In many states, the scope of employment includes any act which benefits the employer in any way. Typically, workers’ compensation covers injuries sustained in company softball games. The game itself is clearly not work-related and might not even occur on company property. But the employer benefits from the activity, mostly because happy and healthy employees are more productive and less costly.
In Virginia, lawmakers have added the arise-out-of rule to the scope of employment doctrine. Workplace injuries are only covered if they arise out of the job itself. More on that below.
Since the workers’ compensation laws are so broad in many states, it’s often unnecessary to get a lawyer. But since the laws are so narrow in Virginia, a Richmond work accident lawyer is usually a must-have. The arise-out-of rule is only one example. Claims examiners in Virginia routinely deny claims on linguistic technicalities. Without legal representation, your chances of obtaining fair compensation for your serious work-related injury are rather slim.
Benefits Available
Since most families have almost no financial reserve, a few weeks without a paycheck is financially devastating in most cases. Insurance companies know these households are under extreme financial pressure, so they usually make quick, “low ball” settlement offers.
That’s why the wage replacement benefit is so important in these cases. This benefit enables families to resist insurance company pressure and hold out for fair compensation. As a bonus, wage replacement benefits are normally retroactive to the filing date. So, the longer the insurance company drags its feet, the more it usually ends up paying.
Most injured victims receive two-thirds of their average weekly wage for the duration of a temporary disability. Let’s break these items down.
In a few cases, an attorney just needs a calendar and a calculator to determine the average weekly wage. But in most cases, this calculation is more complex.
Many employees have uneven incomes. For example, hospitality workers often get more hours during special events and school vacations. Other workers are entitled to future bonuses based solely on the number of hours worked. The AWW must account for these changes. If Sally will miss a bonus or miss the March Madness crowd because of an injury, her AWW must reflect that money.
As for the disability’s duration, workers’ compensation in Virginia lasts up to 500 weeks. That’s almost ten years. This extended period, which is one of the longest covered periods in the country, gives injured victims plenty of time to get treatment and fully complete physical therapy.
Workplace Injuries and the Arise-Out-Of Rule
This rule often applies to work-related muscle injuries. Assume Philip hurts his back as he is picking up a heavy box. The injury is not a repetitive stress injury, because he doesn’t normally pick up heavy boxes. However, timing is everything.
If Philip hurt his back as he was bending over, workers’ compensation might not cover the claim. Bending over does not arise out of Philip’s employment. But if Philip hurt his back as he was straightening up, workers’ compensation probably applies.
There is a very fine line here. Frequently, to satisfy the arise-out-of rule, an attorney partners with a medical professional who determines the exact nature and timing of the injury. Such proof is often quite compelling, especially during an administrative law hearing.
Your Job Injury Claim
Before victims have their day in court, a claims examiner usually reviews the facts of the incident, along with the medical records, and evaluates the claim. Most claims examiners deny most claims, at least in part.
It’s important not to give up. This denial does not mean your claim is weak or meritless. It’s just part of the process. The system is designed to frustrate victims into abandoning their claims or settling them for less than they are worth.
Besides, a denial is simply your ticket to a trial-like administrative review hearing, At this hearing, an attorney can introduce evidence, like the aforementioned medical report, challenge the other side’s evidence, and make legal arguments. As a result, victims have an excellent chance of obtaining fair compensation.
In addition to wage replacement, this compensation usually includes payment of all reasonably necessary medical expenses.
Connect with Our Office for a Free Consultation
Workers’ compensation benefits are available if your injury is directly related to your job. For a free consultation with an experienced workers’ compensation attorney in Richmond, contact Geoff McDonald & Associates, P.C. Virtual, home, and hospital visits are available.
