Nothing in this article should be taken as legal advice. Every case is different.
The biggest Virginia workers’ comp decision so far this month says a full and final settlement does not erase the insurance company’s duty to pay medical bills from before the settlement, when the settlement made it responsible for them. Four other decisions from the Full Commission cover reporting new earnings, falls with no known cause, getting every injured body part into your medical records, and old injuries. All five came from the Full Commission, which reviews the deputy commissioners who hear cases first. Once the Full Commission finishes deciding a case, its decision can be appealed to the Court of Appeals of Virginia.
| Decision | What it means for you |
|---|---|
| Kempsville Auto Care Center (Nov. 5) | A settlement that made the insurance company responsible for bills up to the settlement date can still make it pay unpaid balances on reasonable, necessary, and related bills from before that date. |
| JKM Com Archives (Nov. 2) | If you don’t report higher earnings right away, the insurance company can recover what it overpaid, even beyond 90 days. |
| City of Norfolk (Nov. 2) | A fall at work with no known cause usually isn’t covered. |
| Smithfield Foods (Nov. 4) | A body part your medical records never mention is hard to get covered. |
| Accomack County (Nov. 4) | An old injury made worse at work usually needs a doctor to explain how the accident made it worse. |
Settlement Doesn’t Erase Bills From Before It
If your settlement made the insurance company responsible for medical bills up to the date the Commission approved it, the insurance company can still be made to pay unpaid balances on reasonable, necessary, and related bills from before that date. In a case against Kempsville Auto Care Center (VWC No. VA02000001452, Nov. 5, 2026), the worker settled full and final in 2013. The settlement said the insurance company would pay all reasonable, necessary, and authorized medical bills related to the accident up to the date of the settlement order. It also said the settlement was a “complete extinguishment” of all claims. In 2025, 12 years after he settled, the worker asked the Commission to make the insurance company pay balances still owed to three of his medical providers for treatment before the settlement.
The deputy commissioner said the “extinguishment” language ended any claim. The Full Commission reversed. It followed the Court of Appeals of Virginia, which has held the same thing in a published decision involving Portsmouth Plumbing Services (No. 1132-25-1, Va. Ct. App. Sept. 29, 2026). Read together, the settlement gave up claims for future benefits but kept the insurance company’s promise to pay for treatment before the settlement. The Commission sent the case back to decide how much, if anything, is still owed.
What this means for you:
- A full and final settlement still closes future medical care for the injury. The Kempsville Auto Care decision doesn’t change that. Here’s more on workers’ comp settlements in Virginia.
- Read what your settlement says about past bills. The result in the Kempsville Auto Care case turned on the settlement’s promise to pay bills through the settlement date.
- If a provider is still billing you for treatment from before your settlement, that bill may be the insurance company’s to pay.
Report Higher Earnings Right Away
If you’re getting workers’ comp checks and your earnings go up, you have to tell the insurance company immediately, or it may be able to take back what it overpaid for the time you didn’t report. In a case against JKM Com Archives (VWC No. VA00002063546, Nov. 2, 2026), a worker on light duty was receiving partial wage checks. His pay went up on January 1, 2025, but he didn’t report it until April 2025, and the insurance company didn’t ask the Commission to lower his checks until July.
Two laws applied:
- The 90-day rule. When a worker is under a continuing award of partial wage checks, either side can ask the Commission to adjust those checks for the 90 days before the request (Va. Code § 65.2-502). The insurance company got a credit for that period.
- The duty to report. A worker receiving comp checks must “immediately” report a return to work or an increase in earnings (Va. Code § 65.2-712). The Full Commission held that the 90-day limit does not cap what the insurance company can recover for the time a worker failed to report.
There was a limit on the insurance company, too. The duty to report starts when you are actually receiving comp checks, not when an award is entered. The Commission sent the case back to find out whether this worker was being paid when his earnings went up. It also refused any credit for the week after he reported the raise, since that week fell outside the 90 days and after he had reported.
When the Commission finds an overpayment came from a worker’s failure to report, the law lets the insurance company recover it from future checks or by suing for it (§ 65.2-712). Here’s more on working another job while on workers’ comp.
A Fall with No Known Cause Usually Isn’t Covered
In Virginia, falling at work is not enough by itself. You have to show something about the job or the workplace caused the fall. In a case against the City of Norfolk (VWC No. VA00002264929, Nov. 2, 2026), a case manager fell while walking quickly down a hallway at work and talking on the phone with a client. She hurt her shoulder. She testified there was nothing wrong with the floor and that she didn’t know why she stumbled.
The Full Commission agreed she was hurt at work, but held her injury did not “arise out of” the job. Virginia uses an “actual risk” test: the job itself has to expose you to the danger that hurt you. When the evidence can’t show how and why a fall happened, it is an unexplained fall, and unless a legal presumption applies, it is not covered.
What made the difference was the missing cause. If a wet floor, a loose mat, a step, something you were carrying, or the way the job required you to move played a part, say so, as specifically as you can, from the first report to the first doctor.
Every Injured Body Part Needs to Be in Your Medical Records
If a body part is hurt in the accident, make sure the doctor writes it down. In a case against Smithfield Foods (VWC No. VA00002312807, Nov. 4, 2026), a production worker was hit in the lower back by a load on another worker’s motorized jack, and his right knee struck a safety pipe. The Full Commission affirmed ongoing medical care for his back. It reversed the award for his knee. He testified the knee didn’t hurt, he told the first clinic the leg pain had gone away, and no medical record mentioned a knee injury.
Injuries sometimes start hurting later. When one does, tell the doctor, and make sure the record shows when the pain started and how the accident happened. Here’s more on choosing a doctor for a Virginia workers’ comp claim.
An Old Injury Usually Needs a Doctor to Connect It to the Accident
A work accident that makes an old injury worse can be covered, but you usually need persuasive medical evidence explaining how the accident made it worse. In a case against Accomack County (VWC No. VA00002145178, Nov. 4, 2026), a firefighter-paramedic hurt her low back lifting a patient, and that injury was covered. Her claim for her neck was denied. She had treated for neck problems for years before the accident, her medical histories were inconsistent, and the only two opinions linking her neck to the accident didn’t persuade the Commission: a nurse practitioner’s note that didn’t explain why, and a chiropractor’s theory, given after one exam more than two years later, that medication for her back inflamed her neck.
The Full Commission affirmed the denial. Here’s more on how pre-existing conditions affect a Virginia claim.
Questions About These Decisions
Are Full Commission Decisions Binding?
The Full Commission hears appeals from deputy commissioners, and deputy commissioners are expected to follow its decisions. Once the Full Commission finishes deciding a case, its decision can be appealed to the Court of Appeals of Virginia, and the Supreme Court of Virginia is over both. Each decision here turned on its own facts.
Can Any of These Decisions Still Change?
Yes. The Kempsville Auto Care and JKM Com Archives cases were sent back to a deputy commissioner to finish deciding. A decision that sends part of a case back usually isn’t final, so an appeal in those two cases would generally come after that’s done. The City of Norfolk, Smithfield Foods, and Accomack County cases could be appealed to the Court of Appeals of Virginia within 30 days from the date of the decision. Here’s more on how appeals work in a Virginia workers’ comp case.
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