Six Reasons Why Your Virginia Workers' Compensation Claim May Be Denied
The Virginia workers’ compensation system provides legal protection to workers injured on the job. It also requires benefits to be paid for job-related illnesses. The system allows injured workers to receive medical benefits, and reimbursement for a percentage of their lost wages, due to their temporary or permanent disabilities.
Obtaining workers’ compensation benefits is not always an easy process. In many situations, your workers’ compensation claim may be denied. It is important to understand that denial of your claim by an insurance company or your employer does not prevent you from being paid benefits. In fact their decision is nearly irrelevant to whether you can ultimately get paid workers’ compensation benefits. Only the Virginia Workers’ Compensation Commission can decide whether your claim is valid.
All contested claims are heard in front of an administrative judge called a Deputy Commissioner. The Deputy Commissioner will hold a hearing and make a decision based on all of the evidence presented by your attorney. Listed below are seven common reasons for the denial of workers’ compensation claims:
Failure to Timely Notify Your Employer of Your Injury
If a job-related injury or illness occurs, you must notify your employer immediately in writing. If you fail to provide notice within 30 days, you could lose your right to receive workers’ compensation benefits. The sooner you notify your employer of an injury, or being diagnosed with a work-related illness, the better off you will be.
In the event of a sudden accident on a job site, you should let your immediate supervisor know as quickly as possible so that you can receive the proper emergency care. Follow up with your employer as soon as you are able to do so. In the event you suffer a job-related illness, inform your employer as soon as the illness or condition is discovered/diagnosed.
Make sure to keep a copy of the written notice that you give to your employer. You should keep a copy for your own records. If your claim is denied due to an alleged failure to give proper and timely notice, you will have the proper documentation to be able to refute this allegation at a hearing.
There are exceptions to the requirement to provide written notice of a work-related injury. In most cases the exceptions can be successfully argued by an experienced workers’ compensation lawyer.
Failure to File Your Workers’ Compensation Claim Within the Statute of Limitation Time Limits
Under Va. Code Ann. § 65.2-601, you have up to two years from the date of an injury or illness to file your claim with the Virginia Workers’ Compensation Commission.  If you fail to act within this two-year period, you will be barred from filing a claim. The exceptions to this statute of limitations are extremely limited and failure to file is, in most cases, fatal. Speaking with a qualified workers’ compensation lawyer that specializes in denied claims is the only way to obtain an objective evaluation of whether your claim can be pursued.
Once you have notified your employer of your injury or illness, the employer must file a report with the Commission within 10 days.
Having a Non-Work Related Injury or Illness
The Virginia workers’ compensation system covers injuries that occur within the course and scope of your employment.  For example, if part of your job involves running errands in an automobile, you would be covered in the event of an accident while running those errands. On the other hand, if your accident occurred while you were on a lunch break, running a personal errand, or going to and coming from work, you would most likely not be covered. Â
In addition to non-work-related injuries, you will not be eligible for workers’ compensation coverage if you were under the influence of alcohol or drugs when your injury occurred, or if you were engaged in reckless behavior on the job. Injured workers are often given toxicology screenings after a workplace accident to test for the presence of alcohol or drugs in their system.
Employer not Subject to the Virginia Workers' Compensation Act.
Virginia law requires any business with three or more employees to carry workers’ compensation insurance coverage. A business with less than three employees is, in most cases, not covered by the Virginia Workers’ Compensation Act. As a result, these businesses are not required to carry workers’ compensation insurance. Any claim for compensation filed against an employer that does not have 3 or more employees will be denied. A competent workers compensation lawyer will attempt to identify as many employees as possible to satisfy the employee requirement. For purposes of this defense, it may be possible to count the employees of contractors that work for the employer.
Independent contractors and “casual employees” are typically not covered under the Virginia Workers’ Compensation Act.Â
Having a Pre-Existing Condition Not Aggravated by Your Work Injury
When you file a claim for workers’ compensation benefits, the doctor who treated your injury or illness will prepare a medical record documenting your diagnosis and treatment. If your physician renders an opinion that you have a pre-existing condition that was aggravated as the result of your job-related injury, it will typically be covered. However, failure to obtain a supporting medical opinion will most likely prevent the condition from being covered. You will not prevail on an aggravation claim based only on your testimony.
Failure to Cooperate with the Insurance Company
When you are injured on the job, your employer will report it to the insurance company. Â You may be required to fill out additional forms, provide written or verbal statements, or consent to a release of certain medical records.
You should consult with an experienced workers’ compensation attorney before making any statements to the insurance company.  However, it is important to cooperate with the insurance company. Failure to do so could result in your benefits being denied by the insurance carrier. In that case, the matter may require a hearing.
Additionally, if your doctor recommends a suggested course of treatment, you must follow the suggested course of treatment. Failure comply with medical treatment may lead to the denial of your workers’ compensation claim.
Talk with a Virginia Workers’ Compensation Lawyer
If you or someone you care about has suffered an on-the-job injury or illness, and has been denied workers’ compensation benefits, contact us immediately. Vanessa Reed is experienced workers’ compensation attorney that will provide aggressive legal representation, and will assist you in pursuing the benefits you deserve. We have extensive experience representing injured workers throughout the Commonwealth of Virginia. Contact us today for a free consultation.
Our Process
Step 1
Initial Review and Development of Litigation Plan
The client will meet with the attorney to review the current status of the case, develop a plan of action, and formulate a timetable for resolution. The attorney will discuss the client’s specific goals, review any relevant caselaw or statutes related to the claim for workers’ compensation and answer the clients questions about the process.
Step 2
Pleadings, Discovery, and Motions
Being party to a workers’ compensation clam requires ongoing effort to organize your case through documents that are submitted to the Commission and opposing parties. It also may require pretrial motions. During this stage, we will prepare any pleadings to be submitted to the commission, draft discovery requests, responses and objections, issue subpoenas, conduction depositions, and prepare and argue any pretrial motions. This stage typically occupies 70-80% of the total timeline for your claim.
Step 3
Hearing Preparation and Settlement Negotiation
This stage includes review of all relevant evidence, preparation of any potential witnesses and the formulation of strategy for your upcoming hearing. Our experienced staff will assist in the assembly of any documents that will be relied upon as evidence at your hearing. During this stage, settlement negotiations may take place in an effort to resolve your case without a hearing if possible.
Step 4
Hearing
If your case cannot be resolved through negotiation, a hearing will be required. Based upon the plan we develop with you, we will present the evidence and witnesses that we have prepared to present your case in the light most favorable to you. Hearings can sometimes have unpredictable outcomes. However, when you hire the Reed Law Firm, you can be confident that the evidence, arguments, and testimony you want to have heard will be presented in a coherent, organized, and compelling way to provide you with the best possible opportunity to win your case.
Workers' Compensation Case Results
We offer our legal services to clients working in all industries. This particular client had been working in a warehouse when a forklift ran over his foot. He suffered a partial amputation and degloving injury to his foot. Our team protected his rights and helped him receive the compensation that he was rightfully entitled to.
Our client was working as a secretary, when she tripped over a box and struck her head forcefully on the corner of a wall. The client sustained severe head and brain injuries. We obtained $865,044.80 in workers’ compensation benefits on behalf of client which included payment of all medical expenses. The case was concluded by settlement after entry of an award order.
Our client was operating a blown insulation machine at work that jammed. The client attempted to clear the jam, when the machine suddenly restarted causing the amputation of several fingers, and severe hand injuries. We obtained $734,065.02 in workers’ compensation benefits and personal injury proceeds on behalf of this client. The case took several years to litigate.