As a worker in Virginia, you can take comfort in the fact that your employer has probably taken out workers’ compensation insurance. This is meant to compensate you financially if you are unfortunate enough to have an accident at work and become injured or develop an illness that has been caused by conditions at work. You will have to make a workers’ compensation claim detailing your medical costs and how long you have been off work. Claims are examined by your employer’s insurer, but sometimes they are denied for a number of different reasons. You may still be entitled to full and fair compensation but it will mean appealing with the help of a workers’ comp. attorney. Workers’ Comp. Law in Virginia Virginia requires nearly every employer to take out workers’ comp. insurance, mostly with a private carrier. This insurance cover is meant to protect both the employer and employee. The employee must let their employer know the details of the accident / illness as soon as possible after it happened and certainly within 30 days, or some or all of any compensation payment may be forfeited otherwise. The Virginia Workers’ Compensation Commission (VWC) is the state agency that manages workers’ compensation in Virginia. Compensation in Virginia is for medical expenses and lost earnings. A claim can be filed with the VWC within two years of the accident happening. The VWC will inform the insurer who will examine any necessary documentation provided from the physician you attended or hospital and make a decision about payment. Why a Workers’ Comp. Might be Denied Not all workers’ comp. claims are accepted by the insurer. The insurer may deny a claim for a number of reasons. A common reason for denying a claim is because the employer received notification of the injury or illness too late or information was missing. A late claim or a claim without accompanying medical information might also lead to a denial. Insurers rely on information they get from the employer who is paying for insurance policies. Information is not always correct. Mistakes may be made which can delay or lead to a denial. Common mistakes are discrepancies involving the dates at work. These mistakes can usually be rectified without having to make a formal appeal. More serious are allegations that you were playing around at work when an accident happened, or you were intoxicated or had taken drugs. You may need reliable witnesses to challenge these allegations. Other reasons include claims that you: were not using safety equipment provided or ignored safety rules; had a pre-existing condition and that the injury or illness did not happen at work e.g. you broke your leg slipping and falling on your way home and not at work; deliberately caused an accident in order to make a claim. How the Workers’ Comp. Appeals Process Works in Virginia If your claim is denied by the insurer you have the opportunity to file an appeal. This can become a very protracted process unless the reason for the denial can be challenged easily such as mistakes by the employer over dates as mentioned above. The first stage of the appeal is to request a hearing with a Deputy Commissioner. The evidence for the denial will be reviewed at the hearing and this is an opportunity to provide as much supporting documentation as possible. The Deputy Commissioner will make a decision based n the review. This decision can be challenged within 30 days of receiving it with a request for reconsideration. There are further stages of appeal in Virginia but if it gets to this stage you must be able to provide a convincing argument why the appeal is warranted. The next stage in an appeal is to the full Workers’ Comp. Commission and finally to the state’s Court of Appeals. The procedures for both these steps are quite complicated and there are specific time limits within which the procedures must be completed. This is not something which you should attempt without sound legal advice otherwise it may be a wasted opportunity to recover the cost of a workplace injury or illness. The Reasons for Hiring a Workers' Comp. Attorney As has been described above, the appeals process in Virginia is quite complicated. It makes sense to contact an experienced workers’ comp. attorney early on before submitting the initial request for a hearing. The attorney can review the original claim and the evidence you have for supporting it and make sure that it is convincing. The process can be derailed unless you understand the procedures so the attorney’s help can avoid mistakes being made along the way.
