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Overview of the Workers Compensation System in Virginia

Jan 29, 2014 | Workers' Compensation

If you’ve been hurt or gotten sick because of your job, you need to understand how the Virginia workers’ compensation system works. Benefits are available for injuries caused directly by work, including injuries from exposure to toxins. However, there is a process that you must follow to get the money you deserve.

At Geoff McDonald & Associates, P.C., our experienced Richmond workers’ compensation lawyers can help you pursue your workers’ comp claim and deal with any problems that arise, such as a claim denial or dispute over benefits.

Don’t give up on your workers’ compensation benefits. 

The Virginia Workers’ Compensation Process

Virginia law requires employers to either self-insure or buy workers’ compensation insurance for covered employees.

The steps in a benefits claim begin as soon as a work accident happens or a work-related illness is diagnosed. Benefits may continue on an indefinite basis until you have recovered.

The steps in a workers’ comp claim may include:

1.      Get immediate medical help. In an emergency, go to the nearest hospital for treatment. For non-emergency care, your employer will provide you with the names of three doctors. You may choose one. You may pick your own physician if you are not provided with a list within a certain period of time. 

2.      Report your injury to your employer. You have 30 days from the time the injury happens. An attorney can help submit written notice of the injury. You may also wish to file your claim with the Workers’ Compensation Commission at this time. You must file within two years of your injury if a dispute arises regarding eligibility for benefits. An attorney can assist with the filing process.

3.      First Report of Injury. Your employer must report your injury to the Workers’ Compensation Commission within 30 days for less-serious injuries, and within 10 days of a serious injury or death on the job. A lawyer can make sure notice is filed properly and help you take action if it is not.

4.      Receive notification of rights and a Notice of Award Order. The commission will send you details on your rights and responsibilities after receiving the First Report of Injury. If your claim is accepted, you will also receive an Award Agreement.

5.      Receive benefits or appeal your denial. If the claim is accepted, you will need to sign the Award Agreement, and a copy will be filed with the Workers’ Compensation Commission. It is essential that this agreement is filed with the commission to protect your right to benefits. Before signing, have an attorney look over all paperwork to ensure you do not mistakenly give up any of your legal rights.

Workers’ Compensation Benefits in Virginia

If your claim for benefits is approved, you may have all of your medical bills paid and you may receive cash payment equal to two-thirds of your wages if you are temporarily or permanently disabled. Temporary disability benefits continue until you are cleared to return to work or until you reach maximum medical improvement (MMI).

If you are still impaired once you have reached MMI, you may receive permanent disability benefits. If you were partially disabled by your workplace accident and are on restricted duty, partial benefits may also be available. Temporary partial disability payments are calculated as two-thirds of the difference between your average weekly wage at the time of the injury and your weekly wage after the injury.

When workers’ compensation benefits are to be stopped or reduced, a Termination of Wage Loss Award must be signed by all parties and a copy sent to the Workers’ Compensation Commission.

Appealing a Benefits Denial

If your claim is denied or if there is a dispute regarding benefits, the Workers’ Compensation Commission has processes for settling disputes. You should have an attorney guide you through this process.

The appeals process involves:

  • A request for hearing. An attorney can make this request for you.
  • Voluntary mediation. Either your attorney or the employer/insurer may request mediation, during which a compromise may be reached.
  • The case is assigned to a workers’ compensation judge. This is an administrative judge employed by the Workers’ Compensation Commission, not a judge in a court. A Deputy Commissioner may serve as the judge.
  • A hearing is held. You and the employer/insurer will have the opportunity to present evidence. At Geoff McDonald & Associates, we can work to get the proof you need to make a very strong case.
  • A decision is reached. The judge will write an opinion, which will be mailed to you. The decision will either grant or deny benefits.
  • Appeal to the full Workers’ Compensation Commission. If you are not satisfied with the outcome of the initial hearing, you have 30 days to file an appeal to have your case heard by the full Workers’ Compensation Commission. Appeals rely on technical legal arguments that your attorney can make on your behalf.
  • Appeal to the Court of Appeals. You can file this appeal within 30 days of an unfavorable decision from the full Workers’ Compensation Commission. This takes your case out of the administrative system and into court. This is the last step in the appeals process before seeking an appeal to the Supreme Court of Virginia.

Help with Your Workers’ Compensation Claim

While the workers’ compensation system is set up to ensure that injured workers receive benefits, it is a complex legal process. Trust the Virginia workers’ compensation lawyers at Geoff McDonald & Associates to put our decades of legal experience to work on your case.

Geoff McDonald and Associates: 866-369-9051.

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