Introduction to Workers’ Compensation

Office on Volunteerism and Community Services

§65.2-603 Duty to Furnish Medical AttentionOffer a panel of three physicians–

http://www.covwc.comIt is important to offer a panelSend in documentation of panel offeringReferrals to other doctors must come from panelInjured workers cannot change physician without

authorization

What Constitutes a Proper Panel?Three physicians who do not share a community

interest in a joint practiceNot valid if includes a physician unwilling to see

new patients or take WC patientsMay not be valid if travel of 50 miles each waySpecialty Panels—eye injuries, etc...Medical clinics do not meet panel requirements

as physicians must be listed by nameAvoid chiropractors, orthopedics are preferred

Where Can an Agency Locate a Panel?Online at http://www.covwc.com

Contact:Chad Smith or LaTarsha McMahand

Return to Work Specialists Chad.Smith@dhrm.virginia.gov or 804-786-2311 LaTarsha.McMahand@dhrm.virginia.gov or 804-786-2310

What Documents Do I Submit?First Report of Injury via Visual Liquid Web

(VLW)Anything Signed by the EmployeeSupervisor’s/Safety Officer’s Investigative

Report/PhotosWritten Witness StatementsMedical ReportsAny Police Reports

First Report of Injury Submit the claim electronically via Visual Liquid

WebVisual Liquid Web claim entry is

https://apps.frankgates.com/vaear-hr

Mail supporting documentation to:Managed Care InnovationsP.O. Box 1140Richmond, VA 23218

Electronically submit scanned documents:covimaging@avizentrisk.com

Identification of AmeriCorps in VLW

Employer Section AgencyAmeriCorps c/o DSS-OVC, Richmond, VaAgency 998

If there is an additional employer or location utilize the Employer case number and location fields in the Employer section

Claims Handling ProceduresIf claim cannot be immediately determined to be covered, the following activities may occur:

Investigations/Recorded StatementsAgency Internal Investigations or PhotosWritten Request for Information from Employer

and Medical Provider30 Day Letter will be sent if no decision can be

made

Coverage for Injuries Under the ActEmployees are entitled to receive compensation

benefits for an “Injury by accident, arising out of and in the course and scope of employment” or and “Occupational Disease”

Benefits include medical bill payment, mileage reimbursement, and prescription reimbursement

Coverage for Going and Coming to Work

Where transportation is provided by the employer, transportation cost reimbursed, or transportation time paid

Where the way used is the sole and exclusive way of ingress or egress or employer constructed

Where the employee is charged with some duty or task in connection with their employment

Exceptions to the going to or from work rule:

Cases Where Coverage May or May Not Apply

Voluntary ActionsHorseplayAssault/Murder/RobberyStress/PTSDIdiopathic/Unexplained FallsHeart AttacksGoing to or Coming from WorkPre-Existing ConditionsSuicideSteps/Stairs

“Willful Misconduct” Defined

The Safety Rule was ReasonableThe Rule was Known to the EmployeeThe Rule was for the Employee’s BenefitThe Employee Intentionally Undertook the

Forbidden Act

Employer Must Establish:

§65.2-603 Eyeglasses (Prosthesis)

Duty to provide only in cases of injury by accident, arising out of and in the course of employment.

Greater Risk and Work Related RiskTo be compensable, an injury must grow out of

risks particular to the nature of the work. Risks to which all persons similarly situated are equally exposed and not traceable to some special degree to the particular employment are excluded.

The mere happening of an accident at the workplace, not caused by any work-related risk or significant work-related exertion, is not compensable.

Injury by Accident, Arising Out of and in the Course of Employment

Occur at work or during a work-related functionBe caused by a specific work activityHappen suddenly at a specified timeNot incurred gradually or as a result of repetitive

traumaNotice must be given to their

Supervisor/Manager within 30 days of the injury

In order to be covered, an “Accident” must:

Your Requirements When a Claim OccursSubmit the claim via Visual Liquid Web (VLW)

within 10 days of the injuryEvaluate work-related injuries and illnesses to

prevent themEstablish goals to reduce serious occupational

injuries and illnesses and to enhance workplace safety

Include in managers’ performance expectations, when appropriate, goals to encourage a safer work environment and reduce injuries and illnesses

Websites to Visit for Phone Numbers, E-mail Addresses, or Answers to Your QuestionsFor the Virginia Workers’ Compensation

Commission:http://www.vwc.state.va.us

For the Dept. of Human Resource Managementhttp://www.dhrm.virginia.gov

For the Managed Care Innovations Workers’ Compensation Programhttp://www.covwc.com