Virginia Workers Comp FAQs

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.

Your employer cannot legally fire you for reporting a workplace accident or filing a valid workers' compensation claim. That is illegal retaliation under Virginia law. But Virginia is an at-will employment state, so being under a doctor's care does not protect your job: an employer can still let you go for other legitimate reasons, such as having no light duty work that fits your restrictions. Being fired doesn't automatically end your benefits.

Read more: Can I Be Fired for Filing a Workers' Comp Claim in Virginia?

It may well be real. Workers' compensation insurance companies sometimes hire private investigators to follow and video injured workers, and in most cases this is legal. They're looking for evidence that you're less injured than claimed, or doing more than your light duty restrictions allow.

If you suspect you're being watched, call your workers' compensation attorney, and don't confront the person. The best protection is simple: follow your doctor's restrictions completely, and don't do anything you wouldn't want your doctor to see.

Read more: Is Someone Following Me? Insurance Surveillance in Virginia Workers' Comp Claims

The short answer is, “yes.” In fact, J. Aaron Thomas has recovered several million dollars in combined settlement money for his clients over the course of his career. In the event an injured worker is interested in settling their case, Thomas & Thomas will conduct a settlement analysis of the case and will discuss with the injured worker what a settlement demand might look like. If the injured worker agrees with the proposed settlement demand, Thomas & Thomas will then work on obtaining the maximum settlement value for the injured worker. It is important to remember that being interested in settling a case does not obligate an injured worker to settle. It only means that if the insurance adjuster offers an amount that is pleasing to the injured worker the case can then settle. If the offered amount never arises to the level that satisfies the injured worker, the injured worker simply says, “no thank you,” and the case proceeds along its natural course. If Thomas & Thomas, however, is successful in settling the case, the Workers’ Compensation Commission provides 20% of the lump sum settlement to Thomas & Thomas. This is an excellent value, as personal injury attorneys routinely receive 33.3% of any settlement money they recover.

It depends on how the injury happened. If you can point to a specific moment, such as a sharp pop or sudden pain while lifting one particular item, it can be a covered injury by accident. If the injury came from gradual wear and tear with no single event, such as waking up the next morning with a bad back, Virginia generally won't cover it unless an exception applies. Note the exact moment, report it right away, and speak with an attorney before discussing it with the insurance company.

Read more: Hurt From Heavy Lifting at Work? When Virginia Workers' Comp Covers It

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.

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.

Usually not. Virginia follows the "coming and going rule," so accidents during your normal commute generally aren't covered, because you aren't yet doing work for your employer. But there are important exceptions, including a company vehicle, paid travel time, an errand for your boss, an accident on the employer's parking lot or only entrance, and jobs where travel is a core duty. If you were hurt on the way to or from work, contact us before you speak with the insurance company.

Read more: Hurt Driving to or From Work? Virginia's Coming and Going Rule Explained

Yes, but how hard it is depends on how it developed. If a sudden workplace accident caused it, it's treated like any other work injury. If it developed gradually from repetitive work, Virginia treats it as an "ordinary disease of life," and you must prove it by clear and convincing evidence, a much higher standard. That usually means a specific diagnosis, a doctor's written opinion that your job was the primary cause, and proof it didn't come from hobbies or other causes. Contact us before speaking with the insurance company.

Read more: Is Carpal Tunnel Covered by Workers' Comp in Virginia?

Often, yes. The choice of where to file belongs to you, not your employer, and an employment contract can't take away Virginia jurisdiction when Virginia law provides it. If you were hurt in Virginia, or your job is rooted here (hired here, with an employer that has a place of business here), you may have a Virginia claim even for an out-of-state accident. When more than one state has jurisdiction, you can often pick the state with better benefits.

Read more: Hurt Out of State? When You Can File for Virginia Workers' Comp

No, you should not immediately jump on the phone with a Virginia workers' compensation insurance adjuster right after getting injured.

While you must eventually cooperate with the claim process, rushing into an unguided phone call—especially before seeking medical care or understanding your rights—can inadvertently harm your claim.

The insurance adjuster works for the insurance company and your employer, not you, and their primary professional objective is to minimize payouts and control costs. Often, they look for reasons to deny claims, not approve them.

The Danger of the "Initial Phone Call"
When an adjuster calls you shortly after an accident, their primary goal is often to obtain a recorded statement.

• The Trap: Adjusters are highly trained to ask questions that will cause a claim to be denied and will create evidentiary issues later on if the Workers’ Compensation Commission needs to make a decision on the claim.
• The Risk: In Virginia, not all workplace injuries are covered (for example, the injury must stem from a specific, identifiable accident, not repetitive trauma). A minor misstatement, speculation about how the injury happened, or failing to list a specific hurting body part during a stressful first phone call can be used to deny or severely limit your benefits later.

How to Handle the Adjuster Safely
If the adjuster contacts you before you are prepared or before you have legal representation:

• Be polite but advise you are not ready to discuss your claim. Do Not Give a Recorded Statement: Politely decline to be recorded on the spot and are not prepared to give a detailed statement yet.
• Consult an Attorney First: It is highly recommended to speak with a qualified Virginia workers' compensation lawyer before giving detailed structural accounts of the injury. If you hire an attorney, the adjuster is legally barred from contacting you directly and must go through your counsel.

Critical Steps to Take First – WE ALWAYS RECOMMEND SPEAKING WITH A WORKERS’ COMPENSATION ATTORNEY AS SOON AS IS POSSIBLE FOLLOWING A WORK ACCIDENT. You must remember that filing a workers’ compensation may cause your employer’s insurance rate to increase. Consequently, some employers have a vested interested in shutting down a workers’ compensation claim before one is filed. If you find yourself not calling a workers’ compensation attorney immediately after your work accident—ensure you have handled these critical legal and medical steps required by the Virginia Workers' Compensation Commission: A. Report the Injury to Your Employer: You must notify your employer about the accident as soon as possible to preserve your right to benefits. We recommend creating a paper trail, when reporting. Confirm it in an email or text to your employer, so your employer cannot deny you ever reported the accident. B. Request a Physician Panel: In Virginia, your employer is legally required to provide you with a panel of at least three medical providers to choose from for your ongoing care. C. Seek Medical Attention: Go to an emergency care facility or panel doctor immediately. Explicitly state that your injury occurred at work so it is properly documented in your medical records. D. File a claim for benefits with the VA Workers’ Compensation Commission as soon as is possible. Filing a claim with your employer’s insurance company IS NOT THE SAME THING as filing a claim with the VA Workers’ Compensation Commission. The later, filing the claim with the Commission, is what will determine your legal rights.

No. Reporting your injury and dealing with your employer's insurance company can get your medical care and checks started, but only a formal Claim Form filed with the Virginia Workers' Compensation Commission legally protects your rights. You must file it within two years of the accident. If you don't, the insurer can stop paying, and you may lose the right to force them to pay. File with the Commission even if the insurance company seems cooperative.

Read more: Insurance Claim vs. Commission Claim: Why Filing With the Virginia Workers' Comp Commission Matters

Yes, you must know what caused your workplace accident to qualify for workers' compensation benefits in Virginia.

Virginia law is notoriously strict regarding the burden of proof for injuries. It follows the "actual risk" test, meaning your injury must arise from a specific hazard or risk, ‘a risk peculiar to the employment,’ that is related to your employment.

An accident suffered by simply being "on the clock" or getting hurt at the physical workplace is not enough to get your claim approved.

In other words, The VA General Assembly writes the criteria that a work accident must meet for workers’ compensation coverage. If a workplace accident does not meet that criteria, it is rejected for coverage. An unexplained accident, therefore, faces significant resistance, as the injured worker is unable to explain why their accident is one that occurred to a risk unique to their workplace environment.

The Danger of the "Unexplained Fall"
If you suffer a slip, trip, or fall but cannot point to the exact cause, unless the Commission accepts circumstantial evidence to explain why the accident occurred, it would exceptionally difficult for an injured worker to prove their accident occurred to a risk peculiar to their employment.

You must be able to identify a specific work-related factor or condition that contributed to the incident. Examples include:

• Tripping over a piece of equipment or an uneven floorboard.
• Slipping on wet surfaces, oil, or debris.
• Being struck or losing your balance by a falling item.

A Cause Based System –Not a Fault Based System

It is vital to distinguish between fault and cause:

• • Workers' compensation in Virginia is a no-fault system. You do not need to prove your employer was negligent, and you can still receive benefits even if your own minor mistake, carelessness, or clumsiness caused the accident—as long as your accident did not occur due to willfully violating a known and enforced workplace safety rule.
  • While VA, generally speaking is not concerned with fault when it comes to workers’ compensation coverage, an injured worker must establish the environmental or situational cause to prove the injury "arose out of" your employment.

Exceptions: very rare cases—such as if a worker is found dead at the scene and cannot testify—the Virginia Workers' Compensation Commission may allow a legal presumption or look strictly at heavy circumstantial evidence to deduce a work-related cause.

But for a typical injury where you remain conscious, you are fully expected to identify what happened.

Not automatically, but expect the insurance company to scrutinize your claim closely. You're entitled to benefits if a workplace accident aggravates, accelerates or worsens a pre-existing condition, or causes a new injury to a body part that had fully healed. But pain alone isn't enough: your medical records must show what actually changed, such as new swelling, a new sprain or an enlarged disc herniation. Tell your doctor your full history and ask them to document exactly what the work accident changed.

Read more: Reinjured an Old Injury at Work? Virginia Workers' Comp and Pre-Existing Conditions

In Virginia, you must report a work injury to your employer in writing within 30 days of the accident. While 30 days is the strict legal deadline, you should notify your supervisor as soon as possible. Some employers have internal policies requesting notice within 24 hours. While missing an internal company deadline cannot legally bar you from workers' compensation benefits, if you are within the 30-day window, it can result in termination from your employer. Your employer then can argue ‘termination for cause,’ which could prevent you from getting certain types of workers’ compensation benefits. Key Steps and Timelines for Virginia Workers' Compensation Notify the Employer: Give written notice to your supervisor, as soon as is possible—within minutes of the event if you are able. While the law provides 30 days, waiting beyond the day it occurred will likely result in the insurance company denying the claim. A hearing will then be required to decide whether the claim is covered. Waiting beyond the work shift, where the accident occurred, to report the accident, provides the insurance company with footing to argue your injury occurred due to something other than the work accident. We highly recommend notice is made verbally and by an email or text to your employer, so your employer cannot later deny the accident was reported. Demand to file an accident report with your employer and retain a copy for yourself for this very reason. Employer's Obligation: Once you report the injury, your employer must file a First Report of Injury (FROI) with the Virginia Workers' Compensation Commission (VWCC). CAUTION: Formal Claim Deadline: Reporting the injury to your boss is not the same as filing a formal claim with the Commission. You must separately file an official claim with the VWCC within 2 years of the date of the accident to preserve your legal rights.

The answer is it depends. Generally speaking, when you settle a Virginia workers’ compensation case, you generally enter into a voluntary agreement to completely close your case for one-time lump sum payment of money.

The settlement agreement, however, controls what is actually settled. Generally speaking, and most frequently, we see the following types of settlement (these are generalized descriptions for a basic understanding and they do not explain all the complexities involved in each. Please contact us for a free consultation to discuss which is a better fit for your situation):

1. The case can be settled with the insurer paying out just a lump sum of money and covering no medical bills;

2. The case can be settled with the insurer paying you a lump sum of money and agree to cover your medical bills for a limited period of time, with the coverage of new medical treatment ending most commonly on the day the Commission approves the settlement.

3. A settlement is only for one aspect of the claim—for example for compensation only—keeping the insurer responsible for all medical treatment going forward.

4. A settlement, where the injured worker is on Medicare, and the insurance company agrees to pay out a lump sum of money to close out future, past, and present compensation entitlement and a separate medical account, limiting Medicare’s responsibility to pay for future medical expenditures related to the workplace accident.

In Virginia, the settlement process yields concrete long-term legal and financial results. The consequences of settling your case depend entirely on the structure of the agreement and how it impacts your future rights:

Your Right to Future Benefits Ends (In Most Cases)

• Giving up rights: You take a lump-sum payment or a structured payout in exchange for completely giving up your right to any future wage-loss benefits, permanent disability payments, or medical care related to that injury.
• No reopening: Once the settlement is finalized, you cannot reopen your claim or ask for more money later—even if your medical condition unexpectedly worsens.

The Legal Process Requirements
A settlement in Virginia is not officially binding just because you and the insurance adjuster shook hands or signed a contract.

Commission Approval: All settlement paperwork and medical records must be submitted to the Virginia Workers' Compensation Commission for review. The Commission must officially approve the agreement to ensure it is fair.

The Approval Timeline: It typically takes a few weeks for the Commission to approve the settlement and issue an Approved Order. It can take longer if the Commission issues a technical request, meaning something more is needed before the settlement can be approved.

The Payment Timeline: After the Commission issues the Approved Order, the insurance carrier legally has 44 days to mail or issue your settlement check.

** If, however, the insurance carrier places your settlement check into the mail on day 45, following the Commission’s approved Order, that payment is late and the insurance company may very well owe you an additional 20% on top of the settlement.

Financial Realities and Hidden Costs

• • Tax-Free Status: Under state and federal law, your workers’ compensation settlement funds are 100% tax-free.
  • Past Medical Bills: The insurance company may still be responsible for medical bills incurred before the settlement date, if that was part of the settlement agreement. But the insurance company may not seek out those bills. If you receive a medical bill for treatment rendered before the Commission’s approved Order—you must provide it to the insurance company to be paid.
  • Third-Party Liens: If private health insurance paid for your medical treatment, rather than worker’ compensation, if that private insurance policy arose under Federal ERISA law the private carrier may have a lien against your workers’ compensation settlement proceeds for what was paid on your treatment.

We recommend you consult with a workers’ compensation attorney immediately if an insurance company has offered you a settlement and you are unrepresented to discuss how the settlement may affect your legal rights.

As most things in law, the answer is ‘it depends.’ Most of the time, the answer would be no. In the case of settlement, usually there is only one attorney’s fee, awarded by the Commission. At that point, the prior attorney and the current attorney will decide how that awarded fee is split. Where things can get a little complicated is when the prior attorney was already awarded an attorney’s fee by the Commission for past work but did not collect that attorney’s fee before being discharged as the representing attorney. That unpaid attorney’s fee could become part of the prior attorney’s lien against their client’s ongoing case. When confronted with such a situation, our firm seeks to consider and calculate such a lien into the fee split, after there has been a full and final settlement on a case.

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.

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.

A Virginia Workers' Compensation Full and Final Mediation is a voluntary, confidential, and free dispute resolution process where the injured worker and the employer (or insurance carrier) attempt to permanently resolve the entire workers' compensation claim in exchange for a lump-sum settlement.

Facilitated by the Virginia Workers' Compensation Commission's Alternative Dispute Resolution (ADR) department. If a settlement reached, the final settlement Order, generally speaking, closes the case forever. By accepting a full and final settlement, and having the Commission enter the settlement Order, the injured worker gives up all future rights to benefits, including lifetime medical coverage and wage loss payments, in exchange for the agreed-upon payout.

Characteristics of Full and Final Mediation

• • Mandatory Legal Representation: Unlike standard "Issue Mediations" (which resolve smaller, isolated disputes), the Commission strictly requires the injured worker to be represented by an attorney to participate in a Full and Final Mediation.
  • Voluntary and Non-Binding: No one can force either party to mediate or accept a settlement. If the parties cannot reach a mutually agreeable dollar amount, the worker retains their full right to an official judicial hearing.
  • Structure and Duration: These sessions are typically scheduled for 3 hours and are led by a trained, neutral Commission mediator. The mediator does not judge the case or force a decision but rather helps both sides negotiate.
  • Final Approval: If an agreement is reached, it must be drafted into a written compromise settlement agreement and formally submitted to the Commission for final approval before it becomes legally binding.

Not automatically. It depends on whether you have an open award from the Commission. With an open award, your benefits should continue if your employer has no light duty for you. Without one, Virginia law requires you to look for suitable light duty work elsewhere: at least five job contacts every week, spread through the week and recorded in a written log. Each week you document five valid searches is a week you can be paid. The same rule applies if you're working light duty but earning less than before.

Read more: No Light Duty Available? Your Virginia Workers' Comp Job Search Requirements

Don't simply accept your employer's or adjuster's doctor. If medical care is authorized, you're entitled to a panel of three doctors to choose from, so ask for one. Choose carefully: after a few visits, that doctor becomes your authorized treating physician, whose opinion carries the most weight, and changing later is difficult. Usually it takes a referral from that doctor, the insurer's agreement, or an order from the Commission. If your claim is denied or no panel is offered, you can choose any doctor.

Read more: Choosing and Changing Your Doctor in a Virginia Workers' Comp Case