If the insurance company denies your workers’ compensation claim in Virginia, you have several options.  This article explains the process.

But My Employer Said They Would Take Care Of Me

It is important to remember that the nice lady in the Human Resources Department at your employer does not have any control over your workers’ comp claim or the insurance carrier that accepts or denies your claim.  Often, an employer might tell an injured worker that they will take care of everything  dealing with the employee’s claim.  However, sometimes those are empty promises that the employer is not able to deliver on.

When Your Claim Is Denied

Claim for Benefits Form

If the insurance company denies your workers’ compensation claim in Virginia, you must make certain that you have filed a Claim for Benefits form with the Virginia Workers’ Compensation Commission (VWCC).  Find instructions for filing here.

We sometimes see that employers may pay their injured workers directly from payroll while the employee is restricted from work.  This often makes the employees believe that their workers’ compensation claims have been accepted.  However, if the employer eventually stops paying you and you have not filed a Claim for Benefits form, you may be prevented from getting additional benefits.

Get the Necessary Medical Treatment

Secondly, it’s also very important that you get medical treatment, even though the insurance company hasn’t agreed to pay for it.  If your employer provides health insurance, you can have the medical bills submitted to your health insurance company.  If you eventually win your workers’ comp. claim, you may have to pay your health insurance company back, but at least you can get the needed medical treatment to heal your injury.  You can choose your own doctor without approval from the insurance company if the carrier has denied your claim.

Next Steps in the Process

After you file your Claim for Benefits form with the Virginia Workers’ Compensation Commission, the employer will be asked to file the “First Report of Injury.”  This is the form that identifies the employer and employee as well as describes the time, place and cause of the accident.  You don’t have to worry about completing this form or reminding your employer to do it.  This is completely the employer’s responsibility.

Twenty days after the employer files its “First Report of Injury,” the VWCC will request that the employer or insurance carrier complete a form indicating whether it has accepted or denied your claim.  There is no penalty to the employer if this form is not completed within 20 days.  So, frequently, employers and insurance companies will stall on providing this information.

The Hearing

If the employer tells the VWCC that it has denied your claim, your case will be scheduled for a hearing at the location VWCC hearing office.  If your case is scheduled for a hearing, you will likely be asked to answer questions called “Interrogatories.”  You may also be asked to testify at a deposition.

At the hearing, a judge called a Deputy Commissioner will listen to your case.  You will have a chance to testify, to call any witnesses you may want, and to cross-examine any witnesses that the employer might bring. All of the testimony at the hearing will be recorded and typed by a court reporter.  You will be asked to speak loudly and not nod your head or say “uh huh”.  At the hearing, you should just tell what you know about how the accident happened and your injuries.  You should testify about pain you have and how your pain affects your ability to work and do things at home.  You should testify about your doctor appointments and which providers are treating you.

Several weeks after your hearing, the Deputy Commissioner will send you his decision by mail.  If either you or the employer doesn’t agree with the decision, you both have 30 days to appeal.

Hearings and Appeals

Hearings and appeals can be a complicated process.  If you have an experienced workers’ compensation working for you, you won’t have to worry about giving all of the important information at a hearing.  Your attorney will know what questions to ask and the information that needs to be highlighted.  The same goes for appeals.  If you don’t note any appeals properly, you could lose your chance to appeal a particular issue.

Do I Need A Lawyer Checklist

Take a look at the checklist below to help you decide whether you should consult with an experienced workers’ compensation attorney about your case:

  1.   Do you have a serious injury? If yes, you may need to consult a lawyer.
  2.   Did you miss more than 7 days of work? If yes, you may need to consult a lawyer.
  3.   Has the employer officially accepted your claim?  If no, you may need to consult a lawyer.
  4.   Have you filed a Claim for Benefits form?  If no, you may need to consult a lawyer.
  5.   Do you have a hearing scheduled or ready to be scheduled in your case?  If yes, you may need to consult a lawyer.

 

For more than 45 years, the Ritchie Law Firm has successfully helped thousands of injured workers navigate the complex workers’ compensation process.  The Ritchie Law Firm specializes in serving injury victims.  We never represent insurance companies or corporations. If your workers’ compensation case is going to hearing, you will want a trial expert on your side. We are board certified trial specialists through the National Board of Trial Advocacy.  The attorney you choose for your workers’ compensation case can make all the difference in the outcome of your case. Choose wisely. . . you can talk to us for free.  Call today 800-277-6124 or fill out the form below.

Ritchie Law Firm is a workers’ compensation law firm devoted to helping individuals who have suffered serious and catastrophic injuries or lost a loved one as a result of a work injury. Ritchie Law Firm serves injured workers in all of Virginia, while helping clients in cities and surrounding areas of Harrisonburg, Charlottesville, Staunton, and Winchester.