Virginia Workers' Compensation Commission

The VWC is charged with administering the Virginia workers' compensation program, which applies to most employers doing business in Virginia and most employees working in Virginia. Other organizations involved in Virginia workers' compensation program include insurance carriers, group self-insurance associations, professional employer organizations, and third-party administrators. Additionally, various vendors provide services to these organizations. Finally, attorneys represent these parties before the Commission.

The Commission provides various services to these persons and entities. These range from online services that facilitate meeting Commission requirements, to customer assistance services that provide specialized help, to adjudication and mediation services to parties with disputes, and everything in between.^[4]

In 2013 the Commission created the Alternative Dispute Resolution (ADR) Department to provide an alternative to litigation for the resolution of disputes. Any party to a claim may request alternative dispute resolution or mediation at any time. ADR can involve Issue mediation, Full and Final (Settlement) mediation and/or facilitation. The ADR program does not affect benefits to which an employee, dependents, or survivors may be entitled under the provisions of the Act.

Mediation may be requested in addition to Adjudication.

• Informal, cost-effective means of alternative dispute resolution
• Parties design their own solutions with the help of a Commission mediator
• Parties agree to mutually satisfactory solution
• Appropriate for any medical charge issue
• Initiated by written request filed with Commission in letter format or using the Commission's mediation request form.

As a general rule, employers with more than two employees in the same business within Virginia are subject to the Virginia Workers' Compensation Act. Employees who suffer on-the-job injuries and diseases may be eligible for workers' compensation benefits. Employers must insure their liability for these benefits through a commercial insurance policy, a self-insurance program, or membership in a professional employer organization or group self-insurance association.

An employee suffering a workplace injury or disease should immediately notify his or her employer.

A report of an accident or disease must be filed with the Commission within ten days of knowledge of the accident or disease. To accomplish this, an employer should immediately notify its insurance carrier about the accident, and the insurance carrier will then file the appropriate reports with the Commission. Insurance carriers file these reports with the Commission electronically.^[5]

Employees who suffer on-the-job injuries and diseases may be eligible for benefits under the Virginia Workers' Compensation Act. If injured, an employee (injured worker) should (1) report his/her injury to his/her employer immediately, and (2) file a claim with the Commission no later than two years after the accident. He/she should take similar immediate action if he/she is diagnosed with a work related disease.^[6]

Claim Administrators, or those organizations managing claims activity on behalf of employers and insurance carriers, play a vital role in the Virginia workers' compensation program. Under section 65.2-900 of the Code of Virginia, all workplace accidents that occur in the course of employment must be reported to the Commission. Additionally, certain events and transactions that occur in the course of handling claims relating to these accidents must be reported. The Commission uses electronic data interchange (EDI) to handle these reports.

Claim Administrators may access their files and conduct certain transactions through WebFile, the Commission's web-based file access portal. WebFile is also a tool available for eligible claim administrators seeking to report EDI information.^[7]

Health care providers play a vital role in the claim process. Accordingly, they have certain rights and remedies available to them under the Virginia Workers' Compensation Act.

Generally, providers become involved in a claim shortly after a work-related accident. Section 65.2-603 ^[8] of the Code of Virginia requires that the employer provide the claimant with a panel of physicians from which to choose. If the employer does not provide one within a reasonable time, the claimant can choose his own physician. Either way, the physician chosen by the claimant becomes the authorized treating physician. Generally, the following charges may be covered where treatment is related to the compensable injury:

• Charges billed but the authorized treating physician
• Charges billed by a physician to whom the claimant is referred by the authorized treating physician
• Charges for medically necessary treatment and diagnostic measures
• Prescriptions

Once the claimant has filed a claim which covers a specific charge, or once the Commission enters an award of compensation applicable to a charge, the health care provider may not attempt to bill the claimant for any part of the charge. However, if the Commission rules that the charge is not compensable under the Act, the provider may bill the claimant.

The Medical Care Provider Specialist provides workers' compensation claims information to medical care providers. The Medical Care Provider Specialist also assists providers with disputes over non-payment and underpayment of treatment by contacting appropriate parties and facilitating resolution.^[9]

The Commission offers attorneys representing clients conducting Commission business several methods of staying current with standard practice and procedure, as well as sources of workers' compensation information. Online access is available to attorneys through WebFile, the Commission's web-based file access portal. Judicial opinions are available for searching online.

Based on the information in the application, and any other information that may be requested, the Commission assesses the applicant's financial status, the nature and hazard of the employment, the number of employees, the amount of payroll, the employer's claims experience (frequency, severity, and cost), the employer's ability to manage claims, and such other factors as may affect the viability of the applicant as an individual self-insurer for workers' compensation in Virginia.

This assessment results in a determination of whether the privilege of self-insurance can be granted and what security is necessary. The security may be in the form of a bond from a licensed surety company, certificate of deposit, United States government obligations, letter of credit or cash, in the minimum amount of $750,000. Most security amounts are considerably higher than the minimum. The employer may also be required to carry excess coverage. If the applicant is a subsidiary of a larger corporation, a parental guarantee will usually be required. The Commission requires that even if self-insurance is subsequently surrendered or revoked, the security must remain in place to cover all outstanding liability for the period of self-insurance.

If approved, the applicant is issued a Certificate of Self-Insurance which remains in full force and affect until voluntarily surrendered or revoked by the Commission. The self-insurer must pay directly all benefits to which the employee is entitled under Virginia Law. The Commission also requires that the self-insurer designate a single in-state representative who can meet the requirements specified in the 1991 directive on designated representatives. Requirements regarding addresses to be used for the routine handling of claims are included in Section 4 of that same directive.^[10]

Virginia employers that are required to insure their workers' compensation liability may be eligible to participate in a group self-insurance association. The Virginia Workers' Compensation Act established this program in section 65.2-802^[11] of the Code of Virginia. The program is administered by the State Corporation Commission, Bureau of Insurance.

For those associations currently providing services under the program, the Commission provides online access to such associations to satisfy their reporting obligations. This access is available through WebFile, the Commission's web-based file access portal.^[12]

Virginia employers required to insure their workers' compensation liability may be eligible to participate in a professional employer organization. The Virginia Workers' Compensation Act established this program in section 65.2-803.1^[13] of the Code of Virginia. The program is administered by the Commission.

Pursuant to Section 65.2-803.1,^[13] all professional employer organizations must register with this Commission prior to transacting business in Virginia, and provide regular reports subsequent to the initial registration. PEO registration and reporting requirements are found in the Virginia Workers' Compensation Act and in the Commission's regulations.

For those professional employer organizations currently providing services under the program, the Commission provides online access to such organizations to satisfy their reporting obligations. This access is available through WebFile, the Commission's web-based file access portal.

• Website of the Virginia Workers' Compensation Commission Archived May 25, 2009, at the Wayback Machine
• Website of the Criminal Injury Compensation Fund Archived July 22, 2011, at the Wayback Machine
• Website of the Virginia Birth Injury Program