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How Does Workers’ Compensation Decide Who To Pay?

While you have bills stacking up on your kitchen table and medical expenses hanging over your head, you’re worried about your Virginia workers’ comp claim. That’s a fair reason to worry. While you’re healthy, it seems like workers’ comp will always be there for you in reality, that couldn’t be further from the truth.

Workers’ comp is private insurance through your employer that has a back-up office through the government for appeals. Basically, your employer’s insurance can fight any claim and continue to fight claims until the State of Virginia tells them to pay up.

Why is there a Government Office for a Private Insurance Claim?

The Virginia Workers’ Compensation Commission exists to protect employees when a private workers’ compensation insurance has failed them. However, it does extend some protection to the insurance companies as well to protect them against fraudulent claims.

The VWCC does their best to ensure that employers that should have the proper insurance do. They will intervene in many situations or claims. Usually, the VWCC won’t get involved until you file a claim that your employer does not carry the necessary insurance. Or, in the event that your claim received a denial and you need to file an appeal.

How Does My Employer’s Insurance Decide How Much To Pay Me?

How the process should go is something like:

  • Experience an injury
  • Seek immediate medical attention and alert your employer
  • File a report of injury
  • Receive notifications of your rights
  • Receive benefits or denial

Your workers’ compensation insurance will evaluate your medical costs and may take into account some of your time lost at work. Lost wages are a difficult aspect to consider, as you may receive temporary disability benefits or have other avenues to cover your lost wages.

Can I Argue for More Compensation?

You can appeal a denied claim, and you can state that your insurances’ settlement is not sufficient. That said it would require you to deny the settlement offer and file an appeal. When doing this, you will need an attorney on your side to explain why you denied the initial offer. However, the insurance company will always strive to cover their needs first. Usually, that means shortchanging claims or denying them whenever it’s possible.

One of the tactics that insurance may attempt to use is the quick-settlement option. In these cases, you may receive a settlement check right away. Usually, people are very happy to take these checks and cash them, which may waive their right to further compensation.

However, you should not cash these right away. Instead, consult with a Virginia workers’ comp attorney and see if this amount accurately reflects the expenses you had associated with your injury.

What Will Happen During Appeals?

When you file for an appeal with the VWCC, you will technically only request a hearing. Then you and the involved insurance company will go into voluntary mediation. You should not start this process without consulting a Virginia workers’ compensation attorney. Only with proper legal guidance can you understand how to navigate these waters.

You may reach a complete agreement during voluntary mediation. Otherwise, you may need to move forward and seek the help of an administrative judge. An administrative judge will act to make a decision based on the evidence of both sides. While it is on you to show your expenses, it is on the employer to justify any reason for not providing full compensation.

Many employers will argue that there was no cause for a claim because the injury either did not come from the job or was a result of failure to follow policy. Workers’ compensation attorneys are all too familiar with these claims. An attorney can help you present gaps between policy and actual procedure and the dangers within your workplace. Always rely on expert legal advice when handling a workers’ compensation appeal.

Contact a Virginia Workers’ Comp Lawyer

A Virginia workers’ comp lawyer can make all the difference in your case. Working through your claim alone can be confusing and frustrating. Don’t let an insurance company get you swept up in getting the fastest settlement possible. Or, let them ambush you with questions and allegations about how you may be faking an injury.

Handle your workers’ compensation claim quickly and with precision. Deliver the medical evidence and your bills so you can show what you need in full demand.

Contact Ashcraft & Gerel for guidance and legal assistance with your Virginia workers’ comp claim, and appeals. Get the help that you require.

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