News: E-Blast

We all know the definition of a compensable injury is a “sudden and identifiable injury by accident arising out of and in the course of the employment.” Va. Code § 65.2-101 (emphasis added). However, it is easy to forget that our common understanding of the word “accident” can differ from the definition applied by the Commission in Workers’ Compensation matters. One such instance of this occurs when the injury in question is not “accidental,” but caused by an intentional act. It is well-established pursuant to the Act that an employee’s intentional self-inflicted injury is not compensable. Va. Code § 65.2-306(A)(1);...

Historically, the Commission has followed the precedent set in Morris v. Morris, which ruled “[i]n order to carry his burden of proving an ‘injury by accident,’ a claimant must prove that the cause of his injury was an identifiable incident or sudden precipitating event and that it resulted in an obvious sudden mechanical or structural change in the body.” Morris v. Morris, 238 Va. 578, 589, 385 S.E.2d 858, 865 (1989) (emphasis added). We began to see a shift in the Commission’s analysis of injury by accident claims in cases such as Van Buren v. Augusta County, 66 Va. App....

Thanks to all who attended our Open House in February. It was a great success!  

Dealing with medical providers can prove difficult at times, especially when it comes to agreeing on reasonable prices for the services they render. In a recent decision, Roanoke Ambulatory Surgery Center v. Bimbo Bakeries USA, Inc. , 2019 Va. App. LEXIS 21, the Court of Appeals added an extra layer of difficulty by expanding the time a medical provider has to file an application contesting the sufficiency of payment. Va. Code § 65.2-605.1(F) provides the statute of limitations for medical providers to bring a claim contesting payment for health care services provided to a claimant. Such a claim cannot be heard unless...

An award order is a legal directive issued by the Virginia Workers’ Compensation Commission (“Commission”) requiring the employer and insurance carrier to pay workers’ compensation benefits to a Claimant. However, during the life of a claim, a Claimant’s condition may change warranting a termination of the award order which could lessen the overall exposure of the claim. How do you terminate an award order? There must be a basis to move the Commission to terminate the existing award. The following conditions can form a basis for termination: Claimant returned to pre-injury work; Claimant was released to full-duty work; Claimant returned...

In June, the Commission released a set of preliminary regulations for E-Billing with the aim of having a final rule in place this year, with an implementation date of January 1, 2019. The Commission had a working session in August and received comments from interested parties. On September 18, 2018, the Commission issued its proposed final E-Billing regulations, along with a Companion Guide.   The most noticeable change the Commission made was to move the implementation date back six months to July 1, 2019. All non-exempt providers and payers will be expected to be ready to send and receive bills and payment electronically by that date. In addition, the Commission...

While somewhat infrequent, hearing loss claims do arise from time to time. Thus, it is important that the Virginia adjuster understands how to analyze these claims. It is important to note that these claims, depending upon the facts, may be considered as (1) an injury by accident; (2) a compensable consequence or (3) an ordinary disease of life. The first two require proof by the claimant by a preponderance of the evidence, and the third requires proof by claimant by clear and convincing evidence and not a mere probability. The   Macudzinski v. Omniplex World Service, Inc., VWC File No. 218-73-91 (Feb. 21, 2007) decision is an example of a...

On September 13, 2018, the Commission issued its Annual Report for the year 2017.  In its report, the Commission highlighted several updates to their operations and new programs implemented over the previous year. The Chairman of the Commission, Wesley Marshall, in his Chairman’s Statement pointed out that this year, 2018, marks the 100th Anniversary of Workers’ Compensation in Virginia. He also mentioned the relocation of the Richmond headquarters, and the Manassas and Virginia Beach offices to new locations and the resulting improvement in information security, which allowed the Commission to meet or exceed all of the Virginia Information Technology Agency’s information security standards. Commissioner Marshall made special...

Few topics have garnered as much attention and anticipation as the medical fee schedule that was recently enacted. In the 2016 regular session, the Virginia General Assembly proposed a major change to the landscape of medical payments under the Virginia Workers’ Compensation Act. Thereafter, on March 7, 2016, then Governor Terry McAuliffe signed a bill to implement a medical fee schedule to take effect on January 1, 2018. The new legislation is covered in Virginia Code Section 65.2-605.

A recent Virginia Circuit Court case, Spicer v. Robinson (Circuit Court of Buckingham County, Case No. 16-99), raises concern as to the steps required by the employer and carrier to protect a third party lien. In Spicer the Circuit Court Judge held that a voluntary lump-sum settlement payment to the claimant should not be included as part of the employer’s lien under Virginia Code Sections 65.2-309, -309.1 and -310. The Court noted its reliance on Noblin v. Randolph Corp., 180 Va. 345 (1942) and Slusher v. Paramount Warrior, 336 F. Supp. 1381 (W.D. Va. 1971) in reaching this decision. The Circuit...