You must file a workers comp claim directly with the Workers Compensation Commission to alert the Commission of the occupational injury or illness and protect your legal rights.
Otherwise, you may forfeit your eligibility for benefits under the Workers Compensation Act.
But a work comp claim can do more than preserve your rights and satisfy the statute of limitations. When you accurately complete the claim form and include supporting paperwork, the workers compensation claim can persuade your employer and their insurer (or claim administrator such as Sedgwick, ESIS, or Gallagher Bassett) to offer an Award Letter or pay a fair settlement without litigation.
This article explains how to file a workers comp claim, focusing on submitting the claim form in Virginia. You will learn the steps to complete the claim for benefits and what documents to attach to increase the likelihood the insurer will accept your claim and set high insurance reserves that drive up the potential workers comp settlement value.
Keep reading to learn more.
And check out our other articles for more information on Virginia workers compensation laws.
If you want to talk to a top-rated work injury attorney, call our firm at (804) 251-1620 or (757) 810-5614. We have helped hundreds of injured workers get results that provide financial security.
A claim is a demand for money, property, or a right provided by law.
When you file a workers compensation claim, you seek coverage for your occupational injury or illness under your employer’s insurance policy. Submitting a claim for workers comp benefits, therefore, is similar to filing a claim with your auto liability insurance carrier after a car crash.
Filing a workers comp claim seems complicated because you must notify multiple entities (the employer and its insurer, the Workers Compensation Commission) and satisfy several deadlines.
But you can satisfy the procedural rules for filing a claim by following these steps:
1. You must report the injury to your employer (in writing): Under the Workers Compensation Act, you have 30 days from the work accident date to tell your employer how you got hurt and what body parts you injured. Review this sample work injury letter for ideas on what to say.
2. Ask your employer to do three things: (a) complete a written work incident report (giving you a copy); (b) provide a list (panel) of physicians for you to see; and (c) ask for the employer’s workers comp insurance information so you can contact the claims adjuster directly. These documents are critical if the insurance company defends your claim and raises a notice defense.
3. Seek medical treatment. Whether you suffered a back injury, head trauma (concussion), or a torn rotator cuff, you will need medical evidence to get approved for benefits. You must, therefore, seek medical treatment with an emergency provider or a doctor from the panel of physicians. Or, if the employer refuses to give you a list of doctors, treat with someone you trust.
4. File a workers comp claim with the correct state agency: Telling your employer or the insurance company about the work-related injury or illness is necessary but insufficient to get workers comp benefits. You must also file a claim with the executive agency overseeing occupational injuries. In Virginia, this means filing a claim with the Workers Compensation Commission.
Filing this claim form (or letter) starts the litigation process.
5. The insurer approves or denies the claim: After you submit the claim form to the Commission, the insurer must tell the Commission if it accepts the claim, denies it, or needs further investigation. Depending on the insurer’s response, you may need to ask the Commission to docket your claim for benefits for a workers comp hearing where you can present evidence.
You should file a workers comp claim once you have the medical records from your initial hospitalization or doctor appointment – the sooner, the better.
Submitting a claim for benefits with medical reports within a few weeks of your work injury is essential for several reasons:
First, filing a timely claim ensures the statute of limitations will not expire (two years for most work injury claims in Virginia). Waiting until the statute of limitations expires to file the claim may bar you from receiving wage loss or lifetime medical benefits you are otherwise entitled to.
Second, waiting a few days or weeks to report the occupational injury to your employer or a few months to file a work comp claim will raise a red flag for the insurer. This increased investigation may cause a delay in getting the income replacement and medical treatment you need to heal and stay afloat financially.
Third, the sooner you file a claim for benefits, the sooner the Commission will schedule your claim for trial if the insurer denies benefits. And the sooner your hearing, the less time you will go without medical treatment or income.
Fourth, the Commission will docket your case for a hearing once it has medical evidence. Indeed, you risk dismissal of your claim (without prejudice to refiling) if you fail to file medical reports within 90 days of submitting the claim for benefits or requesting a hearing.
You have several options for filing a workers compensation claim.
These methods include the following:
1. By WebFile (Online): The fastest way to submit your claim is online using the Workers Compensation Commission’s electronic filing system. This system is called WebFile. But you must create a WebFile account using your Jurisdiction Claim Number (JCN) and PIN (Personal Identification Number) before filing a workers comp claim with the Commission online.
2. In person: The second method is to complete the Claim for Benefits Form and deliver it to one of the Workers Compensation Commission’s offices (Richmond, Bristol, Fairfax, Harrisonburg, Manassas, Roanoke, or Virginia Beach). Bring a photo ID (driver’s license) to enter the Commission’s offices.
3. By mail: You can mail a workers comp claim to the Commission’s headquarters at 333 E Franklin St, Richmond, VA 23219, or one of the Commission’s regional offices.
If you choose this method for filing a work comp claim, send it by certified mail return receipt requested.
The Commission considers any claim sent by certified mail as being filed when mailed. Otherwise, the Commission will only consider your workers compensation claim filed once received. And a delay may create problems if the Commission receives the claim form after the statute of limitations expires.
4. By fax: A fourth option is to fax the workers comp claim to (804) 367-6124. But I recommend avoiding this method because it depends on someone else noticing your fax and noting the pleading.
5. By counsel: A fifth option is to ask your workers comp lawyer to file your claim. I review and submit all the paperwork for my clients.
The Workers Compensation Act does not define the term “claim.”
But the Workers Compensation Commission’s Rules say that an injured employee must sign the original claim for benefits and include the following information within the pleading:
You can satisfy these procedural rules by completing the Commission’s template claim form and submitting it by WebFile.
But your goal should not be a bare-bones, “basic” pleading. Instead, I recommend completing the claim for benefits and filing the form with additional letters and evidence that persuade the insurer you have a prima facie compensable injury under workers comp.
For example, you should submit this information and paperwork via WebFile when you file the claim for benefits.
Yes.
We recommend filing a workers comp claim even when your employer or the insurer pays for medical treatment or covers wage loss benefits.
There are several reasons for this.
First, the law says the employer should provide an agreement letter if the parties agree on compensation. Your employer and its insurer, therefore, are not complying with the law when they pay benefits voluntarily but refuse to offer an award agreement memorializing the injury and entitlement to benefits.
Second, the insurer’s voluntary payments do not bind the insurance company to future payments. And at any moment, your benefits could stop if the Commission has yet to enter an Award Order. This will cause financial stress and hinder your healing and recovery process.
Third, subject to some exceptions, the insurer can stop payments if you fail to file a workers comp claim within the statute of limitations. And I have seen some employers and insurance companies do this – make voluntary payments to lull the injured worker into a false sense of security, then stop benefits when the statute of limitations for filing a claim expires.
We have noticed a trend over the past years.
Many injured workers are afraid to file a workers comp claim because they do not want to sue their employers. Selflessly, they are concerned that filing for workers comp may upset their boss, supervisors, and coworkers or cause bankruptcy. And they do not want to do that to people they care about.
These concerns are understandable. And admirable.
But I will tell you what I tell the people who call me for help: filing a workers comp claim will not hurt your employer.
Through the Workers Compensation Act, society has determined that workers comp insurance coverage is a cost of doing business. You – the injured worker – should not be the only person to bear the costs of a work accident.
And this is why workers compensation insurance coverage is mandatory for almost all employers in Virginia.
If your employer asks you not to file a workers comp claim because it will affect their business somehow, ignore it.
They had an obligation to protect you and your coworkers by purchasing workers compensation insurance or meeting self-insure requirements. Either they broke the law or want you to forfeit your legal rights for no reason.
And you should act to protect yourself and your family first.
No.
Many employees worry they will lose their job if they file a claim for work comp.
But an employer faces civil liability (meaning you can file a civil action) if it retaliates (fires, disciplines, or demotes you) for claiming workers compensation benefits.
No.
Injured workers are responsible for filing claims for benefits and requesting hearings with the Workers Compensation Commission.
The employer may submit a claim on your behalf, but it does not have to. Indeed, its responsibility is limited to reporting the accident or disease to the Commission within ten days or risking a civil fine under Code Section 65.2-902.
Further, we do not recommend asking your supervisor, human resources manager, or safety manager to do so.
For example, I have seen employers submit claims with inaccurate accident descriptions that suggest an injury not covered under workers comp laws. This wrong information led the insurer to deny the claim and protracted litigation.
In addition, employers may submit claims listing the wrong body parts (or not all of them) or a lower pre-injury average weekly wage, which affects your claim’s value.
Filing a workers comp claim that describes a compensable injury by accident or occupational disease and includes documents showing legal and medical causation and disability will expand the scope of pretrial discovery and scare the insurance adjuster into making a reasonable settlement offer.
In addition, submitting a claim that shows you know the procedural rules and what you must do to satisfy your burden of proof allows you to demand a better settlement.
Contact our work injury law firm to get started on the path to healing financially, physically, and mentally.
We have offices in Richmond, Newport News, Baltimore, Hagerstown, and Cambridge, allowing us to serve injured workers across the Commonwealth of Virginia.