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If you are dealing with being denied Workers’ Compensation in Virginia, it is important to understand what that denial really means and what steps may still be available to you. In this article, we’ll discuss…
There are a number of reasons. I would put them into two broad categories.
First, some claims are denied because there are legitimate questions about whether the claim should be covered or whether the injured worker is entitled to benefits. For example, the employer may think it was a gradual onset injury, that it involved an ordinary risk of life, that it happened outside Virginia’s jurisdiction, or that some other defense applies.
Sometimes there are also legitimate doubts about whether the accident actually happened the way the claimant says it happened, or whether, even if it did happen that way, it is covered under Virginia law.
But there is also another category: many claims are denied simply because insurance companies are profit-driven businesses. They know that if they deny a claim, even one that appears open and shut, some claimants will not act. Some people will assume the insurance company has the authority to decide the claim, believe the denial, and give up. They may never talk to an attorney or file a claim on their own.
From the insurance company’s perspective, that is a win. Sometimes denial also buys time. It may discourage the claim. It may put pressure on the injured worker. Medical bills start piling up, wages stop coming in, and no Workers’ Compensation benefits are being paid. In that situation, the insurer may hope to force a cheaper settlement later because the worker is under financial pressure.
At the same time, there are many legitimate defenses insurance companies raise. One of the most common involves pre-existing conditions. If there is any sign of a prior injury to the same body part, the claim is often denied right away. Even if that earlier condition was from many years ago and ultimately does not affect the claim, the insurance company may still view it as worth denying the claim.
If your employer’s insurance company refuses to pay your workers’ comp claim voluntarily, the next step is to file a claim for benefits with the Virginia Workers’ Compensation Commission. This will be a simple one-page form. Once your claim is filed, the matter can be set for a hearing.
You should have an attorney help with this process early on. Your attorney can file the form for you, and that matters because even simple forms are often filled out incorrectly. A missed error may not always be fatal, but mistakes are common.
If the deputy commissioner who decides your case rules partially or entirely against you, you may appeal the decision first to the full Commission and then again to the Court of Appeals.
Remember, your employer’s insurance company is not the final judge or authority on your claim, and there are still steps available to contest a refusal to cover your injury or any dispute you may have with your employer.
When benefits are denied, many injured workers assume the process is over. Terry Armentrout of Armentrout Accident and Injury Law, LLC helps people understand that a denial is often the beginning of the fight, not the end of it. He has represented workers facing disputed claims, gathered the evidence needed to support their cases, and helped clients pursue hearings, benefits, and settlements under Virginia Workers' Compensation law. That experience gives him a grounded view of what can change the outcome after a denial.
If your benefits were refused, contact Armentrout Accident and Injury Law, LLC to discuss your next move.
Some of the most important evidence is fairly straightforward. You should compile any medical records you have. If there were witnesses, get their names, addresses, and contact information. If you have witness statements, that can help too.
Having said that, one of the problems with witnesses is that they are often co-workers. If they still work for the employer, you may be asking a lot of them to testify against their current employer. Even so, an attorney will want to know who they are and may want to speak with them.
If you have access to your wage records, those matter too, because they help determine your compensation rate.
You should also keep any communications that may be relevant, such as texts or emails. That can be especially important in disputed claims. For example, if your employer says you never reported the injury, or claims you were terminated for an unexcused absence or a no-call, no-show, any written communication on those points can be important.
The best thing you can do is have an experienced Workers’ Compensation attorney review the denial. An experienced attorney can usually tell fairly quickly whether a claim is a…
In most cases, I can tell fairly quickly whether it is a strong case, whether there’s little chance of approval, or what issues will arise if your claim goes to a hearing.
As much as possible, yes. That said, the Commission is not going to penalize you simply because you cannot afford treatment after a claim has been denied. If health insurance, Medicaid, or Medicare can cover treatment, then yes, you should continue treating through those options if possible.
But if you cannot continue treatment because you cannot afford it, the Commission is not likely to hold it against you. Still, the burden of proving your entitlement to benefits falls on you.
Because of this, at some point between the date of the accident and the hearing, you need medical documentation, such as off-work notes or restriction notes from the doctor. If you go to your hearing without medical support for disability or restrictions, the Commission cannot award compensation for that period.
So even when it is not your fault, and even when money is the obstacle, you still have to find a way to get at least that minimum medical documentation if you want to prove the claim.
When benefits are denied, many injured workers assume the process is over. Terry Armentrout of Armentrout Accident and Injury Law, LLC helps people understand that a denial is often the beginning of the fight, not the end of it. He has represented workers facing disputed claims, gathered the evidence needed to support their cases, and helped clients pursue hearings, benefits, and settlements under Virginia Workers' Compensation law. That experience gives him a grounded view of what can change the outcome after a denial.
If your benefits were refused, contact Armentrout Accident and Injury Law, LLC to discuss your next move.
If your claim has been denied by the insurance company, one possible outcome is that once a formal claim is filed, the insurance company changes course and agrees to begin paying voluntarily. That does happen, but not often.
The second possibility is that your claim goes to a hearing, where you may win, lose, or win some but not all of the benefits you were seeking.
A third possibility is settlement. In many cases, the parties negotiate a settlement before the hearing takes place. A settlement is exactly what it sounds like: a compromise that ends the claim in exchange for a one-time agreed-upon cash payment.
A case can settle across the full range of claim strength. Some settlements happen in weak cases. Some happen in very strong cases. So the fact that a case settles does not necessarily say much about who would have won at a hearing. Sometimes, both sides simply decide that compromise is better business than continuing the fight.
If the case does go to a hearing, there are generally three categories of benefits you may be trying to win.
First, you will always be seeking a medical award. That means the Commission rules in your favor and awards lifetime medical benefits for the injury.
Second, you may be seeking back compensation. For example, if the hearing takes place several months after the accident and you have supporting evidence for lost time during that period, you may be awarded compensation for that past period.
Third, if at the time of the hearing you are still out of work or still suffering wage loss and have the medical support for it, you may be placed on an open or ongoing award for weekly compensation. In some cases, that ongoing weekly award is the most significant benefit of all.
In Workers’ Compensation claims, the value of having an attorney’s help comes close to being essential. There are requirements in Workers’ Compensation that injured workers would not know about, even if they read the statute from beginning to end. Some of the most important rules come not from the statute, but from case law.
A good example is ‘marketing.’ If an injured worker is not totally out of work, but instead has work restrictions and is not earning wages, that worker has a duty to look for work. In plain terms, ‘marketing’ means looking for light-duty work.
The problem is that unrepresented claimants often do not know they are supposed to be doing this. There is no obvious reason they would know. And even if they do know, they may not realize they need to keep records and bring proof of their job search to the hearing. So even if they have made the effort, they may still lose because they cannot prove that they were actively searching for light-duty work. This rule is not even in the Virginia statute.
That is just one example. Workers’ compensation has countless nuances like this that even a careful, intelligent, and diligent injured worker will likely not spot on their own. Without the knowledge an experienced workers’ compensation attorney has, you are at a significant disadvantage against a workers’ compensation insurance company and its attorneys, who do know the law.
For more information on being denied Workers’ Compensation in Virginia, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (540) 564-1466 today.
When benefits are denied, many injured workers assume the process is over. Terry Armentrout of Armentrout Accident and Injury Law, LLC helps people understand that a denial is often the beginning of the fight, not the end of it. He has represented workers facing disputed claims, gathered the evidence needed to support their cases, and helped clients pursue hearings, benefits, and settlements under Virginia Workers' Compensation law. That experience gives him a grounded view of what can change the outcome after a denial.
If your benefits were refused, contact Armentrout Accident and Injury Law, LLC to discuss your next move.