wages should be paid.
- Nurse Case Manager – The Nurse Case Manager (NCM) is hired by the insurance company. Their role is to monitor your medical care, they will even be present at your doctor’s appointments and report back to the insurance adjuster on your progress.
- Workers’ Comp Doctor – The WC Doctor is the doctor the insurance company sends you to for medical care. For ACCEPTED Workers’ Comp cases, you must see the insurance companies doctor for care; this is a doctor “hand-picked” by the insurance company and this will be your primary doctor for your work-related injuries until he or she refers you to another physician.
- Voc Rehab Counselor – The Voc Rehab Counselor is also hired by the insurance company. Their job is to help the injured worker return to some form of work within your new work abilities so that you will be earning wages instead of collecting money from the insurance company for time off of work.
- Virginia Workers’ Compensation Commission– The Virginia Workers’ Compensation Commission (VWC or Commission) is the state agency that oversees the administration of all workers’ compensation benefits by insurance companies. It is required that the Commission knows of all work injuries, but many insurance companies fail to notify them and it falls upon the injured worker to file a Claim for Benefits with the Commission. The VWC is also the entity that would hold a hearing and determine if you are entitled to workers comp benefits in the event that the insurance company is denying your claim.
About the Author: Michele Lewane
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.