Clarke & Sampson Blog

VA Workers Compensation - Claims Process

Posted by Matt Stephens

Mar 8, 2017 12:00:00 AM

    
Workers’ compensation is a system of no-fault insurance that provides monetary and medical benefits to employees or their survivors for work-related injuries, diseases and deaths. Workers' compensation is governed by state law.

The Virginia Workers' Compensation Act (WCA) establishes the process for handling workers’ compensation claims in the state. The Virginia Workers’ Compensation Commission (Commission), investigates and handles workers’ compensation claims. The processing of a claim typically begins with a notice of injury and may end up in administrative or judicial appeal.

EMPLOYEE’S REPORT OF INJURY

Employees must provide written notice of any work-related accident to their employers.

  • Employees who do not provide written notice immediately or as soon as practicable after an accident may lose any benefits that would otherwise accrue from the accident until the employee provides the notice.
  • Employees who do not provide written notice within 30 days of an accident may lose their rights to compensation altogether.
  • For occupational diseases, an employee’s written notice is due within 60 days after the diagnosis of the disease is first communicated to the employee

EMPLOYER’S REPORT OF INJURY AND CLAIM ADMINISTRATION

Employers must file a first report of injury with the Commission within 10 days after an employee injury or death occurs or after first having knowledge of an occupational disease. The filing period is extended to 60 days for minor injuries.

Employers must also file reports with the Commission (for claims that do not involve a minor injury) any time they:

  • Deny an employee’s claim;
  • Make payments to an employee for a claim;
  • Make payments to medical providers for an employee’s claim; and
  • Stop making payments to an employee or medical providers for an employee’s claim.

DISPUTED CLAIMS

The Commission has the authority to resolve any questions or disputes that arise under the WCA. While the law expressly encourages employees and employers to resolve issues on their own and reach settlement agreements among themselves, the Commission must approve these agreements before they may take effect.

If an employer and employee (or his or her dependents in cases involving the employee’s work-related death) fail to reach an agreement, or if they have a Commission-approved agreement but disagree as to the continuance of any payment under the agreement, either party may file an application for a hearing with the Commission.

JUDICIAL APPEALS

Any party that is dissatisfied with a decision issued by the full Commission can appeal for review by a Virginia Court of Appeals. This appeal must be filed with the clerk of the Commission and with the clerk of the Court of Appeals within 30 days of the full Commission’s award.

Decisions made by the Court of Appeals may be appealed to the Virginia Supreme Court for the highest level of state review.

MORE INFORMATION

Contact Clarke & Sampson, Inc. 703-683-6601 or visit the Commission website for more information on workers’ compensation laws in Virginia.

Learn More

 

Topics: Workers Compensation Virginia, VA Workers Compensation Claims Process, Claims Process Virginia Workers Compensation