If you have been injured on the job and are pursuing 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 and hopefully this will help you have a better understanding as to who you are communicating with and what is going on with your claim.
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 works 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. They also give an opinion to the insurance adjuster as to whether or not they agree with the course of treatment your doctor is recommending. Many times, the NCM will also consult with your doctor, and possibly put pressure on him or her to return an injured worker back to some for of light duty status.
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. Their job is not to find you the job of your dreams. Their job is to save the insurance company money. Voc Rehab Counselors report back to the insurance company on the progress you are making in your job searches and let them know whether or not you are making a full effort to cooperate with their requirements.
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 the insurance companies.It is required that the Commission know 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. Injured Workers’ can go to the VWC for a hearing (if necessary) and they can have any benefits they are entitled to formally recognized through the Commission by getting an Award Order. You must understand that the VWC is separate from the insurance company. The VWC makes the final determination if a matter is contested.