After You’ve Been Injured On The Job
We’ve helped thousands of people like you navigate their Workers’ Compensation cases over the past almost 40 years. Powell Law Group knows what it’s like to be injured and suffering at the hands of what maintains your livelihood. While the best next step is to call us so we can learn more about your unique case, we’ve gathered a list of some of the top questions people with Workers’ Compensation cases have asked us over the years. We hope they help you in this hard time, but mostly we hope you call for help.
**The answers rendered are designed as general suggestions and do not constitute legal advice. We are available to provide a free consultation if you call our office. Don’t wait - call today to begin your road to justice.
WORKERS' COMPENSATION FAQ
WHAT SHOULD I DO AFTER I GET INJURED AT WORK?
You must first notify your employer/supervisor that you have been injured.
If you fail to report your accident in a timely manner an insurance company may deny your claim for medical or out-of-work benefits. The Virginia Workers’ Compensation Act requires that notice be given within 30 days unless you give good cause for giving notice late.
You need to seek out medical attention for your injury. You also need to tell your employer of your intent to seek out medical attention if you are not authorized to go to a doctor or hospital promptly after an accident. The employer is required to give you a panel of physicians specialized in the type of injury you suffered.
After you have safely addressed your injury you must file a document with the Virginia Workers’ Compensation Commission called a “Claim for Benefits” or seek an attorney’s representation.
WHAT IS A RECORDED STATEMENT AND WHAT DO I DO IF MY EMPLOYER ASKS ME TO GIVE ONE?
If your employer or the insurance company is asking you to provide them with a recorded statement it could be for several reasons. It could be to facilitate the process of your claim, but most frequently the carrier wants to take the statement so that they could find a reason to deny your claim.
Insurance adjusters, employers, nurse case managers, and fellow employees may try to trick or trap you when you give a statement, so talk to an experienced Workers’ Compensation attorney before giving a statement.
Anything in that statement that you give orally, write, or sign your name to can be used against you. These statements are often presented as evidence at the hearing and can be extremely damaging to your case.
WHY DO I NEED TO HIRE AN ATTORNEY AFTER I AM INJURED AT WORK?
Hiring an attorney after a work-related injury may make a difference between success and failure of your worker’s compensation claim.
Workers Compensation law can be confusing and an attorney would be able to properly guide you through the claim process.
Additionally, if you hire an attorney at the beginning of your case the attorney would be able to apply for all the benefits under the Workers’ Compensation Act available to you.
AFTER I AM INJURED AT WORK WHAT BENEFITS CAN I RECEIVE?
Lifetime Medical Benefits
The Virginia Workers’ Compensation Commission will award you treatment costs from the injury or condition casually related to the injury or occupational disease you suffered.
This is a benefit separate and apart from the categories of disability compensation listed below.
Temporary Total Disability
You may be awarded compensation at two-thirds (2/3) of your average weekly gross wages for up to 500 weeks.
The Virginia Commission uses your earnings for up to 52 weeks before the accident as the basis for calculating the average weekly wage.
Temporary Partial Disability
If you are limited in your pre-injury capacity, you may be awarded two-thirds (2/3) of the difference between what you earned before your injury or onset of your occupational disease and what you earn at the limited duty job.
Once your injury or condition is accepted the insurance carrier is required to offer a panel of physicians to you.
IF YOU ARE UNDOCUMENTED in Virginia, you cannot receive this form of compensation.
Permanent Partial Disability
Insurance companies will often try to send you to doctors who give low ratings, so an attorney is helpful to obtain the highest permanency rating for your injury.
Virginia does not allow for permanency of the back, neck, brain, or any internal organ unless it affects the use of an appendage.
Compensation for the complete loss or permanent loss of use of an arm, leg, hand, finger, and other body parts listed in the Act. There is a schedule of permanency values for this type of permanency. Permanency is best determined upon reaching Maximum Medical Improvement (MMI). However, the insurance carrier may attempt to have permanency established before you have reached MMI. This can potentially cause your permanency compensation to be less than what you would have been entitled to after reaching MMI.
Permanent Total Disability
If you suffer the total loss of use of two limbs or otherwise become permanently unable to ever work again, and there is adequate evidence from multiple sources that you can never work again, then you may be awarded compensation for the remainder of your life plus the medical award for life.
There may be a variety of other costs and expenses which you may have to bear until your award is secured. This may include prescription and treatment costs. These out of pocket expenses will be reimbursed to you once an award order is entered.
Mileage to/from doctors and therapists. You must request this from the Insurer. Mileage is reimbursed at the I.R.S. value which is adjusted yearly.
WHAT IS A CLAIM FOR BENEFITS AND WHEN MUST IT BE FILED?
After you suffer a work-related injury you must file a document with the Virginia Workers’ Compensation (VWC) Commission called a claim for benefits.
The claim for benefits must list ever injury that you suffered as a result of your work-related injury.
Once a claim for benefits is filed it forces the insurance company to accept or deny your claim.
If the insurance company accepts your claim, then it must send you “agreement forms”. The agreement forms must list all body parts that were injured in the accident and will recite all the benefits that you are receiving. After the agreement forms are signed and sent to the Commission an award will be entered, which will grant you the benefits listed in the Award.
If the insurance company denies your claim, a hearing date is set and on that date you must appear before a Deputy Commissioner to present evidence to your entitlement to benefits.
If after two (2) years you fail to file a claim, you will be barred from obtain any workers compensation benefits. If you claim the onset of an occupational disease, you must file this claim within 3 years of receipt of communication of that disease by a doctor.
You can file a Claim with the VWC Commission in-person, by mail, or online. Please note that this is an area that can be confusing and an experienced Workers’ Compensation attorney needs to be consulted. Frequently the carrier’s agreement form omits art of the injuries you received.
Address: Virginia Workers’ Compensation Commission, 1000 DMV Drive, Richmond, VA 23230
Phone Number: 1-877-664-2566
Online Claim Form: Click here.
WHAT TYPE OF ACCIDENTS ARE COVERED UNDER THE VIRGINIA WORKERS COMPENSATION ACT?
Injuries that arise out of and in the course of your employment are covered by the Workers’ Compensation Act.
However, through case law there have been narrowing bases for which work accidents are covered by the Act. Having an attorney guide you through the process is extremely helpful because of the case law. An experienced worker’s compensation attorney would be able to take the facts of your case and properly interpret the case law to advise you of the likely outcome.
WHAT IS AN OCCUPATIONAL DISEASE AND HOW ARE THEY DIFFERENT THAT OTHER INJURIES?
An occupation disease is one that arises out of and in the course of employment.
An occupation disease cannot be just an ordinary disease of life, which is a disease that the general public is exposed to outside of the employment and is normally not covered by the Workers’ Compensation Act.
Factors that make an ordinary disease of life an occupational disease are below:
A direct connection to the employment
It is a natural consequence of the employment
It is proximately caused by the employment
It was not caused by exposure outside the employment and is not a condition of the neck or back
It is not independent of the employer-employee relationship
It has its origin in a risk of the employment
An “ordinary disease of life” to which the general public is exposed to outside of the employment can be treated as an occupational disease if:
All of the “factors” listed above for an occupational disease are established by “clear and convincing evidence” and not a mere probability, AND
The ordinary disease of life does not result from causes outside of the employment, AND
ONE of the following exists:
It follows from an occupational disease, OR
It is an infectious or contagious disease contracted in the course of one’s employment in a hospital, sanitarium, laboratory or nursing home,
or while directly delivering medical care, or in the course of one’s employment as emergency rescue personnel, OR
It was characteristic of the employment and was caused by risks peculiar to the employment.
WHAT DO I DO IF MY EMPLOYER GIVES ME A LIST OF DOCTORS AND TELLS ME TO CHOOSE ONE?
Under the Virginia Workers Compensation Act when an employee is injured at work the employer must provide the employee a panel of physicians.
A panel of physicians is just a list of three (3) doctors that you have to pick from to get paid treatment for your work-related injury.
If you don’t ask for a panel to be provided to you within 30 days of your accident you may lose this right.
Once you choose a physician from the panel you must seek treatment from that physician. You cannot unilaterally change your doctor once one has been chosen and if you do it could negatively impact you case. But if you are dissatisfied with your treating doctor or you need additional treatment you may request another treating physician and the carrier may allow this. If the carrier refuses, then an application for a hearing needs to be filed to require the carrier to offer you another panel of physicians.
You should have the advice of an attorney before you make a choice from the panel, since some doctors are more “claimant-friendly” than others.
WHAT HAPPENS IF THE INSURANCE DENIES MY CLAIM?
If the insurance company denies your claim, the Virginia Workers’ Compensation Commission will give you a date for a hearing.
A hearing is a trial. Both you and the employer and carrier would present evidence and you would have the opportunity to testify. The hearing would be before a Deputy Commissioner, and will follow Virginia Rules of Evidence.
After the hearing, a Deputy Commissioner will issue an opinion about whether your claim is compensable and what benefits you would receive, if any.
You should never take the risk of going to the hearing on a contested claim without an experienced Workers’ Compensation attorney to represent you.
WHAT HAPPENS IF MY DOCTOR RELEASES ME TO LIGHT DUTY WORK?
If your doctor believes you can work in any capacity, you may be released to restricted or light duty. If you are released to light duty work you could still be eligible for compensation if you properly market your residual work ability.
Once you are released to light duty by your treating physician you must ask your employer if there is light duty job that you could do that would comply with your restrictions.
If you are released to light duty work and your employer does not have any light duty work for you to complete you must actively search for employment. You have a duty market and thus you must search for work that could fit your restrictions. If you do not search for work you will not be entitled to weekly compensation than your pre-injury work.
If the light duty work pays less, then you may be eligible for compensation for two-thirds of the difference between the 2 salaries. You may need to talk to a lawyer about this to ensure you are receiving the correct amount. (See also, the Temporary Partial Disability)
WHAT IS A NURSE CASE MANAGER AND WHAT DOES SHE DO?
Often in a worker’s compensation case the insurance carrier will assign a person called a “nurse case manager” to manage your care. The job of a nurse case manager is to ensure that you receive appropriate medical care and return you to work as soon as possible.
Your failure to cooperate with the nurse case manager can result in a suspension of benefits. If this happens, call an experienced Workers’ Compensation attorney.
Often nurse case managers ask you to sign medical authorizations, which would allow them access to all of your medical records, without issuing a subpoena, and which also allows them to talk to your doctors without you being present. We recommend against this. This is very unwise and permits the carrier to build a case against you and may very well delay acceptance of your claim. Signing a release for the carrier would allow the case manager to talk to your doctor without your knowledge. It is to your advantage to have an attorney to ensure that you will not be taken advantage of and that your case will not be denied unjustifiably.
There are serious implications when you deal with a nurse case manager directly, so an experienced Workers’ Compensation attorneys could help you handle them.
WHAT IS VOCATIONAL REHABILITATION?
Often in a Worker’s Compensation Case the insurance company may send you a letter telling you that you must attend an appointment with a vocational rehabilitation counselor. If you have an award, you MUST attend the vocational rehabilitation appointment if referred. If you do not attend the vocational appointment the insurance can stop paying your benefits.
A vocational rehabilitation counselor’s job is to ensure the worker quickly returns to some form of light duty work. You may be sent for a Functional Capacity Evaluation (FCE).
If you have not been released to any form of light duty work, the vocational rehabilitation worker will often attempt to obtain a light duty release from your doctor in order to start job placement.
If the vocational rehab worker finds a light duty job for you, the general rule is you must accept the light duty job.
If you do not like the job (due to the hours, type of job, commuting distance, etc.), call an experienced Workers’ Compensation attorney for advice.
There are ways to hold vocational rehabilitation counselors accountable and an experienced Workers’ Compensation attorney could guide you through that process and help protect your rights. It is also important that the duties you are released to perform are within your abilities and also that the FCE examines you based on your true prior work duties. These are issues that an experienced Workers’ Compensation attorney will assist you with.
WHAT IF THE INSURER WANTS TO SETTLE MY CLAIM?
Generally, a settlement of a worker’s compensation claim means that you are agreeing to give up your rights to compensation benefits, both medical and indemnity (weekly compensation), in exchange for a monetary sum. The way the money is paid can take various forms, and an attorney should guide you in this process.
The true value of a claim can be extremely difficult to calculate without experience and expertise. When you settle your claim, there are a lot of things to take into consideration. You rarely know the true value of your claim and therefore you should never settle a claim without seeing an experienced Workers’ Compensation attorney.
Settlement of a workers’ compensation claim can have an adverse effect on other benefit claims such as a personal injury lawsuit. The Powell Law Group is experienced in both Workers’ Compensation and personal injury litigation. We can properly advise you about this matter.
Even though you have a financial emergency, you should not settle without knowing the real value of your claim. Contact our experienced attorneys for a free initial consultation before taking such a big and potential costly step.
This may be considered an ADVERTISEMENT or advertising material under the Rules of Professional Conduct governing lawyers in Virginia. The information presented is designed for general information only. It should not be construed as formal legal advice nor a formation of a lawyer-client relationship.
E. Wayne Powell has been a practitioner of Virginia Workers’ Compensation law in the Richmond area for more than for almost 40 years. He was a Deputy Commissioner for the Virginia Workers Compensation Commission for 6 years, and as a Deputy Commissioner he presided over hundreds of Worker’s Compensation cases of various degrees of complexity. He and the attorneys at the Powell Law Group continue to represent injured workers in the same vein. You may call the Powell Law Group at (804) 794-4030 for more information.