If you’re injured on the job, workers’ compensation benefits are not automatic. You must follow a specific process to receive the compensation provided under the Virginia Workers’ Compensation Act. Timelines and deadlines apply throughout the process. In this discussion, our experienced workers’ compensation lawyers at Renfro & Renfro provide a step-by-step overview of the process.
Step #1: Get Medical Attention for Your Injury
The top priority after a work accident is getting professional medical attention for your injury. If the injury is serious and requires immediate medical care, call 911 or go to the nearest hospital or medical facility. If the injury doesn’t require urgent medical attention, you must select a doctor from a panel of physicians (list of medical providers) supplied by your employer after you report the accident. If the employer fails to provide the list, you may obtain care from any physician.
Step #2: Provide Written Notice to Your Employer
You must provide written notice of your work injury to your employer within 30 days of the accident. If you fail to give timely written notice, you may lose your right to benefits. It’s always best to provide notice immediately. An injury may seem minor immediately after an accident, only to turn into a significant medical issue. That is also a reason to see a doctor right away, even if you don’t think the injury is serious.
Virginia law requires your employer to file a First Report of Injury with the Workers’ Compensation Commission within ten days of being notified of a workplace injury or death or within 30 days for a minor injury. After receiving the report, the Commission will issue a Notification of Injury to all parties and send you information about your rights and responsibilities.
The employer’s report to the Commission does not protect your rights, and it is not a claim filed on your behalf. To protect your rights, you must file a Claim for Benefits with the Commission yourself.
Step #3: File a Claim for Benefits with the Commission
Filing a Claim for Benefits with the Virginia Workers’ Compensation Commission is an important part of the process. While you have two years to file the form, you should file it as soon as possible. Your medical records from your physician should accompany the form or be submitted within 90 days after the form is filed.
The Claim for Benefits form is detailed and can be confusing. In many cases, getting assistance from a workers’ compensation attorney in completing and filing the claim is advisable. If your injury is serious and you have long-term effects, talking with a knowledgeable lawyer before you file the claim is strongly recommended. At Renfro & Renfro, your consultation and case evaluation are always free of charge and without obligation.
After you file the form, the Commission issues a 20-day order, requiring your employer’s insurance company to respond within 20 days. The response may be acceptance or denial of the claim, or they may reply that they are still investigating the case.
Step #4: Navigate the Claim Investigation
If you are not represented by a lawyer, the insurance adjuster may contact you as part of the claim investigation of the accident and injuries. You should never agree to give a recorded statement unless you have talked with a workers’ compensation lawyer. If an adjuster contacts you, it usually is advisable to consult with a lawyer before you even communicate with them.
Any statements you make to the adjuster, including a recorded statement, can be used as a basis for denying your claim. The adjuster does not represent you. They represent the insurance company. Their goal is to deny your claim if they can find a basis for it.
Step #5: Respond to Acceptance or Denial of Your Claim
If your employer and their insurance company accept your claim, you will receive an Award Agreement form. If the form correctly states your injuries and benefits, you can sign and return it. The company then files it with the Commission, which issues an Award Order for lifetime medical treatment and periods of wage loss stated in the agreement.
If you do not agree with the terms in the Award Agreement or have questions about it, you should not sign it and should immediately talk with a workers’ compensation lawyer. Your attorney can go over the Award Agreement with you, address your concerns, and help you decide the best way to proceed.
If your employer and their insurance company dispute your accident or injuries or deny your claim, the Commission will schedule a hearing before a Deputy Commissioner. At this point, representation by an experienced workers’ compensation lawyer is absolutely essential to protect your rights to benefits and defend your claim to the Commission. There is an established appeal process to follow when an employer denies a workers’ compensation claim. It is not advisable to contest a denial without legal representation.
Step #6: Understand the Workers’ Compensation Appeals Process
If the employer’s insurance company denies your claim, you should get help from a workers’ comp lawyer in pursuing your claim. Here is a brief summary of the appeals process:
- Request for hearing: If the insurer denies the claim, a hearing is scheduled by the Commission once medical records are received and a Notice of Hearing letter will be sent to all parties. Your attorney can also request a hearing.
- Voluntary mediation: Mediation may be requested by you (or your attorney) or your employer and its insurer. This process seeks to reach a compromise between the parties.
- Assignment to judge: Your case will be assigned to an administrative judge.
- Hearing: A hearing will be held in front of the administrative judge and you and your employer will have the chance to present evidence.
- Decision: The judge will issue a written opinion either granting or denying benefits.
- Appeal to the full Commission: If you are unhappy with the decision of the judge, you have 30 days to file an appeal. On appeal, the full Workers’ Compensation Commission will hear your case.
- Appellate Courts: If you are dissatisfied with the full Commission decision, you have 30 days from the unfavorable decision to file an appeal with the Virginia Court of Appeals. Any party also has 30 days from the date of the Court of Appeals’ decision to request an appeal to the Supreme Court of Virginia.
Throughout the appeals process, timelines and deadlines apply, and specific filings are required. Your lawyer will explain the entire process in detail, and help you navigate through it.
Schedule a Free Consultation with Our Virginia Workers’ Compensation Attorneys
If you received an injury at work, our experienced Virginia workers’ compensation attorneys at Renfro & Renfro are here to help. We assist injured workers with every step of the claim process. We welcome you to call us at (804) 601-4433 or to contact us for a free consultation.