Who Are The People Involved In A Virginia Workers' Compensation Claim?

The injured worker or employee is referred to as the "claimant". One of the most frustrating things for people injured on the job is that they must deal with many different people with varying roles and allegiances. This list includes:

  • Workers' Compensation Commissioners;
  • The Employer;
  • The Insurer;
  • Physicians;
  • Evaluating Physicians;
  • Vocational Counselors;
  • Nurses;
  • Claimant's Attorney
  • The Workers' Compensation Commission

Workers' Compensation Commission

The Commission is composed of three (3) commissioners who are appointed by the General Assembly and many Deputy Commissioners (presently twenty (20) who preside at hearings. The address of the Commission is 1000 DMV Drive, Richmond, Virginia 23220. Their toll free phone number is 804-367-8600 and their web site is www.vwc.state.va.us.

Deputy Commissioners preside at hearings that are usually set near the County where the injured worker was injured. A Commissioner is similar to a Judge. They do not take any side and do not issue any benefits. Their sole purpose is to make a decision when there is a dispute and to regulate the practice of Workers' Compensation. A decision of the Commission on an issue is enforceable in any Virginia Court.

The Employer

The employer is the company or person that hired the claimant.Every employer in Virignia with at least three (3) employees is required to maintain workers' compensation coverage or qualify as a self-insured. Many counties or municipalities are self-insured. If the employer is self-insured they pay benefits to the claimant directly.

The Insurer

These companies have contracted with employers to pay any workers' compensation benefits that the claimant may be entitled to. They are not an insurer for the claimant. They work for the employer. There will act in the employer's best interests, not the claimant's. Therefore, a claimant should never deal with an insurer directly since the insurer's interest will probably be to find a way to reduce the amount of benefits paid to the claimant. This may involve using information obtained directly from the claimant in defense of the claim! The person assigned to your case by the insurer is called an adjuster or claims representative.

Physicians

These are the people that will treat your injury. The law permits you to receive treatment from the physician of your choice. This list can include chiropractic, osteopathic or other disciplines. However, it is important to realize that in order to receive benefits timely and obtain approval from the insurer for medical care, that it is mandatory that your physician issue reports timely. Therefore, it is wise to discuss the choice of physician with your attorney.

Evaluating Physicians

The insurer has the right to obtain an IME (they call it an independent medical exam and we call it an insurance medical exam). This physician will not treat you and rarely will offer you any medical advice. They exist merely to render an opinion that the insurer can use to guide their future conduct in the case and as evidence against you in Court. It is wise to be courteous and honest when you see these physicians, but be aware they are watching every move you make, including comparing the physical complaints you make to how you remove your shoes, etc. for your exam! It is rare that an insurer IME will give you the benefit of any doubt or believe anything that cannot be supported by medical tests. If you are asked to see this physician you must go, but contrary to what is usually stated in the letter that is sent to you by the insurer, you do not need to gather any test results for the review of the IME.

Your attorney may also ask you to see a physician.The purpose of the exam is usually to obtain an opinion as to the degree of permanent disability you have sustained, an opinion as to what caused your injury, or a second opinion as to what type of treatment is needed (should you want one). Once again, this physician will not treat you unless specifically asked to do so.

It is extremely important not to miss these appointments since it may delay your receiving benefits!

Vocational Rehabilitation Counselor

Since Virginia law requires that the insurer provide vocational rehabilitation assistance in certain circumstances, there is a need for vocational counselors. These are the people claimants usually find most frustrating to deal with. They are hired by the insurer and their job is to get you back to work. Our job is to insure that it is a job with dignity and the process is fair. They will often require that you keep a list of your employment contacts, that you contact up to ten employers per week, and be available for interviews with employers and meetings with them. We keep a short leash on many counselors because of the potential that:

Information they obtain will be used against you by the insurer; or

That your conduct will be used against you by the insurer.

Thus, vigilance is a must, but co-operation is crucial. We will use our experience and the Commission rules to pressure the counselor to act in your interest instead of the insurer's.

Fortunately, many counselors do act on behalf of the claimant. When they do, with the claimant's co-operation, extraordinary things can be accomplished!

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Nurses

Nurses are often hired by insurers when the claimant's injury is severe. They can perform a useful service in coordinating medical care and speeding the approval by the insurer for treatment. However, once the acute phase of recovery from the injury has passed they often become a problem to the claimant and their access to you and your physician should be limited or eliminated. As with vocational counselors, they are hired by the insurer, and therefore at least some of their loyalty is to the insurer. You should be aware that anything you say to the nurse may be placed in a report and used against you by the insurer. This is because you do not enjoy the same privileges of communication with them that you do with your lawyer! If a nurse is directly employed by the insurer then, except in extremely unusual cases, they should not be permitted any involvement in your case.

Your Attorney

Representing claimant's injured on the job certainly requires a knowledge of compensation law. However, in addition, experience can make a great difference in the outcome of your case. Each insurer and self-insured employer operates with a different set of guidelines. Each Deputy Commissioner handles his courtroom differently. Each physician, vocational counselor, nurse and defense attorney have different strengths, weaknesses and biases. Experience with those individuals and or handling similar issues often aides in helping you to avoid a problem or winning when there is one.