A joint investigative report by the ProPublica journalism organization and National Public Radio (NPR) uncovers the “dismantling” of workers’ compensation systems in states across the U.S.
According to the recently published ProPublica/NPR report, “big businesses” and their insurers have pushed for reforms in 33 states. These changes have cut benefits for injured and ill workers and made it harder for them to obtain those benefits.
While these changes have not majorly impacted workers with minor injuries, they have been disastrous to those who have suffered serious injuries or diseases and need workers’ compensation benefits the most, the report finds.
“The cutbacks have been so drastic in some places that they virtually guarantee injured workers will plummet into poverty,” the report states. “Workers often battle insurance companies for years to get the surgeries, prescriptions and basic help their doctors recommend.”
For Virginia workers, there have been no major reforms in recent years, the report states.
However, do you know your rights and options after you have been injured on the job or suffered a work-related disease in our state?
The following is a brief summary of the benefits you may be entitled to receive. Contact a lawyer from Geoff McDonald & Associates, P.C., for a more thorough explanation and a review of the specific facts of your case.
(You can also learn more about the process of seeking benefits by going to our page on “How the Virginia Workers’ Compensation Works” or by going to the Virginia Workers’ Compensation Commission website.)
Under Virginia law, employers must cover an injured or ill worker’s medical expenses for as long as they are needed. However, workers must get treatment from a doctor approved by the employer or its workers’ compensation insurer.
After you are hurt in an accident or diagnosed with an illness, your employer should present you with a panel of three doctors. You must choose a doctor from this panel for your treatment. If the employer doesn’t give you a panel, you can choose any doctor.
After you start treatment for your injury or illness, you cannot go to another doctor unless your employer or the insurer approves the change. If you do not get this approval, the employer can deny paying the costs of your unapproved treatment.
If you have any disputes about your medical benefits coverage – including an employer’s rejection of your request to change doctors – you can seek a hearing before the Virginia Workers’ Compensation Commission.
You can – and should – be represented by an experienced attorney at the hearing. A lawyer can review your medical records, present expert opinion on why you need certain treatment and aggressively challenge your employer’s rejection of coverage.
Lost Wage Benefits
If you cannot perform any work due to your injury or illness, you should receive benefits that cover 2/3 of your gross average weekly wages. However, the amount is capped at a limit set by the legislature each year. See this chart for an overview of those caps.
If you can return to work – but only on a light-duty basis – you should receive 2/3 of the difference between your current wage and what you earned before your injury.
Unless you are “totally and permanently disabled,” you cannot receive lost wage benefits past 500 weeks. A worker is “totally and permanently disabled” if he or she is paralyzed, disabled from a brain injury or has lost both hands, arms, legs, feet or eyes – or any two of those body parts.
You may be entitled to other benefits if you suffer vision or hearing loss, disfigurement or lost use of specific body parts: The arm, leg, finger or eye. The number of weeks you are eligible to receive these benefits will depend on the degree to which you have lost use.
Many disputes arise with lost wage benefits. For instance, employers may challenge whether an injury or illness was truly work-related and the degree of injury that a person has suffered. As with medical benefits, workers can challenge employers in a hearing. Being represented by a lawyer at the hearing can greatly improve one’s chance of success.
Virginia workers’ compensation benefits are available to certain family members if a worker dies from a job-related injury or illness. These family members include a surviving spouse and children who are under age 18 (or under age 23 if enrolled full-time in school). Additionally, an employer must pay up to $10,000 in funeral and burial costs.
Third-Party Injury Claims
You cannot sue your employer if you are receiving workers’ compensation benefits in Virginia. However, if your injury or illness was caused by a non-employer, you can file a personal injury lawsuit against that party. The damages you may recover can go well beyond workers’ compensation benefits and can include compensation for your pain and suffering.
Examples of third-party injury claims include lawsuits against manufacturers of defective products (including chemicals or toxins you may have been exposed to on the job) or against negligent drivers who cause auto accidents.
At Geoff McDonald & Associates, P.C., we know how to identify and overcome challenges that arise in workers’ compensation cases. We also understand the importance of pursuing all options for a worker’s recovery, including third-party personal injury and wrongful death claims.
As the ProPublica/NPR report underscores, workers need to know their rights, and they should work with an attorney who will stand up for them and make sure those rights are protected.