Yes, you should always tell your doctor the complete truth about how you were injured, including discussing your work accident, even if your workers' compensation claim has been denied.

Why You Must Tell Your Doctor the Truth

• Accurate Medical Records: Your medical history must reflect the true cause of your injury so your doctor can provide the correct diagnosis and proper treatment plan.
• Challenging a Denial: If you decide to appeal the workers' compensation denial through the Virginia Workers' Compensation Commission, clear and consistent medical records that document the work-related cause of your injury are critical evidence for your case.

How to discuss a work accident and injury with a medical provider:

• Be Honest and Detailed: Clearly explain to your treating physician treating physician exactly how the workplace accident occurred and specify which job duties caused or aggravated your condition.
• If the insurer denied your workers’ compensation claim, and the Commission needs to make a determination on whether that denial was valid, explain that to your doctor’s office. You may need to use your private health insurance to cover medical care in the meantime.
• No workers’ compensation case is stronger than the medical records that form its underpinnings. In any case, especially an insurer denied claim, an incredibly important rule is to maintain regular, consistent, ongoing treatment for your injuries and use whatever insurance you have to obtain treatment. The Workers’ Compensation judge or Deputy Commissioner will review those records and rely upon them, in part, to decide the case, which is why the work accident must be disclosed. Allow the Workers’ Compensation Commission to determine if treatment should have paid through the workers’ compensation carrier. If you win, the medical provider can reverse bill your private carrier and accept the workers’ compensation coverage.

Emphatically, “yes.” Unless a claim is filed, and an award order entered, the insurance carrier's payment of wage loss and medical benefits is purely voluntary. The insurer can choose to approve benefits or not to do so. Legally nothing can be done to force them to take care of an injured worker and no penalties will be assessed if they fail to do so. This means if the insurance carrier decides not to approve benefits, the entire weight of not being able to work, or only being able to work in a reduced capacity, and the cost of all medical bills associated with treating that injury is shouldered by the injured worker.

Some workers are concerned that filing a workers’ compensation claim is somehow unethical or that they have concerns that filing a claim is the same as suing their employer. While this thought is understandable, it is arises from an incorrect assumption about the Workers’ Compensation system. It is important to understand that in most cases a Workers’ Compensation Claim is filed against insurance company representing the employer—not the employer themselves. Sometimes, the employer even wants to do the right thing and use the policy to take care of an injured worker, and the insurance adjuster will not comply.

While the filing of a claim may make an employer’s insurance premium increase, it is important for a injured worker to keep their focus upon how their injury has effected their ability to work and the cost of the medical care required to treat their injury. Remember, VA, in many cases, has removed the ability of an injured worker to sue their employer for a work place injury. Additionally, there is limited time to file a Workers’ Compensation claim before an injured worker is prevented from doing so. After the time has elapsed to file a claim, all the medical expenses and fall out of not being able to work solely becomes the responsibility of the injured worker. This could very well lead to bankruptcy and financial ruin of the injured work and his or her family. It is far better, therefore, to file a Workers’ Compensation claim to protect your rights and prevent financial ruin.

In the Commonwealth of VA, every employer who hires 3 or more employees, and those employees are in regular service in VA, must have workers’ compensation coverage. Significant fines and penalties are assessed against an employer who is required to have workers’ compensation insurance, fails to have the required coverage, and has an employee who is injured in a work related accident. It is essentially an insurance plan that covers employees in the event of an accident. This is why a workers’ compensation claim is not truly filed against the employer, but really against the insurance company the employer has contracted with.

An Award Order is a judicial order—recognition by the VA Workers’ Compensation Commission—that an injury is protected under the Workers’ Compensation Act. An award order is critically important as it is what places the Workers’ Compensation insurance company on the hook for providing an injured worker with life time medical care and wage loss benefits during the period of complete or partial disability. If an award order is not in place, an insurance adjuster’s willingness to approve medical care and pay wage loss benefits is strictly voluntary. He or She can decide to take care of an injured worker or not, and choosing not to provide medicals and wage loss benefits is not illegal. Once an award order is in place, however, fines and penalties can be assessed against the insurance company for failure to provide medical care and wage loss benefits to an injured worker.

This is a question we very commonly receive. The simple answer is that an employer who fires an employee for filing a workers’ compensation claim, in good faith, opens the door to a serious employment law case for wrongful termination. It is illegal for an employer to fire an employee for exercising their statutory rights, and filing a Workers’ Compensation claim.

Now, all that being said, Virginia is a right to work state. This means an employer could theoretically fire someone if that employer does not like the color of an employee’s shoes. This also means an employer could legally dismiss an employee who was no longer able to do their job as a result of being injured on the job.

What this means is that filing a claim should legally have no effect upon your status with your employer. Either they can provide you a light duty job after your accident or dismiss you because there is no light duty. What they cannot do is terminate you for filing a claim.

First, WHILE THE COMMISSION WILL ALLOW AN INJURED WORKER TO REPRESENT THEMSELVES (A PRO SE CLAIMANT) – it highly recommended that an injured worker has their own attorney well before a hearing begins. The insurance company will have their own attorney, you can rest assured, and an injured worker should have theirs to assist with navigating the complex intricacies of a hearing.

What is a Hearing?
A hearing is scheduled because there is a legal dispute regarding your claim that you and the insurance company cannot resolve on your own.

It means the employer or their insurance carrier has denied all or a specific part of your claim—such as your eligibility for benefits, wage amounts, or specific medical treatments—requiring the Virginia Workers’ Compensation Commission (WCC) to step in and make a formal decision.

Here is what you need to know about why this is happening and what to expect on the day of your hearing.

Why Do I Have a Hearing?
When you file a claim and the insurance carrier refuses to pay, the case is referred to the hearing docket. A Deputy Commissioner (who acts as the administrative judge) is assigned to review the facts and resolve the dispute, an evidentiary hearing (a formal, in-person or virtual proceeding where testimony is taken) is scheduled.

What to Expect at an Evidentiary Hearing
If you have a formal evidentiary hearing scheduled, it functions like a "mini trial" but is generally less strict than regular courtroom trials.

• The Setup: There is no jury. The hearing is presided over by the Deputy Commissioner, and a court official will record or transcribe the proceeding. You, your attorney (if you have one), and the insurance company's defense lawyer will all be present.
• The Timeframe: While standard slots are often blocked out briefly, the hearing itself will last for 30 minutes. If the parties advise the Commission multiple witnesses will be called, a hearing can be extended to up to two or more hours if needed.
• Your Testimony: You will be placed under oath to tell the truth. Your attorney will ask you direct questions about how the injury happened, your current medical symptoms, your limitations, and your employment history. Afterward, the insurance company’s lawyer has the right to cross-examine you.
• Relaxed Rules of Evidence: All medical records, doctor statements, and work slips, are submitted before the hearing begins, while other evidence—work search logs for example—are usually introduced into evidence during the course of the hearing. Unless the Commission is notified in advance, the Deputy Commissioner will typically not accept new medical documents after the record closes. Live doctors rarely testify; their opinions are submitted via written reports or pre-hearing depositions.
• Witnesses: If you have coworkers or bystanders who saw the accident, they must testify live and in person or arrangements must be made to take a witness’ de bene esse deposition ahead of the hearing, with the transcript being entered into evidence before the hearing begins. Written letters from witnesses are not allowed.

When Will You Get a Decision?
The Deputy Commissioner will not give you a decision on the day of the hearing. Instead, they will review the transcribed testimony, medical records, and other evidence before mailing a written Judicial Opinion to both sides. The Commission strives to have hearing decisions out within 21 days, but it can take longer. If either side disagrees with the decision, it can be appealed to the Full Commission within 30 days of the decision.

This is the first error many injured workers make, simply accepting the doctor their employer or insurance adjuster wants them to see.

The unfortunate truth is that not are all doctors are equal; some are better for an injured worker than another, and some are more insurance company friendly. The Workers’ Compensation Commission recognizes this and as a result the prevailing law is that “an employer or insurance company” cannot medically manage an injured workers’ medical care.

The “rub,” however, is that once treatment from a physician is accepted—regardless of how an injured worker gets there—and a treating relationship has been established (in many cases this may occur in just a couple of visits) the Workers’ Compensation Commission then recognizes that physician as the authorized treating physician. The authorized treating physician enjoys a very special status with the Workers’ Compensation Commission. This becomes the sole doctor--and any referrals that doctor makes--whose medical treatment the insurance carrier must make payment. In most cases, the opinion of the authorized treating physician also is given the most amount of weight when the Commission decides a case. Often the outcome of a case hinges upon their opinion. While a change in treating physician is possible, it is in most cases very difficult without the insurance adjuster’s consent. For this reason, the choice of treating physician is a very important decision, and it should only be made after careful contemplation of which doctor is the best for an injured worker.

To combat being sent to a physician,“friendly” to the insurance company, the Workers’ Compensation Commission requires that if medical care is authorized by the employer or insurance company that an injured worker be provided with a panel of 3 doctors from which to choose. A valid panel must be comprised of doctors from different practices, who are specialists in the field of the injury, and are within a reasonable distance from the home of the injured worker. If medical care for your injury has been authorized, it is the responsibility of the injured worker to request a medical panel and not simply accept the doctor his or her employer wishes that worker to see. This also applies to any referrals an authorized treating physician makes. If a referral does not direct an injured worker to a specific provider, the insurance carrier must provide a valid panel to the injured worker from which to choose.

If, however, the claim has been denied or insurance company refuses to issue a panel of medical providers, the injured worker is free to choose any doctor as their authorized treating physician. If the insurer then refuses to pay for those medical visits, reimbursement of medical expenditures related to the work place accident and injury can be pursued before the Commission.