The Virginia Workers' Compensation Commission (VWC) is an agency of the state of Virginia which oversees the resolution of workers' compensation claims brought in that state, in accordance with the Virginia Workers' Compensation Act. The Commission has exclusive jurisdiction to adjudicate such claims. Its decisions may be appealed to the Virginia Court of Appeals. The Commission is headed by three Commissioners and an Executive Director. The Commissioners are chosen by the Virginia General Assembly and serve staggered six-year terms. Virginia R. Diamond, William L. Dudley, Jr. and Roger L. Williams currently serve as Commissioners. The Commissioners elect a Chairman for a term of three years. Mr. Dudley is currently the Chairman and John A. Budesky is the Executive Director. The Commission is headquartered in Richmond, Virginia, but has offices and hearing locations at various places around the state.
The Commission is also directed by statute to administer two other programs. One is the Criminal Injuries Compensation Fund, which assists crime victims. The other is the Birth-Related Neurological Injury Program, which assists children who sustained certain kinds of injuries set forth in the statute at birth.
The Virginia Workers' Compensation Commission is an independent state agency established by the Constitution of Virginia. The Virginia General Assembly, through the legislative process, imparts responsibilities upon the Commission. Additionally, the Commission is authorized to issue its own rules and regulations to help it carry out its statutory responsibilities.
The following titles of the Code of Virginia are pertinent to the VWC:
The following titles of the Virginia Administrative Code contain VWC regulations:
The Virginia Workmen's Compensation Act was enacted on March 21, 1918 over a veto by Governor Westmoreland Davis.[1] Modeled on Indiana's statute, the Act became effective on January 1, 1919 and has been amended numerous times since enactment.[2]
After a pattern of decisions by the Virginia Workers' Compensation Commission and the Court of Appeals of Virginia allowing workers' compensation benefits for workers with repetitive motion injuries, the Virginia Supreme Court issued a ruling prohibiting employees from receiving compensation for those type of injuries on November 5, 1993.[3]
In 2005, the Virginia Court of Appeals upheld a ruling by the Virginia Workers' Compensation Commission that "fighting is an integral part of the game of hockey." The ruling was part of lawsuit filed by Norfolk Admirals hockey player Ty Jones over an injury that he sustained in his role as an enforcer.[4]
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.[5]
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.[6]
Employees who suffer on-the-job injuries and diseases may be eligible for benefits under the Virginia Workers' Compensation Act.[7] 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.[8]
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.[9]
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 [10] of the Code of Virginia requires that the employer provide the claimant with a panel of physicians from which to choose. 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:
Mediation may be requested in addition to Adjudication.
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.[12]
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.
The Workers' Compensation Act provides for the annual payment of a tax up to 3.25 percent of the basic manual insurance premium calculated by applying the manual premium rates effective on January 1 of the calendar year payroll reporting period. The assessment rate may fluctuate from year to year depending on the Commission's operating costs and fund requirements. For the assessment in January 2011, the rates were 2.25 percent for the Administrative Fund, .40 for the Uninsured Employer's Fund, and 0 percent for the Second Injury Fund. (The respective maximum rates for the three funds are 2.5 percent, .50 percent, and .25 percent.)
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.[13]
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[14] 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.[15]
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[16] of the Code of Virginia. The program is administered by the Commission.
Pursuant to Section 65.2-803.1,[16] 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.[17]
|
|||||||||||||||||||