Virginia Workers’ Compensation Frequently Asked Questions

Virginia Workers’ Compensation Frequently Asked Questions 2018-07-03T18:03:41+00:00

 

Virginia Workers’ Compensation Frequently Asked Questions

If I suffer from a severe chronic illness that my doctor believes is related to the work I do in Virginia, should I consider workers’ compensation?

A: The likelihood of recovery under Virginia’s workers’ compensation laws for a chronic illness will depend on the type of illness and whether the illness was directly caused by the work you perform. Even if your doctor attributes a chronic illness to your work, it may not be enough to be classified as an occupational disease that is considered compensable under Virginia workers’ compensation.

Read More

When should I settle my claim?

A: There is no one set of rules for the “best time to settle” in any case, as each case is different. If you are actively seeking medical treatment, or you may have suffered a permanent loss of use of a body part(s), or you have permanent restrictions, there is a danger in settling your claim prematurely.

Read More

How long do I have to report my work injury to my employer?

A: You have thirty (30) days after a work injury to notify your employer of the injury.

Read More

I was injured on a construction site while I was working as an independent contractor. Can I still get Virginia workers’ compensation benefits for my injury?

A: The answer to this question depends on the very specific facts of your case. The Virginia workers’ compensation laws determine who is considered an “employee” of a company and who is an independent contractor.

Read More

How does short term disability apply in Virginia workers’ compensation cases?

A: Workers’ compensation cases involving short-term disability can become complicated. Generally, they are mutually exclusive.

Read More

Can I receive short term or long term disability and workers’ compensation benefits?

A: Probably not.

Workers’ compensation is the “exclusive remedy” – the sole recourse – for benefits.

Read More

I filed a workers’ compensation claim but there’s been no response.

A: First, it is important to know where you filed the claim. If you filed a claim with your employer or with the insurance company, they are not necessarily required to do anything with it.

Read More

Why does workers’ compensation insurance have to know about my auto accident?

A: For an automobile accident that took place before your work injury, the workers’ compensation carrier will want to know if you injured the same body parts before to verify that the work injury is responsible for your need for treatment.

Read More

What happens at a hearing?

A: A hearing is a legal proceeding to determine what, if any, benefits are due under the Virginia Workers’ Compensation Act. A Deputy Commissioner will be present to hear all evidence and testimony. The insurance company and employer will have an attorney representing their interests.

Read More

Can I get a cost of living adjustment?

A: Yes.  However, there are two requirements.

First, you must be under an open award for temporary total disability benefits with the Virginia Workers’ Compensation Commission on or before July 1 of the year you are seeking the Cost of Living Adjustment, also known as COLA.

Read More

My nurse case manager is trying to get my doctor to change my treatment plan, work restrictions, etc. What should I do?

A: This comes close to what is known as “managing medical treatment.” In Virginia, no one but the treating physician can direct medical treatment, not even your nurse case manager.

Read More

What happens when the doctor says I am at maximum medical improvement?

A: Maximum medical improvement (MMI) is a medical term used by your physician to indicate he believes you have basically gotten as good as you are going to get from your recovery of your workers’ compensation injury(ies).

Read More

How will my Social Security Disability benefits be impacted by my workers’ compensation benefits?

A:Your Social Security Disability benefits can be offset by any wage loss benefits you receive in a workers’ compensation claim. However, it also means that the amount of the workers’ compensation benefits that are being offset become taxable income.

Read More

I’m on work restrictions but I don’t want to lose my job, what do I do?

A: Every time you get work restrictions, take them to your employer. If they have work available, then be sure you are doing the best you can within your work restrictions.

Read More

Are you joking, workers’ compensation gets my money from my auto accident claim?

A: If workers’ compensation insurance has paid any benefits to you or on your behalf that are included in the auto accident claim, then the workers’ compensation insurance carrier not only has a lien against any money you get from the auto accident case but you MUST get the workers’ compensation insurance carrier’s permission before you can settle that auto accident case.

Read More

What can Injured Workers’ Law Firm do for me?

We only handle cases that involve the Virginia workers’ compensation claims process (and related matters). Our main goal is to get you the maximum amount of injury benefits possible. There are several reasons for this.

Read More

I got a disease from work can this be covered?

A: It is possible to get diseases that occurred from exposure at work covered, either as an occupational disease (if it is a disease to which the general public is not exposed) or as an ordinary disease of life) if it is a disease to which the general public is exposed. There are very specific requirements that must be met in order to qualify for benefits in either of these cases.

You should speak with a Virginia workers’ compensation attorney who can discuss the specifics of your case and assist you in securing benefits and protecting your rights.

Read More

What happens if I lose permanent function of a body part?

A: When a job related injury results in the loss of use of a certain body part or parts that are specifically included in the Virginia Workers’ Compensation Act, an injured worker may be eligible to collect benefits for the loss of use of that body part or parts.

Read More

Can I get reimbursed for time taken off for doctor appointments related to my work injury?

A: Yes, but you are required to try to schedule the medical appointments around your work hours if you can. Within reason, you should be able to work at least part of your normal shift before or after a medical appointment. However, if you cannot schedule the appointment around your work schedule, you are entitled to benefits for the time you miss from work.

Read More

Can I sue my employer because they were at fault for my injury?

A: No, Workers’ compensation is a no fault system. This means that the injured worker does not have to prove someone else was at fault (it can be their own fault). But it also means that if the employer is at fault, you can only receive workers’ compensation benefits.

Read More

I don’t want any trouble at work or to lose my job, what should I do?

A: The work environment can be a little uncomfortable after a work injury.  Unfortunately, the sad reality is that having an injury at work and then having a subsequent workers’ compensation claim does not protect your job. You need to communicate your work restrictions to your employer by supplying the employer with a copy of your doctor’s note after every appointment.

Read More

Am I responsible for actually filing a claim for workers’ compensation?

A: Yes. The injured worker is always responsible for filing the claim for benefits with the Virginia Workers’ Compensation Commission. Even if your employer completes their own accident report and sends it to their insurance carrier, they are only required to notify the Commission that you were injured which is not the same as filing a claim for benefits.  Remember, it is your responsibility to pursue your claim.

Read More

What is needed to prove my Virginia workers’ compensation claim?

A: It is the claimant’s burden to prove every element of his or her workers’ compensation case. This includes such things as your wages before you were hurt, your wages after you were hurt, that you reported your injury timely, any witnesses to your injury, what medical treatment you have received, and what work restrictions you have, just to name a few. This is why it’s important that you do your part to gather as much evidence as you possibly can.

Read More

What is a Medicare Set aside?

A: A Medicare Set Aside, also known as a MSA, is the amount of money it is estimated will be required to protect Medicare’s interest in the future. This amount is determined by a company who specializes in preparing Medicare Set Aside proposals, typically hired by the workers’ compensation carrier.

Read More

I’ve been waiting for approval of medical care/prescriptions but can’t get it. What should I do?

A: It may take a day or two to get approval of medications from your adjuster. However, if you cannot get a response within this time frame, we can help with getting an answer.

Read More

Must I go to the job interview?

A: Yes. If you are scheduled for a job interview, you must attend the job interview. You must dress appropriately and have a positive attitude. Initial job interviews are generally used to see if the employer feels you have the qualifications and abilities they are seeking.

Read More

How do I report my injury?

A: There are three ways to report your injury. First, you need to report your injury to your employer. Even if your injury was witnessed by other employees, including your direct supervisor, it is YOUR responsibility to immediately (as soon as you are able) contact your employer to advise them of your work injury and how you were injured.

Read More

I was on a business trip and got hurt in the hotel. Can I collect Virginia workers’ compensation?

A: For the most part, yes, you can collect workers’ compensation if you were on a business trip and got hurt in the hotel. The law says that injuries that occur while traveling on a business trip are covered, with some exceptions.

Read More

What is the truth about “lifetime” medical benefits?

A: While you may have an award for “lifetime medical benefits,” this may not necessarily mean what it sounds like. The insurance carrier is only required to cover reasonable, necessary, and causally related medical treatment. Unfortunately, it is the injured worker’s burden to prove these things.

Read More

What does it mean that my Virginia work injury or work related disability has to have arisen from employment?

A: Not all injuries that take place at work are covered. A Virginia work injury or work related disability must have arisen from employment. That means that some part of your employment must have caused the work injury.

Read More

What if I cannot afford the gas money to get to physical therapy?

A: An award for medical treatment allows an injured worker reimbursement for mileage to and from doctor’s appointments, physical therapy, lab work, diagnostic testing, and other medical appointments.

Read More

I was hurt at work, how can my claim be denied?

A: There are many reasons that your claim may be denied. Virginia is referred to as a “specific risk” state, meaning that your injury must be the result of a specific accidental injury due to specific aspect of your employment.

Read More

Who is supposed to pay me when I can’t work because of an injury on the job?

A: The benefits, including lost wages, are actually paid by your employer’s workers’ compensation insurance carrier-not the employer. In some cases, the employer can be self-insured, which means that your employer is paying the benefits.

Read More

Help, I’ve been terminated from my job.

A: Whether you are entitled to any workers’ compensation wage loss benefits depends on why you were terminated. If you were terminated because of something you did that is unrelated to the work injury, i.e., job performance, tardiness, insubordination, then your workers’ compensation wage loss benefits will probably be stopped or you will not be eligible.

Read More

I do not understand about returning to work either light duty or full duty and whether I have to look for other work.

A: If your doctor releases you to full duty work with no restrictions then you are no longer entitled to any workers’ compensation wage loss benefits as any wage loss you have is no longer related to your work injury. However, you are still entitled to medical treatment through workers’ compensation.

Read More

Should I talk to my physician about my work restrictions?

A: Put briefly, you should always speak to your doctor about work restrictions, if it’s at all possible. You should inquire with your doctor about his or her opinion on your ability to return to work with restrictions, what those restrictions should be, what your functional capacity is for sustained labor, and anything else that might be relevant to your ability to work.

Read More

What mistakes do I need to avoid or be aware of when handling my workers’ compensation claim?

A: There are many mistakes that you should avoid making. The best way to avoid them all is to seek the advice of an experienced workers’ compensation attorney. However, some of the most common include:

Read More

What are my Rights and Responsibilities to pursue a workers’ compensation claim?

A: Under the Virginia Workers’ Compensation Act, an injured employee is entitled to a potential 500 weeks of lost wages, including temporary total, temporary partial, and permanent partial disability benefits, and payment of medical treatment for as long as the need for the medical treatment is necessary and related to the work injury.

Read More

What if I get paid less after my injury?

A: If you have work restrictions of some kind that prevent you from doing the job you were doing before you were hurt and you find that you are earning less than you were earning before your injury (as a result of less hours, a reduced hourly rate, or both) you may be entitled to partial compensation, called temporary partial disability benefits.

Read More

My workers’ compensation claim was denied, what should I do?

A: There are many reasons that your claim may be denied. You may have said “I am not sure what I did/why I fell/I didn’t feel any pain at the time.” The reason does not necessarily mean that you do not have a case.

Read More

My wage check is often/always late. What should I do?

A: If you are under an Award and the benefits check is more than 14 days late, you can file a claim with the Virginia Workers’ Compensation Commission for penalties for the late payments.

Read More

What is a third party claim?

A: A third party claim is a lawsuit filed against the person, machine, or other object that caused your injury. For most cases of work place injuries, workers’ compensation will be the only type of benefits you can claim.

Read More

What are job re-training and vocational rehabilitation benefits?

A: If an injured worker is under an award and is able to work in some capacity, but is not able to return to his or her pre-injury job, then the workers’ compensation insurance company may assign a vocational rehabilitation counselor to assist the injured worker in finding a job.

Read More

What can I expect when I meet with a vocational rehabilitation counselor?

A: At the initial interview, the vocational rehabilitation counselor gathers information about you: your prior work history, prior work skills and education, criminal history, and your general interests.

Read More

The adjuster/rep doesn’t respond to me, never returns my calls. What should I do?

A: The adjuster is technically not required to contact you, but it is extremely difficult to handle a workers’ compensation claim properly without communication with you. If you have both called and written to the adjuster and cannot get a response, it may be time to file a claim for benefits to ask the Commission to intervene.

Read More

Does an amputation injury require special procedures under Virginia workers’ compensation?

A: An amputation is one of the most serious injuries at work that can affect you. Losing a limb is a life changing event and can cause long lasting disability and pain. If this has happened, you will likely want to file a workers’ compensation claim to get help for medical bills and other expenses.

Read More

What is the first step that I should take after a work injury?

A: You should immediately notify your supervisor about the accident. Even if you do not think you need medical attention, you should still report your injury. Next, you should file a workers’ compensation claim with the Virginia Workers’ Compensation Commission. You can get a copy of the form on this website.

Read More

How do I change my workers’ compensation doctor?

A: Once you have started a course of treatment with a doctor, he/she is considered your workers’ compensation doctor and you are required to continue seeing them in order to receive your workers’ compensation benefits.

Read More

What happens if someone dies due to a workers’ compensation accident?

A: If someone dies in a compensable workers’ compensation accident their dependents may be eligible to receive death benefits that cover funeral and burial expenses. In addition, they could also be entitled to receive up to 2/3 of their loved one’s average weekly wage for up to 500 weeks.

Read More

What happens at a deposition?

A: A deposition is the insurance company’s opportunity to speak with you and ask you questions before the scheduled hearing. It is part of what is called “discovery.”

Read More

How much do I get paid and for how long?

A: How much you will get paid and for how long depends on many factors. You get 2/3rds your pre-injury average weekly gross wages. The total lost wage benefits paid, with only a few exceptions, are limited to a total of 500 weeks.

Read More

Will my Virginia unemployment benefits affect my workers’ compensation benefits?

A: Yes, your Virginia unemployment benefits will be affected by your workers’ Compensation benefits and vice versa.

Read More

What is the difference between a “personal injury claim” and a “workers’ compensation claim?”

A: A personal injury claim is one caused by another party, called a third party, who is not your employer or co-worker. Sometimes, the same accident can trigger both a workers’ compensation claim and a personal injury claim.

Read More

What is a claim for benefits?

A: A claim for benefits is the name given to the document on which the injured worker asks for the benefits he or she is seeking. It can be the formal document entitled “Claim for Benefits” but it can also be something as simple as a letter. The fact that a document was filed listing an injured workers’ date of injury, body parts injured, and benefits requested is more important than the form on which it is written.

Read More

What documentation will I need when filing a workers’ compensation claim?

A: When you’ve been injured on the job in Virginia and you are filing for workers’ compensation benefits, different documentation will be needed at different times. While the days and weeks following an injury can be difficult, it’s important to gather and protect this vital paperwork as you receive it.

Read More

What does Medicare have to do with my workers’ compensation claim when I haven’t even filed for Medicare?

A: Federal law requires that Medicare’s interest be considered in every settlement. Exactly what Medicare’s interest is depends on how close you are to being entitled to Medicare. For example, if you have filed for Social Security Disability and it is approved, then you will be entitled to Medicare in at least 24 months.

Read More

What is a Functional Capacity Evaluation?

A: A Functional Capacity Evaluation (also referred to as “FCE”) is a detailed series of tests performed by a licensed physical therapist to determine if you have any physical limitations as a result of your injury. The test is quite lengthy, often lasting up to four hours. You will be performing activities and doing tests using equipment. Many tests automatically record results.

Read More

My nurse case manager wants to switch my treating physician but I don’t agree. What should I do?

A: You should never permit your nurse case manager to switch your treating physician without your consent. This comes close to violating the workers’ comp rules.

Read More

What if I can never return to work after my injury? Can I get workers’ compensation wage benefits for life?

A: Usually, and in most cases, no. You will be limited to 500 weeks of wage compensation. However, there are some exceptions. If you have been severely injured on the job and are unable to return to work, you may qualify for permanent disability payments through workers’ compensation insurance. Proving permanent disability can be difficult and it requires a lot of evidence and documentation like medical records.

Read More

What happens if Medicaid is paying for my medical care?

A: If Medicaid is paying for your medical treatment, then Medicaid will assert a lien against any settlement money you receive from the workers’ compensation insurance carrier to cover any payments Medicaid made to any medical provider related to treatment as a result of your work injury.

Read More

Can I settle my workers’ compensation claim?

A: Yes, workers’ compensation cases can be settled in Virginia. However, settlement is voluntary, which means it requires the agreement of both sides to settle and both sides must agree on the amount of the settlement.

Read More

If I had/have a pre-existing injury will it be difficult to prove my workers’ compensation claim or get workers’ compensation benefits?

A: If you suffered an aggravation to a pre-existing condition, then the aggravation should be covered by the workers’ compensation insurance carrier.

Read More