A Step-By-Step Guide to Understanding the Workers’ Compensation Process

Learn more about Virginia Workers' Compensation Process in this comprehensive guide

If you are injured at work, workers’ compensation will likely play a significant role in your recovery. After all, this can provide you with access to the funds you need to cover medical care and time missed from work.

However, for those with little experience in the legal world, the process can be daunting. A lack of understanding of the legal processes, or worker’s compensation as a whole, could mean that injured workers accept lowball offers instead of the money they deserve – which is why legal assistance is necessary.

At Renfro & Renfro, PLLC, we have years of experience supporting injured workers. We’re on hand to talk you through every step of this process, ensuring your best interests are protected.

Overview of Workplace Injuries in Virginia

According to various studies, workplace injuries and illnesses are among the leading causes of hospitalization and missed work in Virginia. Across the country, workplace injuries are on the rise. For example, in 2022 (the latest date for which information is available), “private industry employers reported 2.8 million nonfatal workplace injuries and illnesses in 2022, up 7.5 percent from 2021.

Workplace injuries have a widespread impact, not only on the individuals affected but also on the economy at large. After all, the injured party will have to deal with medical expenses, ongoing symptoms, and, quite often, high levels of stress and anxiety. Furthermore, it is estimated that over the past few years, “a total of 35.2 million working days lost due to ill health and injury have cost the economy a total of $20.7 billion.

Importance of Legal Representation in Workers’ Compensation Claims

As mentioned above, filing a compensation claim can be tedious and complex. As your time and energy should be dedicated towards your recovery following an accident, hiring an attorney is crucial. Not only will this enable you to focus on getting better, but it will also improve your chances of success.

Understanding the Workers’ Compensation Claim Process in Virginia

Here is a breakdown of a workers’ comp claim process to assist you in understanding what to expect when injured in the workplace:

Step 1: Notify your employer

Virginia law requires an injured employee to report the injuries sustained to the employer as soon as they can report it. Generally, you are required to report the injury in writing within 30 days of the injury sustained. Reporting the incident promptly is crucial as there are specific timelines for making a claim.

While you have 30 days to give notice, it is not advisable to wait because failing to provide this notice may result in the loss of your rights to any benefits. Keep in mind that while some injuries may seem minor at the time, a seemingly harmless injury can turn into a much bigger problem if left untreated so it is best to report the accident and injury immediately.

Failure to report the injury within the specified time frame could result in the denial of your claim. Besides, companies must file incident reports to help them learn from mistakes and maintain their workplace compliance.

Step 2: Seek medical Attention

After notifying your employer, seek immediate medical attention for your injury or illness. If your injuries are severe or life-threatening, visit the nearest hospital or medical care facility. If the injuries are not as severe, your employer may provide a list of approved healthcare providers to visit in order to make the claim process easier. Your employer may also recommend that you see a company-appointed doctor for the initial evaluation. Virginia law requires that your employer or their insurance carrier offer you a “Panel of Physicians” which is a list of three different doctors for you to choose who provides your medical care resulting from the accident.

Step 3: Complete the necessary paperwork

Your employer will guide you regarding the essential paperwork that you must complete. Typically your employer will have you fill out an incident report, or they may fill it out and ask you to sign it. Before signing the incident report make sure that it accurately states how the accident occurred (every little detail can be important, especially in slip/trip and fall injuries, like what caused you to slip or trip). Your employer is also required to inform you about your rights under the workers’ comp insurance.

Step 4: File your claim for benefits with Virginia Workers’ Compensation Commission

The next step involves filing a claim with the Virginia Workers’ Compensation Commission. Usually, it is your responsibility to complete the Claim for Benefits Form and file it with the workers’ comp commission. You are also required to file medical documents that support your claim.

Step 5: Employer reports the accident

As mentioned above, the employer should file a First Report of Injury to the Virginia Workers’ Compensation Commission notifying the Commission that an injury occurred. Additionally, the employer also reports workers’ injuries to its insurance company. They must do so within ten days of knowing about a severe injury or death and within 30 days for non-emergent injuries. Once they receive the First Report of Injury, the commission will acknowledge receipt and send you information regarding your rights. The commission will also issue a 20-day order to all parties to inform the insurer that it has 20 days to respond to your claim.

Step 6: Investigation and decision

Once your claim is submitted, your employer’s insurance company will send an adjuster to investigate the claim’s validity. They may review medical records, talk to witnesses, and assess the circumstances of the incident. They will then make a decision on whether to approve or deny your claim.

Generally, the insurance adjuster doesn’t have your best interests at heart. They will look for any reason to reduce your claim or deny it entirely. For this reason, it is advisable to seek the guidance of an experienced Virginia workers’ comp attorney before talking to the insurance company.

Step 7: The insurance company offers a response

If the insurance company approves your claim, you need to take steps to start receiving workers’ compensation benefits. During this stage, the insurance company issues you with forms to execute your compensation benefits. Once all parties sign the agreement, it is filed with the commission. The workers’ compensation commission will then enter an Award Agreement with all parties.

If your claim is denied by the insurance company, you have the right to have a trial at the Virginia workers comp commission. The experienced attorneys from Renfro & Renfro, PLLC can help you file a Claim for Benefits, if you haven’t already done so, to start the litigation process and obtain the compensation you deserve. The following is a brief summary of the workers comp litigation process:

  1. A Claim for Benefits is Filed.
  2. The commission issues a 30-day order to the insurance company to see if they are accepting or denying your claim.
  3. If the claim is denied, the commission schedules a trial/hearing date for your case.
  4. An evidentiary hearing is held before a Deputy Commissioner (an Administrative Law Judge (ALJ) where both parties call witnesses, submit medical reports and other documents relevant to the issues in your case.
  5. After the hearing concludes, the judge issues a written decision after reviewing evidence and witness testimony. It usually takes between two to six months to receive the judge’s written opinion.
  6. If the verdict is unfavorable, you will have 30 days to file an appeal at the appellate courts.

The Litigation Process for Workers’ Compensation Claims

As mentioned above, if your workers’ compensation claim is denied after a hearing, you have the right to appeal this decision, especially if you believe it to be unjust. In Virginia, you must file an appeal within thirty days, per state regulations. The appeal is called a Request for Review.

After filing your Request for Review, the Full Commission will set a schedule for the submission of written statements supporting your position on the appeal. A hearing for oral argument can be requested from the Full Commission, but is typically not granted.

Once a deadline is set for filing your written statement supporting your Request for Review, you, or your attorney, will begin drafting a legal brief containing the relevant facts and law related to the appeal and submitting a written argument on why the trial judge was incorrect. The opposing party will also have the option to file a written statement arguing against your written statement.

After written statements are filed with the Commission, the three Commissioners presiding over the Commission will then make a decision relating to your case. They may determine that the trial judge was incorrect and overturn his decision, or in some cases remand it to the trial judge for another hearing, or uphold the original decision.

While you can represent yourself in these scenarios, the benefits of having a legal professional in your corner cannot be denied. After all, your lawyer will have a deep understanding of the litigation process and will know the exact steps to take to improve your chances of overturning the denial. If you did not have an attorney when you went to trial and lost, It is important to note that many attorneys are unwilling to assist solely in filing a Request for Review. It is always best to have legal counsel in your case from the beginning.

Wrapping Up The Workers’ Compensation Process

Many of those who are eligible for compensation are hesitant to actually make a claim. For example, they may be worried about facing repercussions from their employer or the stress of a lengthy litigation process. However, making a worker’s compensation claim is crucial, as it can:

  • Provide you with a sense of financial security during a troubling time
  • Cover the cost of any medical bills and treatment
  • Subsidise lost income caused by taking time off work
  • Ensure those responsible are held accountable, reducing the chances of workplace accidents occurring again in the future.

Furthermore, the entire process can be simplified by working with an experienced lawyer. They’ll be able to talk you through every step of the process, whether you are gathering the relevant evidence or appealing the initial decision from the insurance provider.

Contact Richmond, Virginia Workers’ Compensation Lawyers

If you are filing a claim for workers’ compensation and are looking for an experienced workers’ compensation lawyer in Richmond, VA to support you throughout the litigation process, you’ve come to the right place.

The attorneys at Renfro & Renfro, PPLC, have years of experience supporting injured workers throughout Virginia as they file their workers’ compensation claims. Unlike insurance adjusters, we operate with your best interests in mind and will do whatever it takes to help you get the compensation you deserve.

Our commitment to excellence means we can obtain the optimal outcome for our clients. For example, when one client injured their back when caring for a patient, we ensured that she received all the necessary funds to cover her medical care, treatment, and lost wages – to a total of $240,000. You can view more of our case results here.

Contact us for a free consultation. Let our team guide you through your claim and help you receive the compensation you deserve.

We look forward to representing you.


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