News: E-Blast

In Virginia we are continuing to see a good number of Applications advanced by medical providers alleging medical reimbursement disputes. Many of these are involving prescription reimbursements. Just days ago, on August 7, 2025 the Full Commission released two Opinions related to medical provider fee disputes—Wil Hanson v. YMCA of South Hampton Roads, JCN: VA00000493234 (August 7, 2025) and Dyson v. Chesterfield County Public Schools, JCN: 1848504 (August 7, 2025). Both of these Opinions highlight some important strategies for employers and carriers to keep in mind with these cases. It appears to this author that the Commission remains frustrated with...

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In Virginia, the state constitution limits how long the General Assembly can be in session. Legislative sessions are limited to 60 days in even numbered years and 30 days in odd numbered years. After the legislative session ends, on the sixth Wednesday after adjournment, the General Assembly reconvenes for two purposes: to take final action on vetoed bills or bills with proposed amendments from the Governor, and to conclude work on the budget bill. The Constitution even specifies that in the reconvened session that other than returned bills and returned appropriations items and bills, “[n]o other business shall be considered…”...

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With the long period of extreme heat we have experienced in the Commonwealth, employers may experience an influx of workers’ compensation claims for heat stroke and other heat-related injuries. With that in mind, it is a good time to revisit the way that claims resulting from heat exposure are treated in the Virginia Workers’ Compensation Commission to help you make decisions about compensability based on the law. The Virginia Workers’ Compensation Commission has found that heat stoke can be a compensable injury, if it results from conditions of employment greater than the hazards that the public at large are exposed...

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Effective July 17, 2025, Centers for Medicare & Medicaid Services (“CMS”) will no longer review a Medicare Set-Aside (“MSA”) recommendation for a “zero-dollar allocation.” This change comes as an acknowledgement that the significant time and expense of reviewing these zero-dollar MSAs is of little benefit to the Medicare Trust Fund. What this means is that, going forward, Virginia employers are no longer required to submit for CMS approval an MSA in which Medicare’s interests are valued at $0 (Section 8.1, WCMSA Reference Guide). This is a significant change, given the difficulty in recent years in obtaining zero-dollar allocation approval from...

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On September 21, 2023, I published an article on a recent ruling from the Commission that delved into the horseplay/assault dichotomy. The case was Ocasio v. Camping World RV Sales, LLC, JCN VA00001870099 (Sept. 11, 2023) and the Commission’s ruling further entrenched already established black-letter law: The dispositive factor in distinguishing between horseplay and assault is the perpetrator’s intent. If the intent was to simply play a prank, with no intention of causing bodily harm, it’s horseplay (and vice versa for assault). The distinction between horseplay and assault is significant because categorizing a case as a horseplay case or an...

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The Full Commission’s decision in the case of Carballo-Cruz v. JC Brothers Construction, LLC, JCN: VA00002155780 (March 27, 2025) illustrates the limits of employer’s ability to argue the defense of unauthorized treatment. In Carballo-Cruz the employer did not present a panel to the claimant but the claimant did begin treatment with a physician and establish a course of care with that physician. The claimant then decided to abandon care with that physician and selected a different doctor, Dr. Malek, for ongoing treatment. The Deputy Commissioner held that, even though the defendants never provided a panel, the claimant entered a course...

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Earlier this year I authored an article entitled, “Virginia’s Employee Misclassification Law.” As I noted in that article, the Virginia General Assembly passed legislation in 2020 to deter companies from misclassifying their employees and to penalize those employers for having misclassified their workers.  This legislation was in response to a study in Virginia that revealed approximately 214,000 Virginia workers that were misclassified as independent contractors. Independent contractors that have been misclassified often have the following additional claims: 1. Claim For Failure to Pay Overtime The Fair Labor Standards Act (“FLSA”) is a federal statute enacted to ensure that employees are...

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We are pleased to announce we now have you covered in North Carolina, as well as Virginia and Washington D.C.! More information to come!

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In January of this year, the Commission issued an opinion that illustrates the importance of ensuring an injured worker’s injury occurs while engaged in an activity that is indeed a risk common to the neighborhood. In this case, a school bus driver was driving his bus route, which included a stop at a recreational center. When he arrived at the recreational center, the driver parked and exited his bus and began walking towards the building to use the bathroom. As he was walking, he felt a severe pain in his left knee and foot and was thereafter unable to walk....

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Click here to watch this month’s one minute adjuster tip that is on the topic of:  Permanent Total Disability

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