Virgina Workers Compensation Basics 101

 ThisTh Workers 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.
 
2.      Obtaining approval from the Virginia's Workers' Compensation Commission to act as an independent self-insurer.
 
3.      Joining a group self-insurance association licensed by the Virginia State Corporation Commission.
 
4.      Having an agreement with a professional employer organization as provided by Virginia statute. (WCxKit)
 
Workers compensation insurance can be purchased at: http://www.workerscompensation.com/insurance/ins_info.php
 
 
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.
 
2.      Loss of both arms, hands, legs, feet, eyes or any two in the same accident.
 
3.      Severe brain injury that is so severe as to render the employee permanently unemployable.
 
4.      If the employee's injury is designated as a permanent and total disability, the employee can draw indemnity benefits for life.
 
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. (WCxKit)
 
 
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:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

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.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Western Australia Proposal Limits Indemnity Payments to One Year

The Minister for Commerce in Western Australia recently announced the introduction of the Workers Compensation and Injury Management Amendment Bill 2011 into State Parliament.
 
 
The Bill proposes a significant change in the scheme with the abolition of age based limits on workers comp entitlements. (WCxKit)
 
 
Under the reforms all workers will have the same entitlements to compensation regardless of their age. At present the scheme discriminates against older workers by limiting the entitlement of injured workers aged 64 or more to only one year of income payments.
 
The bill will also:
 
1.      Provide a mechanism to ensure seriously injured workers have a common law remedy where their employer is uninsured;
2.      Bring significant and much needed improvement to workers comp dispute resolution arrangements; and
3.      Address longstanding technical issues.
 
 
The improvements delivered through this bill will benefit both workers and employers while maintaining the long term sustainability and fairness of the States workers comp scheme.
 
 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
 
 
 
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.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Georgia Workers Compensation Basics

In Georgia, every employer who has three or more employees, whether full time or part time is required to carry workers compensation insurance. There are some exceptions – work comp coverage is elective for planning commissions, partners, sole providers, licensed real estate agents and brokers, agricultural and domestic workers. All county and municipal governments and all school districts must carry workers compensation insurance.
 
Obtaining Coverage:
To obtain workers compensation coverage in Georgia, the employer has two options which are:
 
1.      purchasing a workers compensation insurance policy from a state approved insurance company
2.      qualifying as an approved self-insured employer and posting a surety bond or a letter of credit with the state
 
 
Claim Reporting:
The employee must report the injury to the employees supervisor within 30 days of the occurrence. The employer is required to file the Employers First Report of Injury form, WC-1 with the Georgia State Board of Workers Compensation. If the employer fails to file the WC-1, the employee can report the claim to the Board of Workers Compensation by filing state form, WC-14, Notice of Claim. (WCxKit)
 
 
Medical Benefits:
The employer must provide a list / panel of at least 6 doctors (at least one doctor must be an orthopedist) for the employee to select from. If the employer fails to post a panel of doctors for the employee to choose from, the employee is allowed to select his own doctor. The employee has the right to switch one time to another doctor on the panel. A unique aspect of Georgia law is the employee who is being paid indemnity benefits can demand a “claimants independent medical examination” by the a doctor of the employees choice (i.e., employee's attorneys choice) within 60 days of the start of indemnity benefits, paid for by the work comp insurance company.
 
 
All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation. All billing of medical services by medical providers must be in compliance with the Georgia Workers Compensation Medical Fee Schedule, which is updated on April 1st of each year. 
 
 
Temporary Total Disability Benefits:
The temporary total disability (TTD) benefits are calculated as two-thirds of the employees average weekly wage over the 13 weeks prior to the date of injury, not counting the week of the injury. The maximum amount of TTD benefits that can be paid weekly is changed by the Georgia Legislature from time to time. There is no automatic cost of living increase. The maximum TTD benefits per week for injuries are $500.00 per week. The state minimum weekly benefit is $50. 
 
 
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 400 weeks.
 
 
Temporary Partial Disability Benefits:
In Georgia, the employee will receive TTD benefits as long as the employee is off work from the injury (up to 400 weeks). 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 350 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.
 
 
Permanent Partial Disability Benefits:
Georgia 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 authorized treating doctor assigns a disability rating based on the American Medical Association Guidelines.   Georgia uses a schedule of injuries for limbs, vision and hearing. The loss of an arm or leg is worth 225 weeks of indemnity benefits (with a week calculated the same as TTD). The schedule decreases as the size of the limb decreases with a small toe being worth 20 weeks. A person with an injury to body as a whole is worth up to 300 weeks of indemnity benefits. For example, if the treating doctor gives the employee a 10% disability rating to the back, and the employees TTD rate was $500 per week, the employee will receive $15,000 ($500 X 300 X 10%).
 
 
Catastrophic Disability Benefits:
Georgia permits the employee to collect a maximum of 400 weeks of indemnity benefits for all types of indemnity combined, unless the employee is classified as having a catastrophic injury which is defined as:
 
1.      Spinal cord injury causing paralysis to an arm, leg or trunk
2.      Amputation of an arm, leg, hand or foot involving the effective loss of use of the body part
3.      Severe brain injury
4.      Second or third degree burns over 25% or more of the body, or third degrees burns to 5% or more of the face or hands
5.      Total or industrial blindness
6.      Any other injury that prevents the employee from being able to work (employees attorneys love this one)
 
If the employees injury is designated as a catastrophic injury, the employee can draw indemnity benefits for life.
 
 
Death Benefits:
The burial expenses in Georgia are covered for a work-related death up to $7,500. 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 $500 per week, up to a maximum of 400 weeks, except there is a dollar maximum for death benefits in the amount of $150,000. If there is no spouse or dependent children (includes step children and adopted children), death benefits can be paid to dependent parents, college students and disabled adult children. (WCxKit)
 
 
Vocational Benefits:
Georgia workers compensation law also includes rehabilitation benefits / vocational benefits. If the injured employee is unable to return to their prior job due to disabilities from their on-the-job injury, Georgia requires the employer / insurance company to pay for the cost of retraining the injured employee to perform another job. In addition to job retraining, vocational benefits include:
 
9.      Vocational evaluation
10.Vocational counseling
11.Psychological testing and evaluation
12.Job analysis and job modification
13.Job placement
 
Vocational rehabilitation is in the best interest of the employer, the employee and the insurance company as placement in a new job reduces or eliminates the amount of TPD that will be paid, and stops the employee from making a claim for catastrophic indemnity benefits.
 

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:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

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.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Know the 2 Reasons Employees ELECT NOT to File Work Comp Claims

The question has been asked: Are there any situations where the employee might elect not to pursue a workers compensation claim or might not have a workers comp claim for a work related injury? The answer is yes. While it is not common for the employee to choose not to have a workers compensation claim, or does not have a workers comp claim by statute, it does happen.
1-Excluded People (no coverage)
When an employer does not meet the state's requirements for workers comp insurance, the employee might not have a workers comp claim.   For instance, in the states requiring employers with three or more employees to carry workers comp insurance, and the employer only has two employees, the injured employee would not be able to pursue a workers comp claim.
When the injured employee is the sole proprietor or a partner in the business, s/he will not be covered for a workers comp injury unless s/he buys a workers comp insurance policy on him/herself (which most sole proprietors do not do). (WCxKit)
Another instance where an employee might not be able to pursue a claim is in the states excluding farm laborers, seasonal workers, domestic servants, real estate agents and direct sellers from coverage under the workers comp statutes. When one of these type employees is injured on the job, they still have the right to bring a lawsuit against the employer if they believe the actions of the employer caused their injuries.
2-Pursuing a Tort Claim (want deeper pocket)
In the states where the workers comp insurer has full right to subrogation recovery, the employee will occasionally chose not to pursue the injury claim against the employer. An example of this would be the injury to the traveling salesperson resulting from an automobile accident. The third party was at fault and the accident occurred in a state where the employer controls the selection of the medical provider and the employer/insurer has full subrogation rights. 
An attorney representing the injured employee will often tell the employee they can get a much bigger settlement through the tort system than they can through workers comp. Instead of the employee being treated by the medical provider selected by the employer or the employer's insurance company, the employee is treated by a medical provider selected by the employee's attorney. 
The attorney, of course, is recommending the liberal medical provider who will keep the employee coming back for additional treatment for as long as the employee is willing to go to the doctor. The reasoning for this is simple, the longer the employee is off work and the higher the medical bills are, the greater the settlement the employee's attorney can demand from the insurer of the vehicle at fault in the auto accident. 
Another example of where an injured employee might want to opt out of filing a workers compensation claim is an injury on a construction site. On a large construction project you often find various subcontractors all working at the same time. This will often result in an employee getting injured due to the negligence of a third party. The employee again will have the choice between pursuing the claim for personal injury against the responsible party or filing a workers compensation injury claim. (Of course, in the states where the right of subrogation has been diminished or taken away from the workers comp insurers, the employee's attorney will often pursue both types of claims simultaneously).
A third example of where an employee might choose to pursue a tort claim rather than a workers comp claim is the delivery person who trips and falls on the defective sidewalk belonging to the business where s/he is making a delivery.   While a delivery person has the right to pursue a workers comp claim against the employer, the owner of the property where s/he fell has liability insurance, and the award s/he can collect on the tort claim will surpass what can be collected on a workers comp claim. (WCxKit)
Summary
While it is unusual for the employee to opt out of coverage for a workers comp claim, or for coverage not to apply to the work related injury, it does happen. The wise employer will know when this situation is occurring and keep in close contact with the employee in case the circumstances change.

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.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
WC Linked GROUP:  
http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
NEWSLETTER: Workers Comp Resource Center Newsletter

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.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Missouri Adds Online Fraud Reporting Tip Line

Efforts are on going to make sure all employers in the state play by the rules, Lawrence Rebman, director of the Missouri Department of Labor and Industrial Relations, noted in his July 2010 Director’s Spotlight column.
In every industry – not just those thought of as high-hazard – there are certain risks at the workplace. And an injury that renders a worker unable to do his or her job presents a serious financial strain on Missouri families. Missouri law recognizes this, and requires that injured employees be adequately compensated. This is the role of workers compensation insurance — to provide that important safety net for Missouri’s workforce.
Missouri law also requires every employer in the state with five or more employees to carry workers compensation coverage. And employers in the construction field must carry this coverage if they have one or more employees. (WCxKit)
The vast majority of Missouri employers follow the workers compensation law: they pay their premiums and keep their coverage up to date. But there are exceptions. Employers who do not comply with the law leave their employees in the cold when an accident occurs. This is wrong and illegal, and the Labor Department’s Division of Workers Compensation (DWC) is taking action.
So far this year, the DWC has referred 184 cases to the Attorney General’s Office, 80 more than last year at this time. These cases involved employers who either did not provide coverage or did not report the worker’s injury to the DWC. This reporting is required by law so that injured workers can be made aware of their rights. In 2009, 2,669 work-related injuries were never (WCxKitz) reported by an employer or insurer to the DWC; so far in 2010, this has happened 1,369 times.
In an attempt to stamp out this mistreatment of workers, the Labor Department has begun new efforts to make the workers compensation system more transparent and accountable.
First, we have created a new “Are You Covered?” online tool for our newly developed website at www.labor.mo.gov. This user-friendly tool allows users to access our workers compensation databases and check whether their employer carries coverage, and the effective dates of their policy. 
Second, we have modified our website to give the public an enhanced ability to report workers compensation fraud and noncompliance. The new feature on the website explains the various types of illegal conduct and allows users to report violators with the click of a mouse. (WCxKit)

We owe it to all workers in Missouri, as well as all of the good employers who play by the rules and cover their workers, to catch those who cheat the system.”

  \Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  Contact: Info@ReduceYourWorkersComp.com  or 860-553-6604.  
 
WC Calculator:  http://www.LowerWC.com/calculator.php
TD Calculator:  http://www.LowerWC.com/transitional-duty-cost-calculator.php 

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.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com 

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