Awards In Workers Compensation Cases: What’s The Big Deal?
“Are you under the protection of an award?” Lawyer Landau asks this question in every single case. The Team at Abrams Landau recognizes how important this is because it indicates whether a case may be in “safe harbor” or headed for trouble.
What does an Award Order mean?
This means that an Employer’s First Report of an Accident has been filed, which is the official document that starts a worker’s compensation claim in Virginia. By law, employers, insurance companies, and Third Party Administrators (TPAs) must report workplace injuries, occupational diseases, and fatalities to the government or face fines. If a case file has an Order from the Virginia Workers Compensation Commission (VWC), it is like a Court Order. If someone doesn’t follow what the Order says, they can be held in Contempt of Court. The Order will state the basic facts of the case: the date of injury, body parts affected, compensation rate (if any), to whom compensation is to be paid, by whom it is to be paid, and who else may be involved in the case. These other parties may be the TPA, Claims Administration Service, Administrator of an Estate (in the case of a fatal workplace injury), or other person in the case of a minor or incompetent claimant.
In other words, an Award Order is the foundation for a case that sets the parameters for a Worker’s Compensation file going forward. Clients who are under the protection of an Award have certain guaranteed benefits. An Award may say “medical benefits for as long as necessary.” In other words, if a worker sustained a broken leg on the job and needed a series of operations over several years, “as long as necessary” means that they have full coverage for reasonable, related, and authorized treatment for that leg. Even if there are complications, expensive surgeries, and extended time away from work, it still applies within the parameters of the law. That includes if the injured worker moves out of state; changes jobs; gets married and changes their name; or all of the above!
This also means that the Worker’s Compensation Insurance Company is responsible for the bills, without any co-pays, deductibles, limits, etc. In other words, if a worker receives medical care for a broken leg, and the treatment ordered by the authorized treating physician is reasonable and causally related, they should not have any out-of-pocket expenses. This even includes trips to go to the: doctors, therapists, physicals, x-rays, MRIs, and second opinions. Currently, the rate of reimbursement is $0.55 a mile (plus any tolls, parking charges, and other reimbursements to satisfy what Doug Landau calls “The 3Rs” -reasonable, related, and by referral). Doug Landau will send a copy of the Award Order to the treating doctors for several reasons. Firstly, their offices will be informed that they will receive payment according to the Virginia Workers Compensation Commission’s Medical Fee Schedule. Additionally, if the treatment provided by them satisfies “The 3Rs,” they will be compensated. Lastly, the billing information will be recorded in the file.
Many clients assume that they have received an award due to their weekly payments, full pay while on disability, or the payment of their medical bills. However, it’s important to note that these benefits are provided voluntarily and without the safeguard of an official Award. The insurance company or TPA can cut them off for ANY or NO reason. If an Award Order is active, the insurance company or TPA needs to submit an Application to terminate the benefits. This Application should include the reasons for the termination and payment up until the date of the Application. The VWC Claims Division will then assess if there is “probable cause.” If there is no probable cause, the VWC can reject the Application, and benefits will resume. Even then, the Insurance Company or TPA has the “burden of proof” when the case goes to court. In other words, once an injured worker has an Award in hand, they have certain legal protections. Lawyer Landau points out that is why Worker’s Compensation Insurance Companies and TPAs do not like to agree to the entry of an Award and do not like open-ended Awards.
Lawyer Landau further notes that Award Orders protect injured workers in the event that their employer goes bankrupt, merges, or disappears. If those things happen, then the Commonwealth of Virginia will step into the shoes of the defunct employer and pay the benefits. Abrams Landau and other solvent, responsible Virginia employers pay a portion of their Worker’s Compensation premiums into a state-administered fund that takes care of these situations. If a Virginia employer does not have Worker’s Compensation insurance, despite having the necessary number of employees, the Uninsured Employers Fund (UEF) will intervene. The UEF will handle the claim, provide benefits, and pursue the non-compliant employer. This is an added layer of protection for injured and disabled Virginia workers and their families.
An Award Order is also important as it stops the clock from running against the claim. There is a law called the statute of limitations, requiring that the injured worker perfect their claim within two years of the date of injury. The two-year time limit is very strict and can be raised at any time.
Recently, the Abrams Landau Team had a case where the insurance company stopped paying benefits seven years after an on-the-job accident. The insurance company claimed that since there was no Award Order, the case was time-barred. Stating, that the injured worker was not entitled to benefits. Abrams Landau was able to put evidence to show that this injured worker had faxed their Application on the day of the statute, two years after the injury. They also mailed an Application just prior, which arrived after the two-year mark but had the requisite timely USPS postmark.
Because the worker had posted the Application BEFORE the statute of limitations (the legal time limit for compensation claims) ran and had proof of the fax, they were able to show that they still had time, and an Award Order was entered by Stipulation. A “Stipulation Agreement” is a lawyer’s way of saying the other lawyers agreed so that they do not have to go to court for a Hearing. The worker has not only been getting full compensation benefits since then, but the insurance company paid for the time from when they cut the worker off on the technicality until the present, and continuing!
An Award is important as it may lead to other time limits in the case.
Under Virginia Law, if the Award Order specifies an end date for weekly payments of Temporary Total Disability (TTD), Temporary Partial Disability (TPD), or Permanent Partial Disability (PPD), the injured worker must submit a “Change in Condition” application within the designated timeframe to reopen their case. Furthermore, the Worker’s Compensation court will only go back 90 days for weekly benefits. Generally, if the injured worker or their representative does not reopen their case within two (2) years, they are forever barred from seeking weekly wage-loss compensation payments. There are some very limited exceptions to this rule, such as when a prosthetic or other artificial body part implanted due to a workplace injury needs to be repaired, replaced, or revised.
This is why the question of whether someone is under an Award is very important to the Abrams Landau Team. If you, or someone you know, has been injured on the job and has questions about their Award status, their time limits, or other legal rights, please contact us at 703–796–9055, or email frontdesk@landaulawshop.com.