
Virginia Workers’ Compensation Frequently Asked Questions
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Workers Compensation Claim Questions
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. This is because you can never go back to your employer or to Commission once your claim is settled and funds disbursed. However, if you have reached maximum medical improvement and have returned to work or are in vocational rehabilitation, you may wish to consider settlement.
We can answer your questions regarding this issue and can assist you in evaluating the value of your case and if it might be a good option.
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. You need to be sure that the claim was filed with the Virginia Workers’ Compensation Commission. If you filed your claim directly to the Virginia Workers’ Compensation Commission, it takes a minimum of 10 days, usually longer, for the Commission to process it and assign a file number (referred to as a JCN – jurisdiction claim number).
If you have not received a written confirmation of your claim (Acknowledge Protective Filing), within about three weeks, you can contact the Virginia Workers Compensation Commission directly.
Yes. The injured worker is always responsible for filing the Claim Form 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 Form. Remember, it is your responsibility to pursue your claim.
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.
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. Injuries that could have “just as likely” happened outside of work, such as falling on stairs or repetitive injuries may be denied.
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. Thousands of cases are denied. I, along with numerous other workers’ compensation attorneys, have jobs/careers based upon the fact that adjusters wrongfully deny claims all of the time. Call our office to get a free analysis of your claim to find out if you should continue pursuing workers’ compensation.
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. This includes any temporary total disability benefits for full days out of work, temporary partial disability benefits for partial wage loss or partial days lost from work, and any permanent partial disability benefits for a loss of use of any extremities. However, you are not guaranteed all of the 500 weeks of compensation. If you do not lose time from work in the first two years, you will usually not be entitled to any wage loss benefits. If you are not under an award and you can work in some capacity but the employer does not have any work for you, you have to look for work. If you are not looking for work, you may not get any benefits. If you are under an award and are put in vocational rehabilitation to find a job and do not cooperate, your benefits may be cut off. If you return to work with work restrictions making as much as you made before your work injury, then you have to miss time from work again within two years of the date you returned to work making as much as you made before your work injury or you may lose your entitlement to any benefits in the future. In some cases, when you have missed time from work, you have to request additional benefits within 90 days of the missed time from work in order to receive the benefits you have requested.
Workers’ compensation in Virginia is very complicated and there are many pitfalls that can affect your entitlement to benefits.
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. A good example of this would be if you are driving a company car on your way to a work location and your car is hit by another driver.
Because the accident occurred while you were working, you can have a workers’ compensation case and you can also have a personal injury case against the driver of the vehicle that hit you.
A Claim Form 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 Form” 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.
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.
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.
The benefits usually included in a workers’ compensation settlement are: potential future wage loss, potential permanent impairment, and potential future medical treatment. If you are settling your workers’ compensation claim before you have obtained an Award Order, sometimes past wage loss and medical costs already incurred will be included.
Unfortunately, a workers’ compensation settlement will never include any money for pain and suffering, no matter how hard the case has been on you and your family, what you have lost as a result of your injury(ies), or how badly the employer or workers’ compensation insurance carrier treated you after your injury(ies). There is no pain and suffering payable in workers’ compensation in Virginia. We can answer your questions and can evaluate your case if you are considering this option.
A: The Virginia Workers Compensation Commission has an uninsured fund. If your employer was suppose to have workers’ compensation insurance and they did not, you can still get your workers’ compensation benefits through the uninsured fund. Your benefits will be the same as if your employer did have insurance. There is one difference and that is that your claim will automatically be contested. The uninsured fund cannot automatically accept the compensability of a work injury.
You need to file a Claim Form with the Virginia Workers’ Compensation Commission and go through the litigation and hearing process. If you prevail, the uninsured fund will seek reimbursement from your employer. Sometimes there are companies that are called “statutory employers” who will be liable for your work injury. For example, if you work for a subcontractor and are hurt on the job and the subcontractor has no workers’ compensation insurance, you may get workers’ compensation benefits through the general contractor’s workers’ compensation insurance. It is best to speak to an attorney if your employer has no insurance to determine if there are any statutory employers in your case! It is a free consultation.