What Is a Workers Compensation Claim? A Comprehensive Guide

Workers' compensation is an area of employment law that protects workers who used to have to file personal injury claims to recoup their losses from workplace injuries and illnesses. It is essential to understand the workers' comp benefits available to you, how to file a claim, and where to turn for help if your claim is denied.

Introduction to Workers' Compensation and Its Purpose

Some jobs are more dangerous than others, but all workers face the possibility of occupational illnesses and workplace injuries. Virginia workers' compensation law requires employers with three or more employees to carry workers' compensation insurance to protect workers hurt on the job. 

This compensation insurance requirement applies to full and part-time employees, including seasonal workers, immigrants, and people working in a family-run business. Contractors must count subcontractor employees, even if that subcontractor carries their own workers' comp. insurance.

Virginia workers' comp law protects you regardless of who was at fault for your injury. Some exceptions exist — such as not following company policy regarding protective gear or accidents related to substance use — in which your employer's workers' compensation insurance carrier may successfully deny your claim.

Key Features and Benefits of Workers' Compensation Claims

You are eligible for several benefits if you miss work due to a job-related illness or injury. Taken together, these benefits are meant to help you financially while you recover or help you in the long term if your accident or illness results in a total disability.

Financial Protection for Injured Workers

The Virginia workers' compensation program offers financial protection beyond wage replacement and payment of medical bills for people hurt on the job. It also covers a reduction in your ability to earn money in the future due to your injury or illness. 

Workers' comp offers payment if you need vocational rehabilitation to learn new job skills. For example, a construction worker who can no longer stand for long periods may receive training in customer service or another occupation that doesn't require prolonged standing.

You are also covered for any permanent impairment you experienced due to a work-related injury or illness. Loss of sight, fingers, and toes are just some of the permanent impairments workers' comp covers.

Coverage for Medical Expenses Related to Work-Related Injuries or Illnesses

Under the Code of Virginia § 65.2-603, workers' compensation insurance must cover several medical benefits, including a primary physician's care. Your employer must furnish a panel of three doctors for you to choose from. The doctor you pick becomes the physician of record, and referrals must come from them. Payment of doctor and hospital bills lasts as long as necessary after a covered workplace accident.

When an employee has an amputation or loss of an arm, hand, leg, or foot, or the loss of teeth or hearing, the employer's insurance must also cover the use of prosthetic or orthotic appliances. It must also cover wheelchairs, scooters, canes, crutches, and other necessary equipment. 

Under certain circumstances, coverage also includes the modification of vehicles and the cost and maintenance of adjustable beds, ramps, doorway alterations, and other necessary changes.

Compensation for Lost Wages During the Recovery Period

While they cannot work, employees hurt on the job are entitled to 2/3 of their gross wage, up to a limit set by law. Payments do not begin until after seven days of disability, but if a worker misses more than three weeks, they receive payment for that first week. 

A worker on temporary total or partial disability can receive benefits for up to 500 weeks. After that period, compensation for lost wages only continues if they are granted total and permanent disability.

Employees who lose both hands, arms, feet, legs, eyes, or any two of those in the same accident are eligible for permanent and total disability and lifetime wages.

Steps To File a Workers' Compensation Claim

You must follow the process set out by Virginia law after you are injured on the job. Failure to do so could result in a denial of benefits, regardless of the extent of your injuries or illness.

Initial Reporting and Notification Process for Workplace Injuries

Reporting injuries or work-related illnesses to your employer immediately is critical. If you do not inform them within 30 days, reporting requirements dictate that you may lose your rights to compensation. 

Your employer must file a First Report of Injury with the Virginia Workers' Compensation Commission within 30 days for minor injuries and within 10 days for other work-related injuries and illnesses. Once the Commission gets your employer's report, they will notify you of your rights and responsibilities.

Seeking Medical Treatment and Documenting Injuries for the Claim

Your employer may authorize a doctor at the time of your accident. If they do not and you need emergency medical care, tell your treating physician during that visit that you were hurt at work. Keep any documentation from your initial visits, and keep track of any related expenses.

For a claim to be successful, your medical documentation must show that your work injury led directly to an inability to return to work. This is the case whether you file a claim for being completely out of work, partially out of work, or on light duty. 

When appropriate, your documentation must also back up your claim for permanent disability based on loss of use of a body part, disfigurement, amputation, hearing or vision loss, or lung disease.

Paperwork and Documentation Required for Filing a Claim

In addition to your medical records and bills, you need paperwork documenting mileage to and from doctor's appointments and the cost of prescriptions. Examples of financial assistance documentation you may need for your claim for benefits include mileage logs, receipts, and itemized bills. 

Ask your employer for any incident reports related to your injury or illness, and collect witness statements. While these are not required to file your initial claim, they serve as evidence if your claim goes to a hearing.

Once you have your documentation for each compensation benefit you are requesting, you can file a claim form with the Commission. You can send it by mail or fax or visit an office in person. You can also set up a Webfile account to submit your claim online. 

How a Workers’ Compensation Attorney Can Assist You in Your Process

If you were hurt on the job and need help with the workers' compensation process, contact the experienced team at Commonwealth Law Group. Our lawyers have an intricate knowledge of compensation law and decades of combined experience protecting workers' rights. 

We will answer any questions you have about how workers' comp works, help you file your paperwork on time, respond to any adverse actions by your employer or their insurance company, and appeal any unfair denial of your claim.