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 benefits available to employees who are injured in the course and scope of employment in the state. The Virginia Workers’ Compensation Commission (Commission) oversees and handles all workers’ compensation claims in Virginia.
In general, to be eligible for workers' compensation benefits, an individual must:
- Be a covered employee (as defined by the WCA) or be an eligible dependent in cases of an employee’s work-related death; and
- Sustain a compensable condition.
Compensable conditions include injuries, diseases and deaths that arise out of and in the course of employment.
The benefits an individual may receive depend on, among other factors, the date of injury. This is usually the day on which a work-related accident occurred. For occupational diseases, however, the “date of injury” is the date on which the employee first received a diagnosis of the disease.
Medical Care Benefits
Employers are required to furnish a physician and pay for all necessary medical care to treat an employee’s work-related injury. This includes all necessary surgical and hospital services. All medical expenses must be covered for as long as necessary after an accidental injury takes place. For occupational diseases, an employer’s liability for medical expenses begins 15 days before the date of injury.
When an accident results in certain specified losses, an employer also must cover the cost of prosthetic, orthotic and other medical appliances, such as wheelchairs, canes and crutches, along with the costs of fitting and training the employee for their use. The conditions for which this requirement applies include:
- Amputation or loss of use of an arm, hand, leg or foot;
- Enucleation of an eye;
- Loss of any natural teeth; or
- Loss of hearing.
Average Weekly Wage
An employee’s monetary benefit rates are calculated as percentages of the average weekly wages (AWW) he or she earned at the time of a work-related injury.
The AWW is usually determined by taking the employee’s total earnings from the employer during the 52 weeks before the injury and dividing it by 52. If the employee did not work for the employer for 52 or more weeks before the injury, the AWW is determined by taking the total earnings over the course of the worker’s employment and dividing it by the number of weeks of employment.
In calculating the AWW, the employee’s total earnings must include “allowances of any character” made in lieu of wages, as long as they were a specified part of the wage contract.
An employee’s weekly benefit rates are subject to limits that are in effect on the date of injury. New limits become effective as of July 1 each year. These limits are based on the average weekly wages that all insured employees in the state earned during the previous year.
Except in cases where an employee is permanently and totally disabled, and in certain cases involving coal worker's pneumoconiosis, monetary benefits are also subject to an aggregate limit of either 500 weeks or a monetary amount that is 500 times the maximum rate limit for the year in which the injury occurred (whichever is reached first).
TEMPORARY DISABILITY BENEFITS
Under the WCA, an injured employee is entitled to receive weekly temporary disability benefits to compensate for lost wages resulting from the injury while the employee is recovering. However, an employee who refuses an employer’s offer of work that is suitable to his or her capacity is not eligible for temporary disability benefits during the refusal.
Temporary Total Disability (TTD)
Employers must provide TTD benefits for an employee who, due to a work-related injury, is:
- Completely unable to work; or
- Partially unable to work and the employer cannot provide any work suitable to the employee’s capacity (under these particular circumstances, however, TTD benefits are only payable if the employee is otherwise eligible for lawful employment).
Temporary Partial Disability (TPD)
An employee may be entitled to receive TPD benefits if the effects of a work-related injury cause him or her to lose only a portion of his or her pre-injury wages during the recovery period. This may be due to the employee’s need, as determined by the treating physician, to work reduced hours or to perform a job for which the employee receives reduced wages from the employer. An employee must be otherwise eligible for lawful employment in order to receive any TPD benefits.
Permanent DISABILITY BENEFITS
Employees are entitled to compensation for certain permanent effects of work-related injuries. The nature and extent of an employee’s work-related condition determine the benefit amounts available for permanent disability.
Permanent Partial Disability (PPD)
PPD benefits are available to employees who have certain permanent physical losses or impairments after reaching maximum medical improvement (MMI) for a work-related injury.
The WCA includes a list of body parts and functions and assigns a number of weeks for each of them. When an employee’s loss to any of these parts or functions is complete, he or she is entitled to receive PPD benefits for the full number of weeks assigned to the part or function in the WCA. A partial loss entitles the employee to a proportionate number of benefit weeks. The extent of an employee’s permanent physical loss or impairment is determined by the treating physician.
Permanent Total Disability (PTD)
PTD benefits are payable if a work-related injury causes an employee’s total inability to earn wages on a permanent basis. The following also constitute PTD under the WCA:
- Loss of both hands, both arms, both feet, both legs, both eyes, or any combination of two of them in the same accident;
- Injury, for all practical purposes, resulting in total paralysis, as determined by the Commission based on medical evidence; or
Injury to the brain which is so severe as to render the employee permanently unemployable in gainful employment.
VOCATIONAL REHABILITATION BENEFITS
The Commission may require an employer to pay for reasonable and necessary vocational rehabilitation services for an injured employee. These services may include:
- Vocational evaluation;
- Job coaching;
- Job development;
- Job placement;
- On-the-job training;
- Education; and
Death and Burial Benefits
If an employee’s death results from a work-related related injury within nine years, the employer may be responsible for burial expenses of up to $10,000, plus up to $1,000 in transportation expenses.
In addition, weekly death benefits are available to the employee’s surviving spouse and dependents. Death benefits are generally 66 and two-thirds percent of the injured employee’s AWW, subject to the rate limits described above.
An employee’s dependent spouse and children may receive up to 500 weeks of death benefits. However, a surviving spouse’s eligibility for death benefits ceases upon remarriage, and children’s eligibility ceases upon reaching age 18 or age 23 for full-time students. Children who are physically or mentally incapacitated from earning a livelihood after reaching those ages remain eligible for benefits up to the 500-week limit.
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