You have an injury on the job and have received medical care but then the Workers Compensation Insurance Company turns down your claim. What can you do?
First, you need to find out if your employer filed an accident report with the insurance company and the Virginia Workers' Compensation Commission. If so, what was on it? Did it accurately relate an accident at work that occurred at a specific date and time? You can call the Commission at 1-877-664-2566 and check to see if the accident report was filed.
Second, did your treating doctor provide the insurance company with a medical report stating (1) you had an accident (2) this accident resulted in an injury (3) the diagnosis of the injury, for example, back strain and (4) that you are out of work for a number of days or weeks due to this injury. You can obtain the Attending Physician Report Form at the Commission website at http://www.vwc.state.va.us.
Third, when the insurance company called to take down your recorded statement, what did you say? If you said I don't recall when I was injured, or I don't recall when I first felt the "pain in my back," or I didn't have any problem at work and only had some pain when I got home, then this may be the reason why your claim is denied. You must specifically (1) relate an accident; (2) state you were at work; (3) relate your symptoms to this accident; and (4) have a doctor's note that relates your symptoms to this accident.
Fourth, the "denial letter" from the insurance adjuster will probably only say "your accident is not compensable under the Virginia Workers' Compensation Act." Of course, this is not enough information to know why your claim is denied. However, if you review the above information you may detect why it is being denied.
Fifth, if you have filed a Claim for Benefits for your injury with the Virginia Workers Compensation Commission, then the Commission will sent our a 20 day letter requesting the insurance company to respond in 20 days either accepting the claim or explaining why it is being denied. The Commission does require the insurance company to specify on its response why the claim is being denied.
Sixth, in the case of a "severe injury" at work that has been denied, you should seek the advice of an experienced workers compensation attorney as soon as possible. Finally, claimants need to be aware that attorneys specialize like doctors. Thus, one should not just consult any attorney but preferably consult one who specializes in Virginia workers' compensation law.
This may be considered AN ADVERTISEMENT or Advertising Material under the Rules of Professional Conduct governing lawyers in Virginia. This note is designed for general information only. The information presented in this note should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.
Gerald G. Lutkenhaus--has been doing workers compensation in Virginia for over 30 years. In the July 1999 issue of Richmond Magazine he was rated one of the Best Attorneys for Workers Compensation in Central Virginia. In 2003 he was giving the rating of AV by Martindale Hubbell.
You can get more information from http://www.virginiadisabilitylawyer.com or http://www.geraldlutkenhaus.com