Virginia Workers' Compensation Commission
Encyclopedia
The Virginia Workers' Compensation Commission (VWC) is an agency of the state of Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

 which oversees the resolution of workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 claims brought in that state, in accordance with the Virginia Workers' Compensation Act. The Commission has exclusive jurisdiction
Jurisdiction
Jurisdiction is the practical authority granted to a formally constituted legal body or to a political leader to deal with and make pronouncements on legal matters and, by implication, to administer justice within a defined area of responsibility...

 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
Virginia General Assembly
The Virginia General Assembly is the legislative body of the Commonwealth of Virginia, and the oldest legislative body in the Western Hemisphere, established on July 30, 1619. The General Assembly is a bicameral body consisting of a lower house, the Virginia House of Delegates, with 100 members,...

 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
Richmond, Virginia
Richmond is the capital of the Commonwealth of Virginia, in the United States. It is an independent city and not part of any county. Richmond is the center of the Richmond Metropolitan Statistical Area and the Greater Richmond area...

, 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.

Authority

The Virginia Workers' Compensation Commission is an independent state agency established by the Constitution of Virginia
Constitution of Virginia
The Constitution of the Commonwealth of Virginia is the document that defines and limits the powers of the state government and the basic rights of the citizens of the U.S. Commonwealth of Virginia. Like all other state constitutions, it is supreme over Virginia's laws and acts of government,...

. The Virginia General Assembly
Virginia General Assembly
The Virginia General Assembly is the legislative body of the Commonwealth of Virginia, and the oldest legislative body in the Western Hemisphere, established on July 30, 1619. The General Assembly is a bicameral body consisting of a lower house, the Virginia House of Delegates, with 100 members,...

, 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:

History

The Virginia Workmen's Compensation Act was enacted on March 21, 1918 over a veto by Governor
Governor of Virginia
The governor of Virginia serves as the chief executive of the Commonwealth of Virginia for a four-year term. The position is currently held by Republican Bob McDonnell, who was inaugurated on January 16, 2010, as the 71st governor of Virginia....

 Westmoreland Davis
Westmoreland Davis
Westmoreland "Morley" Davis a lawyer, farmer, and the 48th Governor of Virginia from February 1, 1918 to February 1, 1922....

. Modeled on Indiana's statute, the Act became effective on January 1, 1919 and has been amended numerous times since enactment.

After a pattern of decisions by the Virginia Workers' Compensation Commission and the Court of Appeals of Virginia
Court of Appeals of Virginia
The Court of Appeals of Virginia, established January 1, 1985, is an eleven-judge body that hears appeals from decisions of Virginia's circuit courts and the Virginia Workers' Compensation Commission. The Court sits in panels of at least three judges, and sometimes hears cases en banc...

 allowing workers' compensation benefits for workers with repetitive motion injuries
Repetitive strain injury
Repetitive strain injury is an injury of the musculoskeletal and nervous systems that may be caused by...

, the Virginia Supreme Court issued a ruling prohibiting employees from receiving compensation for those type of injuries on November 5, 1993.

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
Norfolk Admirals
The Norfolk Admirals are a minor professional ice hockey team in the American Hockey League, and are affiliated with the Tampa Bay Lightning. The Admirals play in Norfolk, Virginia, at the Norfolk Scope.-History:...

 hockey player Ty Jones
Ty Jones
Ty Jones is an American professional ice hockey winger. He was drafted in the first round of the 1997 NHL Entry Draft with the 16th overall pick by the Chicago Blackhawks....

 over an injury that he sustained in his role as an enforcer.

Services provided

The VWC is charged with administering the Virginia workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 program, which applies to most employers doing business in Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

 and most employees working in Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

. Other organizations involved in Virginia workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 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
Adjudication
Adjudication is the legal process by which an arbiter or judge reviews evidence and argumentation including legal reasoning set forth by opposing parties or litigants to come to a decision which determines rights and obligations between the parties involved....

 and mediation
Mediation
Mediation, as used in law, is a form of alternative dispute resolution , a way of resolving disputes between two or more parties. A third party, the mediator, assists the parties to negotiate their own settlement...

 services to parties with disputes, and everything in between.

Services for employers

As a general rule, employers with more than two employees in the same business within Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

 are subject to the Virginia Workers' Compensation Act. Employees who suffer on-the-job injuries and diseases may be eligible for workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 benefits. Employers must insure their liability
Legal liability
Legal liability is the legal bound obligation to pay debts.* In law a person is said to be legally liable when they are financially and legally responsible for something. Legal liability concerns both civil law and criminal law. See Strict liability. Under English law, with the passing of the Theft...

 for these benefits through a commercial insurance policy, a self-insurance program, or membership in a professional employer organization
Professional employer organization
A professional employer organization is a single source provider of integrated services which enable business owners to cost-effectively outsource the management of human resources, employee benefits, payroll and workers’ compensation and other strategic services, such as recruiting, risk/safety...

 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.

Services for injured workers

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.

Services for claim administrators

Claim Administrators, or those organizations managing claims activity on behalf of employers and insurance
Insurance
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...

 carriers, play a vital role in the Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

 workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 program. Under section 65.2-900 of the Code of Virginia
Code of Virginia
The Code of Virginia is the statutory law of the U.S. state of Virginia, and consists of the codified legislation of the Virginia General Assembly. The 1950 Code of Virginia is the revision currently in force...

, 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
Electronic Data Interchange
Electronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...

 (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.

Rights and remedies for medical providers

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 of the Code of Virginia
Code of Virginia
The Code of Virginia is the statutory law of the U.S. state of Virginia, and consists of the codified legislation of the Virginia General Assembly. The 1950 Code of Virginia is the revision currently in force...

 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:
  • 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
    Prescription drug
    A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...


Mediation

Mediation
Mediation
Mediation, as used in law, is a form of alternative dispute resolution , a way of resolving disputes between two or more parties. A third party, the mediator, assists the parties to negotiate their own settlement...

 may be requested in addition to Adjudication
Adjudication
Adjudication is the legal process by which an arbiter or judge reviews evidence and argumentation including legal reasoning set forth by opposing parties or litigants to come to a decision which determines rights and obligations between the parties involved....

.
  • Informal, cost-effective means of alternative dispute resolution
    Dispute resolution
    Dispute resolution is the process of resolving disputes between parties.-Methods:Methods of dispute resolution include:* lawsuits * arbitration* collaborative law* mediation* conciliation* many types of negotiation* facilitation...

  • Parties design their own solutions with the help of a Commission mediator
    Mediation
    Mediation, as used in law, is a form of alternative dispute resolution , a way of resolving disputes between two or more parties. A third party, the mediator, assists the parties to negotiate their own settlement...

  • 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
    Mediation
    Mediation, as used in law, is a form of alternative dispute resolution , a way of resolving disputes between two or more parties. A third party, the mediator, assists the parties to negotiate their own settlement...

     request form.


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
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 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.

Services for attorneys

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
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 information. Online access is available to attorneys through WebFile, the Commission's web-based file access portal. Judicial opinions are available for searching online.

Services for self-insured organizations

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
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 in Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

.

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
Bond (finance)
In finance, a bond is a debt security, in which the authorized issuer owes the holders a debt and, depending on the terms of the bond, is obliged to pay interest to use and/or to repay the principal at a later date, termed maturity...

 from a licensed surety company, Certificate of Deposit
Certificate of deposit
A certificate of Deposit is a time deposit, a financial product commonly offered to consumers in the United States by banks, thrift institutions, and credit unions....

, United States government obligations, Letter of Credit
Letter of credit
A standard, commercial letter of credit is a document issued mostly by a financial institution, used primarily in trade finance, which usually provides an irrevocable payment undertaking....

 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
Subsidiary
A subsidiary company, subsidiary, or daughter company is a company that is completely or partly owned and wholly controlled by another company that owns more than half of the subsidiary's stock. The subsidiary can be a company, corporation, or limited liability company. In some cases it is a...

 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.

Services for Group Self-Insurance Associations (GSIAs)

Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

 employers that are required to insure their workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 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 of the Code of Virginia
Code of Virginia
The Code of Virginia is the statutory law of the U.S. state of Virginia, and consists of the codified legislation of the Virginia General Assembly. The 1950 Code of Virginia is the revision currently in force...

. The program is administered by the State Corporation Commission
State Corporation Commission
The State Corporation Commission, or SCC, is a Virginia regulatory agency whose authority encompasses utilities, insurance, state-chartered financial institutions, securities, retail franchising, and railroads...

, 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.

Services for Professional Employer Organization
Professional employer organization
A professional employer organization is a single source provider of integrated services which enable business owners to cost-effectively outsource the management of human resources, employee benefits, payroll and workers’ compensation and other strategic services, such as recruiting, risk/safety...

s (PEOs)

Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

 employers required to insure their workers' compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 liability may be eligible to participate in a professional employer organization
Professional employer organization
A professional employer organization is a single source provider of integrated services which enable business owners to cost-effectively outsource the management of human resources, employee benefits, payroll and workers’ compensation and other strategic services, such as recruiting, risk/safety...

. The Virginia Workers' Compensation Act established this program in section 65.2-803.1 of the Code of Virginia
Code of Virginia
The Code of Virginia is the statutory law of the U.S. state of Virginia, and consists of the codified legislation of the Virginia General Assembly. The 1950 Code of Virginia is the revision currently in force...

. The program is administered by the Commission.

Pursuant to Section 65.2-803.1, all Professional Employer Organization
Professional employer organization
A professional employer organization is a single source provider of integrated services which enable business owners to cost-effectively outsource the management of human resources, employee benefits, payroll and workers’ compensation and other strategic services, such as recruiting, risk/safety...

s must register with this Commission prior to transacting business in Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...

, 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 organization
Professional employer organization
A professional employer organization is a single source provider of integrated services which enable business owners to cost-effectively outsource the management of human resources, employee benefits, payroll and workers’ compensation and other strategic services, such as recruiting, risk/safety...

s 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.

External links

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