Getting hurt on the job can be both discouraging and painful, especially if it is a spinal cord or back injury. You may face an uphill battle in your fight for workers’ compensation (“workers’ comp”) benefits for an on-the-job injury. Dealing with the bureaucracy of a workers’ comp claim is probably the last thing you want to think about when you are recovering from a back injury. Help is available, though, so you do not have to go through this process by yourself. A Virginia workers’ compensation attorney who focuses their practice exclusively on these types of claims can help you understand your rights and options. Workers’ comp attorneys will deal with the insurance companies for you and help relieve some of the stress of a legal battle after you get hurt at work.
If you suffer a spinal cord injury in an accident at work, you must act quickly to preserve your rights. Do note, however, that a workers’ compensation claim and a personal injury claim are not the same. If you were hurt on the job, you would be well served to consult with a workers’ compensation attorney, rather than a personal injury attorney, and complete the following steps.
Seeking medical care should be your first priority. It is extremely important to tell your doctor your injury happened at work and make sure your doctor notes this fact in your medical records. If the earliest medical records do not mention a work accident, this can be a huge impediment to your workers’ comp case down the line. Talk to your doctor about your injury and get a plan in place for your recovery. Ask for copies of your medical records and work notes when you leave your appointments. Medical records are the lifeblood of your workers’ comp case, so making sure they are clear about the fact your injury happened in a work accident is critical. One of the most important things to get at your doctor visit is a written work note stating whether you are taken out of work or have any kind of work restrictions from your injury.
The Virginia Workers’ Compensation Act requires you to report your injury to your employer within thirty days of the accident, ideally in writing. Even though some injuries (like spinal cord injuries or back injuries) are not apparent immediately after an accident, the law only gives you thirty days from the date your accident happens to report your accident in writing. Your employer may have a specific form or process they want you to use to make the report. You should check with your employer’s human resources department to see if they have any such requirements. If you received a work status note at your doctor visit, also give this to your employer. Your employer is entitled to knowing about your work status and your availability to work as a result of your injury or restrictions.
You generally have two years from the date of the accident to file a claim with the Virginia Workers’ Compensation Commission (VWC). You have multiple options for how to file the claim, or any paperwork, medical records, etc., that you have after the claim is filed.
You may complete a claim form and mail it to the VWC at the following address: Virginia Workers’ Compensation Commission, 333 E. Franklin St., Richmond, VA 23219.
You may fax the benefits claim form to 804-823-6957.
You may deliver your claim form in person to the VWC’s main office in Richmond, or to any of its six regional offices in Bristol, Fairfax, Harrisonburg, Manassas, Roanoke, or Virginia Beach.
Once you’ve filed a claim through any of the above methods, the VWC will issue a Jurisdiction Claim Number (JCN) for your claim as well as a personal identification number (PIN). You may use these numbers to create an account with the VWC’s WebFile online portal. Once you have set up the account, you may file paperwork and claims online.
After you file a claim, the Virginia Workers’ Compensation Commission will issue an order to the insurance company requiring them to respond to your claim within 30 days either approving or denying it. An initial denial of an accident victim’s workers’ compensation claim is fairly common, so there is no cause for despair just yet. The denial simply means that your employer or their insurance company will not voluntarily pay you benefits. Yet the process is far from over.
But let’s be real here: If you get to this point and the insurance company says they’re denying your claim, you need to talk with a lawyer. By law, the insurance company is required to have a lawyer in court when your claim goes to hearing. If you don’t, you’ll be going up in court against the insurance company’s lawyer. No matter how compelling you think your claim is, the odds are not in your favor at this point. So, do yourself a favor and talk to an experienced Virginia workers’ compensation attorney if the insurance company denies your claim.
If you receive a denial of your claim from the insurance company, you will have the opportunity to “appeal” this decision by requesting the hearing be docketed with the Virginia Workers’ Compensation Commission. You must submit this request for an evidentiary hearing in writing to the VWC.
At the hearing, you must demonstrate to a preponderance of the evidence that your injuries arose out of and in the course of your employment. A work accident lawyer can guide you through the process of preparing for the hearing, assembling medical evidence, interviewing witnesses, conducting discovery, and other important pretrial steps. They can also then represent you and advocate on your behalf at hearing. You may present evidence at hearing, including testimony from witnesses and opinions from doctors and medical experts. Bear in mind, there are evidentiary rules and procedures you will have to follow. Failing to do so can have serious consequences for your case.
The evidentiary hearing can be the most important part of a work-related injury case. You might feel discouraged because of the amount of time that it often takes to get to this point. It might not seem like it would be worth the effort to attend the hearing. However, this is your chance to make your case in front of the decision-makers, called “deputy commissioners.” You and your lawyer can potentially turn a denial into an approval, but only if you show up and comply with your lawyer’s instructions and requests as the case proceeds toward trial.
If the VWC denies your claim after an evidentiary hearing, you are not necessarily out of options:
As you can see, the litigation process for a Virginia workers’ compensation claim can be long, complex, and difficult. Do yourself a favor and talk with an experienced Virginia workers’ compensation claimant attorney early in the process.
Many types of spinal injuries are possible in different workplaces. Some of the most common types of injuries are as follows:
The cervical spine is located directly below the skull and throughout the neck. Injuries to this area tend to be the most severe spinal cord injuries. The higher up the spine an injury occurs, the greater and longer-term the damage is likely to be, including paralysis. A cervical fracture, more commonly known as a broken neck, can be fatal. The extent to which a cervical spine injury causes nerve damage or impairment into the arms, hands, and fingers depends on the location of the injury in the spine and the degree to which the nerves coming out of the spine are damaged or impinged by the spinal injury.
Injuries to the cervical spine are common in sports like football and gymnastics. In work-related settings, cervical spine injuries may occur as the result of falls, falling objects, lifting or pulling movements, or car accidents.
The thoracic spine is located below the cervical spine in the upper and middle back. Nerves in the upper thoracic spine can affect the muscles that enable you to breathe. The lower thoracic spine’s nerves affect the muscles that you use to maintain posture and balance.
Thoracic spine fractures are also known as vertebral compression fractures. Severe injuries can result in partial paralysis, or paraplegia, as well as problems regulating certain bodily functions. They often result from accidents involving significant impact on the back, such as auto accidents, falls, or lifting, bending, or twisting movements.
The lumbar spine is the lowest major section of the spinal cord. It is in the lower back, below the thoracic spine, and above the sacrum or S.I. joint. It is the lowest section with spinal discs separating the vertebrae.
Injuries to the lumbar spine can result in loss of hip, leg, thigh, and foot function. An accident victim who suffers a lumbar spine injury may need braces or a wheelchair.
The three main sections of the spine — cervical, thoracic, and lumbar — all consist of bones known as vertebrae separated by spinal discs. Each disc consists of an outer annulus that surrounds a nucleus. The discs are essentially shock absorbers for the vertebrae. These components surround and protect the spinal canal, through which the bundle of nerves known as the spinal cord runs.
A herniated disc injury, also known as a slipped, ruptured, or bulging disc, can occur in any section of the spine. It can happen when something pushes part of a disc into the spinal canal. Causes may include:
Disc herniation can lead to radiculopathy, more commonly known as a pinched nerve. A herniated disc can damage the roots of a nerve as it exits the spine. This may affect any body part along that nerve’s path. The nerves that come out of the cervical spine feed into the arms and hands while the nerves that come out of the lumbar spine feed into the legs and feet. Common symptoms of a herniated disc can include, but are not limited to:
A referral to an orthopedic specialist will likely be given to treat the herniated disc. Treatment of a herniated disc often involves steroid injections, pain management, and physical therapy. In severe herniated disc cases, the injured person might require a surgical procedure known as a discectomy. Spinal fusion surgery may also be necessary to stabilize the spine after the complete removal of a disc.
Injuries to the spinal cord itself can be devastating and debilitating. They can result in paralysis, loss of certain bodily functions, or significant changes in mobility.
A spinal cord injury might not be immediately apparent after an accident. While adrenaline is running high, you might not notice certain injuries. It is also possible to worsen someone’s back injury or neck injury if they are moved after an accident without the proper equipment and protective measures. This is why first responders often advise not to move an accident victim at the scene of a car crash unless they are in immediate danger. They may have back or neck injuries that require stabilization before the victim is transported.
Fractures or dislocations of vertebrae may occur at any point along the lumbar, thoracic, or cervical spine. Minor vertebral fractures can heal with medical care and rest, while others may require surgery to correct damage that affects a person’s mobility or threatens the spinal cord itself. Injuries to the upper part of the cervical spine have the potential to be immediately fatal in some situations.
Work-related injuries can cause strains to the muscles and tendons in the back that, while not affecting the vertebrae, discs, or spinal cord directly, can produce similar symptoms. Pulling or twisting a muscle or tendon can result in a strain, sprain, or tear. This may occur suddenly, such as in a workplace accident. Back strains can result in pain, cramps, spasms, and loss of strength or mobility in one or more joints.
There may come a time in your workers’ compensation case where you and the insurance company want to discuss closing out your claim in exchange for a lump sum of compensation. This is called “settlement.” Insurance companies take multiple variables into consideration for work injury settlements.
Please note that settlements are not guaranteed in workers’ comp cases. Settlements are a voluntary compromise between the injured worker and the insurance company, in which they are able to come to an agreement on the case’s monetary settlement value. That said, spinal cord and back injuries can present the kinds of circumstances that could lead to the parties negotiating a voluntary payout arrangement.
Injured workers commonly receive accident compensation in three areas:
It is relatively common for workers to receive lost wage payments in a workers’ comp case, assuming a doctor takes the claimant out of work or restricts them to light duty. Generally, this compensation is temporary, while the claimant is out of work per a doctor’s note. Most cases are capped at 500 weeks of wage loss benefits a claimant can receive.
Permanent total disability compensation, on the other hand, is much less common than temporary disability benefits in Virginia workers’ compensation claims. In certain exceptionally severe instances, permanent total benefits may be available if the claimant can prove they suffered damage to two or more extremities or eyes in a work accident that is so severe the body part can no longer be used in gainful employment. Permanent total disability benefits can also be available if the claimant suffered a brain injury so severe as to render them permanently unable to engage in gainful employment. The facts needed to prove that someone is entitled to perm total benefits, however, could be present in cases involving spinal cord injuries or serious back injuries that involve two or more appendages, eyes, or a brain injury.
Workers’ comp benefits can compensate for your loss of earning capacity. The amount of money you earned at your job before your injury will play a major role in determining how much you might be able to receive in workers’ comp benefits or a settlement. Generally, the law calculates your workers’ compensation rate by taking the average of your earnings in the 52 weeks prior to your accident and paying you two thirds (66%) of this figure on a weekly basis while a doctor has you totally out of work. This may be impacted by numerous other factors, though, so speak with an attorney before agreeing to any kind of compensation awards with the insurance company.
If your injury causes permanent loss of use in one or more eyes, ears, or appendages (such as arms/hands/fingers or legs/feet/toes), you may be able to recover “permanent partial disability” compensation. This benefit is meant to compensate for damage to certain body parts that result from a work accident. A permanent injury to a ratable body part may give rise to permanent partial disability benefits. A Virginia workers’ comp lawyer can help you figure out if this benefit may apply to you.
If your existing health insurance coverage has already paid some or all of your medical expenses so far, you may or may not be the one entitled to reimbursement for those costs. However, a skilled workers’ compensation attorney can potentially help you structure your settlement in a way that puts the most money in your pocket. This is why you should speak with an attorney straightaway if the insurance company starts asking you about settling your case!
How extensive will your future medical needs be? Will you need ongoing medical treatment, physical therapy, durable medical equipment, home or vehicle modifications, vocational rehabilitation, or other services? All these considerations can factor into the settlement value of your case.
Surgery can be very expensive. Insurance companies tend not to want to pay for surgical procedures unless they are absolutely necessary, and they will often fight you overpaying for surgery after a work accident. However, a surgical indication in a workers’ compensation case is often the number one driver of increased settlement value. A seasoned workers’ compensation lawyer can help you gather the evidence you need to support your claim for surgical treatment related to your work accident.
To be eligible for workers’ comp benefits, you must have sustained your injuries arising out of and in the course of your employment. One of the first things an insurance adjuster or defense attorney will likely do is challenge whether your injury fits within the legal criteria to receive workers’ comp benefits. You will probably be surprised to learn that just because an accident happens at work, this does not necessarily mean it qualifies for workers’ comp benefits. For example, the insurance company might deny a herniated disc claim on the grounds that the injury was the result of long-term degeneration and not the work accident. Or they might contend that even if the injury was directly related to your accident, your accident was nonetheless not compensable in the first place, meaning it doesn’t matter what injuries you suffered. An experienced Virginia workers’ compensation lawyer can help you navigate these challenges.
If your spinal or back injury occurred in a car accident, you may be able to qualify for workers’ comp according to the Virginia Workers’ Compensation Act and its interpretive case law. Commuting to work generally does not qualify under the workers’ compensation system unless one of the following applies:
If you were driving a company-owned vehicle and performing job-related duties when the accident occurred, your injury could be deemed work-related.
Even if you were driving your own vehicle, the injury could be deemed compensable if your employer pays you for mileage.
If you were doing something work-related while driving, even in a personal vehicle, you might be able to get workers’ compensation benefits.
Workers’ comp provides benefits for on-the-job injuries. Short-term disability covers injuries and illnesses that are not work-related.
The two types of benefits have a somewhat complicated relationship. If your workers’ comp claim is denied, you may be able to file for short-term disability benefits while your workers’ comp case is in litigation. You should talk to an attorney first, though. If you receive short-term disability when you should have been receiving workers’ comp, you may have to pay the short-term disability benefits back. This is a complex and nuanced area of law you should not try to navigate yourself without the assistance of a Virginia workers’ compensation lawyer.
Legal advice from a workers’ compensation attorney with experience in the Virginia workers’ compensation system may be indispensable for your work accident case.
Workers’ comp is supposed to make the process of claiming benefits easier, but unfortunately it often makes the process harder for injured workers. You must meet strict deadlines and procedures to protect your rights. You have the burden of making sure the Virginia Workers’ Compensation Commission knows about the accident and your injuries, that you timely file a claim for benefits, and of proving the accident caused the injuries you are claiming. There are countless nuances and pitfalls to which you can easily fall prey if you are not intimately familiar with the workers’ compensation process.
A lawyer can help you with this. Workers’ comp attorneys have experience preparing claims, assembling evidence, and advocating for their clients before the Virginia Workers’ Compensation Commission. They can help put your claim in the best possible light and advocate for you. While your attorney represents you, you can focus on healing from your injuries.
Insurance companies know a wide variety of tricks that allow them to deny your claim or minimize the amount of money they must pay you. Insurance adjusters will try to get you to admit facts that would harm your case without telling you about your right to have a lawyer help you out with your case. Workers’ comp lawyers know the insurance companies’ tricks and know how best to respond to them. If the insurance company denies your claim, your lawyer will know how to present your case to the Virginia Workers’ Compensation Commission at an evidentiary hearing or posture your case for a pre- or post-hearing settlement to optimize the outcome for you.
If you suffered a back injury in a work accident in Virginia, Pathfinder Injury Law is here to help. Our law firm can discuss your case with you in a free consultation. Get started today by calling 804-505-0633 or filling out the online contact form.