Virgina Workers Compensation Basics 101

ThisThWorkers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com an excellent service. http://workcompresearch.com/

In Virginia, every employer who has three or more employees, whether full-time or part-time, is required to carry workers compensation insurance. Virginia’s Workers’ Compensation Act includes family members working for the employer, apprentices, minors and illegal immigrants as employees. There are some exceptions – worker compensation coverage is elective for partners, sole providers, and corporate officers. Workers compensation coverage does not apply to independent contractors (including real estate agents), casual workers, domestic workers, and farm workers (unless the employer regularly has three or more employees). Employers with one or two employees may voluntarily obtain workers compensation insurance.

Obtaining Coverage:

To obtain workers compensation coverage in Virginia, the employer has four options which are:

1. Purchasing a workers compensation insurance policy from an insurance company licensed to do business in Virginia.

1. Obtaining approval from the Virginia’s Workers’ Compensation Commission to act as an independent self-insurer.

1. Joining a group self-insurance association licensed by the Virginia State Corporation Commission.

1. Having an agreement with a professional employer organization as provided by Virginia statute.

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Claim Reporting:

The employee must report the injury to the employer in writing within 30 days of the injury and the employee must report the injury to the Virginia Workers Compensation Commission within two years of the occurrence. The employer upon learning of the accident is required to report the workers compensation claim to the insurer within ten days using the Employer’s Accident Report (VWC Form No. 3). The insurer then must send in the report of the accident to the Virginia Workers Compensation Commission.

Medical Benefits:

The employer must provide a panel of at least 3 doctors, who are not affiliated with each other, for the employee to select from. If the employer fails to post a panel of doctor’s for the employee to chose from, the employee is allowed to select his own doctor. In an emergency situation, the employee may be treated at any emergency care facility or the emergency room of a hospital. After the initial emergency care, the employee is must select from the employer’s panel of medical providers. Once the employee has chosen a doctor from the panel, the doctor can not be changed without the insurance company’s approval, unless the Workers’ Compensation Commission orders a change of medical providers.

All medical expenses are covered under Virginia’s workers compensation statutes for as long as the employee needs medical care, provided the claim was filed timely. There is no medical fee schedule in Virginia. The initial panel doctor can refer the employee to other medical providers. If the employee does not cooperate with the medical care, indemnity benefits can be suspended.

Temporary Total Disability Benefits:

The temporary total disability (TTD) benefits are calculated as two-thirds of the employee’s average weekly wage. The maximum amount of TTD benefits that can be paid weekly is changed each July 1. There is an automatic cost of living increase on Oct. 1 each year, if the accident occurred prior to July 1of the same year. The maximum TTD benefits per week for injuries is $895 per week. The state minimum weekly benefit is $223.75.

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid for a maximum of 500 weeks.

Temporary Partial Disability Benefits:

In Virginia, if the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage. The TPD benefits are paid for up to 500 weeks from the date of injury. The TPD benefits plus the post-injury pay rate can not exceed the state’s maximum indemnity benefits rate for TTD.

Permanent Partial Disability Benefits:

Virginia employees are paid permanent partial disability (PPD) benefits for any permanent disability suffered as the result of an on-the-job injury. Once the employee has reached maximum medical improvement, the employee can be paid PPD, even if back at work.

Virginia uses a schedule of injuries for arms, legs, hands, feet, fingers, toes, vision, hearing and severely marked disfigurement of the body. The loss of an arm is worth 200 weeks of indemnity benefits (with a week calculated the same as TTD). For example, if the treating doctor gives the employee a 10 percent disability rating to the arm, and the employee’s TTD rate was $600 per week, the employee will receive $12,000 ($600 X 200 X 10%).

Injuries to the back and internal organs are not scheduled injuries. When a Virginia employee has a back injury, he or she will continue to collect TTD benefits, up to 500 weeks or until he or she is able to return to work.

Permanent Total Disability Benefits:

Virginia permits the employee to collect a maximum of 500 weeks of indemnity benefits for all types of indemnity combined, unless the employee is classified as being permanent and total disabled which is defined as:

1. Paralyzed.

1. Loss of both arms, hands, legs, feet, eyes or any two in the same accident.

1. Severe brain injury that is so severe as to render the employee permanently unemployable.

1. If the employee’s injury is designated as a permanent and total disability, the employee can draw indemnity benefits for life.

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Death Benefits:

The burial expenses in Virginia are covered for a work-related death up to $10,000. The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – currently a maximum of $895 per week, up to a maximum of 500 weeks. The minimum death benefit is 25 percent of the state maximum benefit or the actual wage if less. Spouses who have not been voluntarily deserted or abandoned at the time of the accident, children under the age of 18, children under the age of 23 enrolled full time in an accredited educational institution, any child regardless of age if physically or mentally incapacitated, and parents who are in destitute circumstances, can receive the death benefits.

Vocational Benefits:

Virginia workers compensation law also includes vocational rehabilitation. If the employee cannot return to the prior employment / job, the insurance company is required to pay all reasonable expenses incurred by the employee in his vocational retraining. If the employee is released to light duty work, the employee must prove that he or she is actively looking for a new job within their limitations, or benefits can be suspended. The employee is required to accept any suitable position offered.

NOTE: State laws change frequently. Nothing in this article is meant as legal guidance. For legal advice on a particular state’s most current law, please consult with you legal advisor. To purchase the most up-to-date laws, go to: http://workcompresearch.com/

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: [email protected] or 860-553-6604.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

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