Virginia Workers’ Compensation: Filing, Benefits, & Appeals
Learn how to start your claim, how much you will receive, and how to appeal a denial.
In Virginia, the state’s workers’ compensation laws cover virtually all workplace injuries and occupational diseases. This means that if you are injured while working in Virginia, or develop an illness related to your employment in Virginia, you likely have a Virginia workers’ compensation claim.
Who Is Covered?
Employers with three or more employees in Virginia are required to obtain workers’ compensation insurance. Most employers secure coverage through private insurance companies, which review and pay out accepted claims. However, large and financially stable employers may get approval from the state to self-insure. If your employer is self-insured, your employer will probably have an outside company administering the company’s workers’ compensation claims. Either way, the types and amounts of workers’ compensation benefits you will receive remains the same.
Any type of injury that occurs while you are performing work-related duties, regardless of where you were at the time, are covered through workers' compensation. Covered injuries can be sudden injuries that are either short-term or permanent. Virginia also covers occupational diseases, which arise out of the conditions of your employment—such as carpal tunnel syndrome caused by too much repetition or poor ergonomics, or lung cancer after being exposed to asbestos in the workplace. (For more information, see What Injuries Aren’t Covered by Workers’ Comp?)
How Do I File a Claim?
If you have a work-related injury or occupational disease, report the injury or illness to your employer as soon as possible, but no later than 30 days from your accident or from a doctor’s diagnosis with a work-related injury.
When you report your accident or disease to your employer, your employer will complete a form and submit it to the Virginia Workers’ Compensation Commission within ten days. You will then receive a letter from the Commission acknowledging submission of your claim. The letter will contain information about accessing your account online.
You must also file an official workers' compensation claim through the Commission’s online claim submittal process. You must file a claim with the Commission within two years of the date of the injury or you will lose your right to a workers’ compensation claim.
What Benefits Can I Receive?
Once your claim is allowed, you will begin receiving the following workers’ compensation benefits.
Medical treatment. Your employer, or its insurance company, will pay for all necessary medical treatment related to your work injury. This includes surgery, doctors’ visits, prescriptions, physical therapy, and most other medical treatments. However, workers’ comp will not cover new or experimental treatments.
Lost wages. If you are unable to work due to your injury or illness, Virginia workers’ compensation law provides compensation for your lost wages. You will receive 66 2/3% of your wages at the time of injury, up to a state maximum of $996 (for 2016). These benefits are available for up to 500 weeks. These benefits stop when you are physically able to return to work or when a doctor finds that you have reached maximum medical improvement.
Permanent disability compensation. Virginia law also provides benefits for workers to compensate for any permanent disability that results from the work injury or illness.
Permanent partial impairment benefits are available for injured workers who permanently lose some body function, such as decreased range of motion or hearing loss. Permanent partial disability benefits are two-thirds of your average weekly wage, but not more than $996 (for 2016). These benefits are paid for a number of weeks based upon the percentage of your disability. You can receive these benefits even if you are able to return to work. (To learn more, see How Are Permanent Partial Disability Benefits Calculated?)
Permanent total disability benefits are available to workers who are unable to return to the workforce due to their workplace injury or illness. If you qualify for permanent total disability benefits, you will receive lifetime wage benefits at your temporary total disability rate. Permanent total disability is provided for workers who lose both arms, hands, feet, legs, or eyes, or is paralyzed or disabled due to traumatic brain injury.
Survivor benefits. In cases of death, survivors may be eligible for funeral expenses and survivor's benefits.
How Do I Appeal a Denied Claim?
If your workers’ compensation claim is denied, you will receive notice from your employer or its insurance carrier of the claim denial. Common reasons for denying a claim include mistakes in the paperwork, reporting your injury or filing a claim late, or the possibility that your condition was caused by something other than work.
You have a right to appeal a denial of your claim. To appeal the claim denial, you must file a Claim for Benefits form with the Virginia Workers’ Compensation Commission, at 1000 DMV Drive, Richmond, Virginia 23220. This form and others are available on the Commission’s website.
Deputy Commissioner Hearing
After you file the form, a Deputy Commissioner will hold an evidentiary hearing regarding your case. You and your employer will each have an opportunity to present witnesses and documentary evidence. You should be prepared to present all of the necessary evidence to establish your workers’ compensation claim. This should include:
- documentation that you reported your injury to your employer on time
- testimony from your doctor about the extent of your injury, your physical inability to work, and that your work activities caused your injury, and
- testimony from witnesses who saw your workplace accident, if applicable.
You will likely not be able to submit additional evidence at later appeal stages, so make sure you present all possible evidence at the Commission hearing. After the hearing, the Commissioner will mail out a decision in about three weeks.
Full Commission Hearing
If you disagree with the Deputy Commissioner’s decision, you may appeal to the Full Commission. To do so, you must file a review request within 30 days of Deputy Commissioner’s decision.
You are not allowed to submit any new evidence to the Full Commission; the Commission will review only the evidence submitted at the Commission Hearing. However, both sides may submit written briefs in support of their positions. Either party may also request to make oral arguments; however, the Commission has discretion to allow or deny such a request. After reviewing the written record of the initial hearing and the parties’ briefs, the Commission will make a decision.
If you are not satisfied with the decision of the Full Commission, you may take the case to Virginia’s Court of Appeals within 30 days of the Full Commission’s decision. To do so, you must file a Notice of Appeal with the Clerk of the Commission and a Notice to the Clerk of the Court of Appeal. The final appeal is with the Virginia Supreme Court, which must be filed within 30 days of the Court of Appeal’s decision.
Do I Need a Workers' Compensation Lawyer?
The workers' compensation laws in Virginia are often very complex can be difficult to navigate. While most workers can handle the initial filing process on their own, disputed claims often require the assistance of an experienced workers’ compensation attorney. This is especially true if you need to attend a workers’ comp hearing or if you plan to appeal in court. (For more information, see Do I Need a Lawyer to Get Workers’ Compensation Benefits?)