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Almost every state in the country requires domestic employers to have workers’ compensation insurance, and Virginia is no exception.

Under workers’ compensation insurance laws, workers who suffer an injury while working can file a workers’ comp claim with their employer to receive appropriate compensation. 

Even though you were hurt at work, an employer may still deny a workers’ compensation claim for various reasons. If you’re concerned about what to do when your workers’ comp claim is denied, then you’ve come to the right place.

If you want to set up a free consultation with an award-winning Virginia workers’ compensation attorney, contact River Run Law right away. 

What Do I Do If My Workers’ Comp Claim Is Denied?

If your employer has denied your workers’ comp claim, the first thing you need to understand is what motivated their decision. There are several legitimate reasons that an employer can deny an employee’s claim.

Several examples are:

  • The employee’s injury is not compensable or not covered under the employer’s workers’ compensation insurance;
  • The employee did not file their workers’ comp claim in time;
  • The employee did not report their injury to the employer within the applicable time limits; or
  • The employer believes that the employee’s injury actually happened outside of work. 

Generally, your employer should state the reasons why your workers’ comp claim was denied in a denial letter that they mail to you.

Once you’ve read their reasons, consider whether you want to pursue your claim in front of a Deputy Commissioner (a Judge in the Workers’ Compensation Commission).

In some cases, there might be some justification to your employer’s decision. If you’re not sure whether you should move forward with a claim, consult a qualified workers’ compensation attorney immediately.

Appealing a Denied Workers’ Compensation Claim 

Now that you’ve reviewed your employer’s decision and determined that you will challenge their denial, let’s take a moment to discuss the claims process.

After your employer has denied your workers’ compensation claim, you must file a claim with the Virginia Workers’ Compensation Commission (VWCC).

The VWCC will process your claim and may schedule a hearing. Before the hearing, the parties normally exchange discovery, which consists of written interrogatories and requests for the production of documents.

These are required to be answered, and if not answered can result in a dismissal of your claim.

Furthermore, the employer almost always takes the deposition of a claimant which is a chance for the defense attorney to question you under oath about the accident.

Even if you have nothing to hide, attorneys are skilled at depositions and a claimant should be cautious in appearing without counsel of their own. 

At that hearing, you (or your attorney) will present evidence showing why your employer’s denial wasn’t the right decision for your claim.

You also have the burden of proof in your claim, meaning it is your burden as the claimant to prove your case. Your employer will likely have an attorney present at this hearing to present their point of view.

The presiding judge at the hearing—referred to as a deputy commissioner—will then consider all the evidence to make a decision.

After the Hearing: Requests for Reconsideration 

After the hearing, the presiding deputy commissioner will release their initial decision, called a judicial opinion, to the parties. The decision may be totally or partially in your or your employer’s favor.

If either party disagrees with the deputy commissioner’s judicial opinion, they can file an appeal.

On appeal, you or your attorney will have to argue that certain laws or facts related to your case prove that the initial decision was wrong.

Once you have submitted your appeal to the VWCC, it will consider all of the evidence that the parties submitted at your initial hearing.

Sometimes, they may opt to hold another hearing for the parties. In either event, the VWCC will release its decision after considering all the evidence in the record.

All appeals must be submitted within 30 days of the initial decision.

Appealing the Commission’s Decision

If the decision of the full VWCC is also unfavorable, you can continue to appeal your case. The next level of appeal would go to the Court of Appeals of Virginia.

After that, you can appeal your case even further, to the Supreme Court of Virginia. 

The Importance of an Attorney

As you can see from this brief article, the claims process can become quite complex. Furthermore, each level of appeal features its own unique procedural rules and timelines.

Most workers have zero familiarity with these numerous procedures, while your employer’s attorney will know them very well. Obviously, this puts you at a serious disadvantage. 

The best way to give yourself a fighting chance is by hiring your own attorney. A workers’ compensation attorney can analyze your claim using their wealth of legal training and experience with workers’ comp cases.

They can then help you decide on the best strategy for your case. Attorneys can also represent you if your case goes to mediation. 

We Can Help You Get the Compensation You Deserve 

It’s easy to feel devastated if your employer has denied your workers’ comp claim. As this article shows, however, you have plenty of opportunities to appeal and turn things around.

That said, it’s critical that you act quickly since you have only a limited amount of time to pursue your claim.

Because of the complicated nature of workers’ compensation cases, it’s also vital that you contact a capable attorney immediately to assess your claim. 

Here at River Run Law, we know Virginia workers’ compensation laws. That means that we know what it takes to win in court.

We are also highly experienced with pursuing our clients’ interests when negotiating with their employer and other involved parties.

Most importantly, our team here at River Run Law believes in treating all of our customers like family, not numbers. When you work with us, we will dedicate ourselves to getting you the compensation that you deserve. 

Don’t gamble with your workers’ compensation claim by going it alone. Call us today at (828) 414-8614 or contact us online to set up a free initial consultation.

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Brooke Alexander

Brooke graduated from the University of Richmond School of Law after receiving her undergraduate degree from the University of North Carolina at Chapel Hill. Brooke worked for five years in private practice with a law firm specializing in insurance defense litigation before becoming the trial litigator for Allstate Insurance Company in the metro Richmond area.

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