What to Do If Your Virginia Workers’ Compensation Claim Is Denied

Getting hurt at work can be stressful enough. When your Virginia workers’ compensation claim is denied, that stress can quickly turn into frustration. While many injured workers assume that a denial means that they’re simply out of luck, many claim denials can be successfully challenged.

It is possible to file an appeal of a claim denial with the Virginia Workers’ Compensation Commission (VWC). An experienced Virginia workers’ comp attorney can help you draft the necessary paperwork and gather evidence and will represent you at a hearing.  Our law firm is adept at handling appeals and at successfully negotiating settlements on behalf of our clients.

Based in Virginia Beach, Poole, Brooke, Plumlee advocates for clients throughout Virginia in workers’ compensation matters. We can assist you with your initial filing through appeals and a final resolution of your claim. Reach out to our law firm today to schedule a free initial consultation with a Virginia workers’ compensation lawyer.

Understand Why Your Claim Was Denied

The Virginia workers’ compensation system is designed to provide benefits to employees who are injured on the job, regardless of fault. If you are hurt at work or develop an occupational illness, you may be able to access benefits such as medical treatment, partial wage replacement, and temporary or permanent disability benefits. In exchange for these benefits, injured workers typically cannot sue their employers directly.

A no-fault system does not necessarily mean that employers automatically pay workers’ compensation benefits without questioning or challenging any aspect of a claim. There are strict rules for workers’ comp claims, and employers often use these rules to their advantage. This may lead to a claim denial.

If your Virginia workers’ compensation claim has been denied, the first step is to understand exactly why it was denied. There are many possible reasons for a denial, such as:

• Failure to report the injury on time: In Virginia, injured workers must notify their employers of a work injury within 30 days, or 60 days from when an occupational disease is communicated. Injured workers then must file a formal claim with the VWC within 2 years of the date of the injury. Missing either deadline can be grounds for an automatic denial.
• Employer disputes that the injury is work-related: An employer or insurance company may argue that an employee’s injury was unrelated to their job duties, occurred during a break, or happened outside of work. To qualify for benefits, an injury or occupational illness must arise “out of and in the course of employment.” 
• Pre-existing conditions: In some cases, an insurer will argue that an injury is related to a pre-existing condition instead of a workplace incident. A pre-existing condition does not automatically disqualify a claim, but it may require more evidence to show that work aggravated or worsened the condition.
• Lack of medical evidence: Workers’ compensation claims are heavily reliant on medical documentation. An employer may deny a claim if a worker delayed seeking treatment, a doctor does not clearly connect the injury to work, or medical records are incomplete.
• Failure to seek treatment from an approved provider: In Virginia, employers typically have the right to choose treating physicians from a panel of approved doctors. Workers who seek treatment outside of this panel may jeopardize their claim.
• Allegations of misconduct: Workers’ compensation does not cover injuries related to alcohol or drug use, willful misconduct, or horseplay. This may be the basis for a denial if there is evidence to support these allegations.

The denial notice should state the specific reason for the denial and whether the denial came from the employer, the insurance carrier, or the VWC. Once you know why your claim was denied, you can decide how to respond. If you are unsure of your rights or want to know your options, you should schedule a no-cost consultation with a Virginia workers’ compensation attorney.

File an Appeal with the Virginia Workers’ Compensation Commission

A denial is not necessarily final. In Virginia, you have a right to appeal a denied workers’ compensation claim. While doing so, you should continue medical care and document everything related to your injury.

If your claim was denied by your employer or its insurance company, you can file a formal claim with the VWC. This should be done with the help of an experienced Virginia workers’ comp lawyer. They can help you fill out the correct paperwork, draft a detailed explanation of your case, and gather supporting documentation to prove your case. An appeal must be filed within 2 years of the date that you first received notice of a claim denial.

Typically, you will be required to go to a hearing before the VWC. During the hearing, your attorney will present evidence, question witnesses, and make arguments. Your lawyer will also help to draw the connection between your injury and your job.

During the appeals process, your lawyer will likely also attempt to negotiate a settlement with your employer. An appeal can take time and is often stressful. Negotiating a fair settlement can be a faster way to get just compensation for your injuries, medical expenses, and lost wages. 

Our Virginia workers’ compensation attorneys are skilled at negotiating settlements on behalf of our clients. We can also represent you in a hearing if your employer refuses to offer you the benefits that you deserve for your work injury. Throughout the process, we will advocate for your rights while fighting to get you benefits.

Experienced Legal Representation for Virginia Workers’ Compensation Appeals

If your Virginia workers’ comp claim has been denied, that is not the end of the road. You can potentially file an appeal with the VWC to get the benefits that you are entitled to under Virginia law. Our experienced Virginia workers’ comp lawyers can help you with the process.

Poole, Brooke, Plumlee represents injured workers in Virginia through all stages of workers’ compensation claims, including appeals. We understand that being hurt at work can be incredibly stressful, and we work hard to help our clients get the benefits that they need to fully recover from their injuries. To schedule a no-cost consultation with a member of our legal team, give us a call at 757-499-1841 or fill out our online contact form to talk to a Virginia Beach workers’ compensation attorney.