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What to Expect When Your Virginia Workers’ Comp Claim is Denied

The workers’ comp system in Virginia provides legal protection for workers who sustained injuries on the job or suffer job-related conditions. Usually, injured employees are entitled to medical benefits and lost wages reimbursements as they recover from their injuries. Also, workers who suffer from temporary or permanent disabilities may be eligible for wage replacement, lifetime medical care, financial protection, and other kinds of benefits. But getting such benefits can be challenging. The process usually takes time and claims can get denied by insurance providers. However, claim denial is not the end. An injured worker can fight back and still get the compensation they deserve. By working with an experienced Virginia injured at work attorney, they can appeal the denial and get a better chance at getting the benefits due to them. 

Reasons Your Claim Can Be Denied

Workers’ comp insurance providers may deny claims if the injured employee did not notify their employer regarding the workplace accident and their injury. Under the law, injured workers must give written notice to their employer within thirty days from the date of their injury or lose their right to get workers’ comp benefits. A claim can also be denied if the employee did not file their claim before the time limits specified by the law. In Virginia, they have two years from the date they got injured to file their claim. 

If the worker fails to prove that their injury is work-related, their claim can also be denied. The workers’ comp system in Virginia only provides coverage for injuries sustained within the scope of the workers’ work duties. Other reasons for denial include unqualified employment classification, a pre-existing condition, and a refusal of the worker t cooperate with the insurer’s investigator. 

What to Do After Your Claim Has Been Denied

After the insurance company has denied your claim, you must follow some steps to make sure you get the best outcome possible. First, you need to file a claim form with the Virginia Workers’ Compensation Commission and then request a hearing. A deputy commission will decide your case during the hearing. They will evaluate the documents and testimony presented. If the commission denies your claim, you can accept the claim denial, file a motion for reconsideration, or request a review by the Commission. Usually, the third option is the best bet. In this case, the Commission will ask for written statements or schedule an oral argument. 

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