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RULES OF THE VIRGINIA WORKERS'
COMPENSATION COMMISSION
Amended effective March 12, 2009
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These rules are issued to provide procedures
to identify and resolve disputed issues promptly through informal dispute
resolution or hearing.
The following words and terms, when used
in these rules, shall have the following meaning, unless the context clearly
indicates otherwise:
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"Act" means the Virginia Workers'
Compensation Act.
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"Commission" means the Virginia
Workers' Compensation Commission.
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"Employer" includes the employer's
insurance carrier unless the context otherwise requires.
Rule
1. Prehearing Procedures
1.1 Employee's Original Claim
for Benefits
Rules text
An employee's original claim for
benefits shall be filed within the applicable statutes of limitation.
- An original claim for benefits shall be in writing,
signed and should set forth:
- Employee's name and address;
- Employer's name and address;
- Date of accident or date of communication of
occupational disease;
- Nature of injury or occupational disease;
- Benefits sought: temporary total, temporary
partial, permanent total, permanent partial or medical benefits;
- Periods of disability, if appropriate.
1.2 Employee's Claim on the Ground
of Change in Condition or Other Relief
Rules text
- A change in condition claim must be in writing
and state the change in condition relied upon. A copy of the claim
should be sent to the employer.
- Additional compensation may not be awarded more
than 90 days before the filing of the claim with the Commission.
Requests for cost of living supplements are not subject to this
limitation.
1.3 Dismissal Upon Failure to
File Supporting Evidence
Rules text
If supporting evidence is not filed
within 90 days after an employee's claim is filed, it may be dismissed
upon motion of the employer after notice by the Commission to the
parties.
1.4 Employer's Application for
Hearing
Rules text
- An employer's application for hearing shall be
in writing and shall state the grounds and the relief sought.
At the time the application is filed with the Commission, a copy
of the application and supporting documentation shall be sent
to the employee and a copy to the employee's attorney, if represented.
- Each change in condition application filed by
an employer under § 65.2-708 of the Code of Virginia shall:
- Be in writing;
- Be under oath;
- State the grounds for relief; and
- State the date for which compensation was last
paid.
- Compensation shall be paid through the date the
application was filed, unless:
- The application alleges the employee returned
to work, in which case payment shall be made to the date of
the return.
- The application alleges a refusal of selective
employment or medical attention or examination, in which case
payment shall be made to the date of the refusal or 14 days
before filing, whichever is later.
- The application alleges a failure to cooperate
with vocational rehabilitation, in which case payment must be
made through the date the application is filed.
- An employer files successive applications,
in which case compensation shall be paid through the date required
by the first application. If the first application is rejected,
payment shall be made through the date required by the second
application.
- The same application asserts multiple allegations,
in which case payment is determined by the allegation that allows
the earliest termination date.
- An employer may file a change in condition application
while an award is suspended.
- No change in condition application under § 65.2-708
of the Code of Virginia shall be accepted unless filed within
two years from the date compensation was last paid pursuant to
an award.
- A change in condition application may be accepted
and docketed when payment of compensation continues.
1.5 Acceptance or Rejection of
Claim or Application
Rules text
- After receipt the Commission shall review the
claim or application for compliance with the Workers' Compensation
Act and Rules of the Commission.
- The Commission may order the employer to advise
whether the employee's claim is accepted or to provide reasons
for denial.
- Response to the order shall be considered a
required report pursuant to § 65.2-902 of the Code of Virginia.
- The employer's response to this order shall
not be considered part of the hearing record.
- If the employer's application is technically
acceptable, the opposing party shall be permitted up to 15 days
from the date the application was filed to present evidence in
opposition to the application.
- Pending acceptance or rejection of the application,
the employer may suspend or modify compensation payments as
of the date for which compensation was last paid.
- If rejected, the Commission shall advise the
employer of the reason for rejection and compensation shall
be reinstated immediately.
- If accepted, the application shall be referred:
- For dispute resolution,
- For decision on the record, or
- For an evidentiary hearing.
1.6 Review of Decision Accepting
or Rejecting Claim or Application
Rules text
- A request for review of a decision accepting
or rejecting a change in condition claim or application shall
be filed within 20 days from date of the decision. No oral argument
is permitted.
- The letter requesting a review should specify
each determination of fact and law to which exception is taken.
A copy of the request shall be sent to the opposing party.
- The opposing party shall have 10 days from the
date the review request is filed to provide a written response
to the Commission.
- Only information contained in the file at the
time of the original decision along with the review request and
any response from the opposing party will be considered. Additional
evidence will not be accepted.
- If rejection of a claim or application is affirmed
on review, the penalty and interest provisions of §§ 65.2-524
and 65.2-707 of the Code of Virginia shall apply from the date
the application was initially rejected.
1.7 Compromise Settlement; Lump
Sum Payment
Rules text
- A proposed compromise settlement shall be submitted
to the Commission in the form of a petition setting forth:
- The matters in controversy;
- The proposed terms of settlement;
- The total of medical and indemnity payments
made to date of submission and the date through which all medical
expenses will be paid;
- The proposed method of payment;
- Such other facts as will enable the Commission
to determine if approval serves the best interests of the claimant
or the dependents.
- The petition shall be signed by the claimant
and, if represented, an attorney and by the other parties or their
attorneys. An endorsing attorney must be licensed to practice
in Virginia.
- The petition shall be accompanied by:
- A medical report stating the claimant's current
condition and whether the injuries have stabilized;
- An informational letter from the claimant or
counsel stating whether the claimant is competent to manage
the proceeds of the settlement and describing the plan for managing
the proceeds;
- A notarized affidavit attesting the claimant's
understanding of and voluntary compliance with the terms of
the settlement; and
- A fee statement endorsed by the claimant and
the claimant's attorney.
- If the proposed settlement contemplates payment
in a lump sum, the petition shall set forth in detail the facts
relied upon to show that the best interests of the employee or
the dependents will be served thereby.
If the proposed settlement contemplates
an annuity, the petition shall state that the company issuing
the annuity is authorized by the State Corporation Commission
to transact the business of insurance in the Commonwealth and
that, in case of default, the employer or carrier shall remain
responsible for payment.
- The parties shall submit an original proposed
order, properly endorsed.
- Payment shall be due within 10 days after entry
of the order approving the compromise.
1.8 Discovery
Rules text
- Scope and Method. - The scope of discovery shall
extend only to matters which are relevant to issues pending before
the Commission and which are not privileged. It is not ground
for objection that the information sought will be inadmissible
at the trial if the information sought appears reasonably calculated
to lead to the discovery of admissible evidence. Discovery may
be obtained by oral or written deposition, interrogatories to
parties, production of documents or things, requests for admission,
inspection of premises or other means of inquiry approved by the
Commission.
- Limiting Discovery. - The Commission may limit
the frequency or extent of discovery if it is unreasonably cumulative,
duplicative, expensive or if the request was not timely made.
The Commission will consider the nature and importance of the
contested issues, limitations on the parties' resources and whether
the information may be obtained more conveniently and economically
from another source.
- Stipulation to Discovery. - Except as specifically
provided by these rules, the parties may by written stipulation
agree to other methods of discovery or provide that depositions
may be taken before any person, at any time or place, upon any
notice and in any manner and when so taken may be used like other
depositions.
- Supplementation of Responses. - A party who has
responded to a request for discovery with a response that was
complete when made is under no duty to supplement a response to
include information thereafter acquired unless such information
materially affects a prior response.
- Protective Order. - Upon good cause shown, the
Commission may enter an order limiting discovery to protect a
party, a witness, or other person from embarassment, oppression,
or undue burden or expense.
- Subpoenas. - A party requesting a subpoena for
witness or subpoena duces tecum shall prepare the subpoena and
submit it to the Commission for insertion of return date and Clerk
certification; a check or money order for service fee, payable
to the appropriate sheriff's office, shall accompany the request.
The Commission shall forward the subpoena and service fee to the
designated sheriff's office, unless requested to do otherwise.
Subpoenaed records may be made
returnable to the requesting party or, at the direction of the
Commission, to the Clerk of the Commission or to a regional office.
If subpoenaed records contain medical reports they must be filed
with the Commission pursuant to Rule 4.2.
Requests for subpoenas may be
filed with the Commission at Richmond or in the regional office
assigned to hear the case.
- Subpoenas for Witnesses. - Requests should
be filed at least 10 days prior to hearing.
- Subpoenas Duces Tecum. - Requests should be
filed at least 15 days before hearing and the subpoena shall
describe with particularity the materiality of the documents
or articles to be produced.
All requests for subpoenas duces
tecum shall be served on each counsel of record, or the unrepresented
party, by delivering or mailing a copy to each on or before the
day of filing. Each request shall have appended either acceptance
of service or a certificate that copies were served in accordance
with the law, showing the date of delivery or mailing.
- Depositions. - After a claim or application has
been filed, any party may take the testimony of any person, including
a party, by deposition upon oral examination or upon written questions.
The attendance of witnesses may
be compelled by subpoena. The deposition of a party or physician
may be taken without permission of the Commission. Leave of the
Commission shall be obtained to take the deposition of any other
persons. Depositions shall be taken in accordance with the requirements
and limitations of the Rules of the Supreme Court of Virginia
governing actions at law unless the parties stipulate to discovery
as set forth in Rule 1.8(C), supra.
For good cause shown the deposition
of an attending panel physician may be ordered to be taken at
the expense of the employer if the physician has not prepared
and completed an Attending Physician's Report (Form 6) or has
not otherwise prepared written reports which are sufficient to
answer questions concerning injury, diagnosis, causation, disability
and other matters not stipulated and deemed by the Commission
to be material to a claim or to a defense. The expenses of such
depositions are subject to the approval of the Commission.
Depositions shall be filed with
the Commission and be made a part of the record.
- Interrogatories to Parties. - After a claim or
application has been filed, interrogatories limited to contested
issues may be served by one party on another party, more than
21 days before hearing without prior Commission approval.
Answers under oath to each interrogatory
are to be filed within 21 days after service. Objections must
be included with answers. If there is objection to an interrogatory
and the party serving the interrogatory moves the Commission for
relief, the hearing officer shall enter an order resolving the
issue, after giving the parties an opportunity to state their
positions in writing.
No party shall serve upon any
other party, at one time or cumulatively, more than 15 interrogatories,
including all parts and subparts, without leave of the Commission
for good cause shown. Leave shall be timely requested in writing.
Relevant interrogatories should be served promptly upon commencement
of a contested claim.
It is not necessary to file interrogatories
or answers with the Commission unless they are the subject of
a motion.
- Request for Admission. - After a claim or application
has been filed, a party may serve upon any other party a written
request for the admission of the truth of any material matter.
Each request must be numbered
and set forth separately. Copies of documents shall be served
with the request unless they have been furnished or made available
for inspection and copying.
An admission under this rule may
be used only for providing evidence in the proceeding for which
the request was made and shall not have force or effect with respect
to any other claim or proceeding. An admission or denial must
be offered in evidence to be made part of the record. A party
is required to respond within 30 days or be subject to compliance
under Rule 1.8(K) or sanctions under Rule 1.12.
- Production of Wage Information. - If the average
weekly wage is contested, the employer shall timely file a wage
chart showing all wages earned by an employee in its employment
for the term of employment, not to exceed one year before the
date of injury.
If an employee has earned wages
in more than one employment, the employee shall have responsibility
for filing information concerning wages earned in an employment
other than the one in which claim for injury is made.
- Failure to Make Discovery; To Produce Documentary
Evidence; To Comply With Request for Admission. - A party, upon
reasonable notice to other parties and all persons affected thereby,
may request an order compelling discovery as follows:
A timely request in writing in
the form of a motion to compel discovery may be made to the Commission
or to such regional office of the Commission where an application
is assigned to be heard.
Failure of a deponent to appear
or to testify; failure of a party on whom interrogatories have
been served to answer; failure of a party or other person to respond
to a subpoena for production of documents or other materials;
or failure to respond to a request for admission shall be the
basis for an order addressing a request to compel compliance or
for sanctions, or both.
- Disposition of Discovery Material. - Any discovery
material not admitted in evidence and filed in the Commission
may be destroyed by the Clerk of the Commission after one year
from entry of a final decision of the Commission or appellate
court.
1.9 Informal Dispute Resolution
Rules text
At the request of either party,
or at the Commission's direction, contested claims and applications
for hearing will be evaluated and may be referred for informal dispute
resolution. When it appears that a claim may be resolved by informal
dispute resolution, the Commission will refer the case to a Commission
representative who may schedule the parties for personal appearance
or telephone conference. The Commission will attempt to identify
disputed issues and to bring about resolution through agreement.
Parties need not be represented by counsel. If agreement is reached
it shall be reduced to writing and shall be binding.
Examples of limited issues often
subject to prompt resolution are:
- Average weekly wage;
- Closed periods of disability;
- Change in treating physician;
- Contested medical issues including bills;
- Permanent disability ratings;
- Return to work;
- Failure to report incarceration, change in
address or return to work;
- Attorney fee disputes.
If there is no agreement between
the parties and there is no material fact in dispute, issues may
be referred for decision on the record. If it is determined that
material issues of fact are in dispute or that oral testimony will
be required, the case will be referred to the docket for evidentiary
hearing.
1.10 Willful Misconduct
Rules text
If the employer intends to rely
upon a defense under § 65.2-306 of the Act, it shall give to the
employee and file with the Commission no less than 15 days prior
to the hearing, a notice of its intent to make such defense together
with a statement of the particular act relied upon as showing willful
misconduct.
1.11 Prehearing Statement
Rules text
The Commission may require a prehearing
statement by the parties as to the particulars of a claim and the
grounds of defense.
1.12 Enforcement of the Act and
Rules of the Commission; Sanctions
Rules text
In addition to the statutory authority
of the Commission to levy fines, to assess attorney fees and punish
contempt, the Commission may enforce its rules and the provisions
of the Workers' Compensation Act upon motion of a party, or upon
its own motion, after giving a party or other interested person
the opportunity to be heard, by imposition of the following sanctions:
- Rejection of a pleading including, but not limited
to, all or part of a claim and grounds of defense;
- Exclusion of evidence from the record;
- Dismissal of a claim or application.
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Rule 2.
Hearing Procedures.
Rules text
At the request of either party,
or at the Commission's direction, contested issues not resolved
informally through prehearing procedures will be referred for decision
on the record or evidentiary hearing.
2.1 Decision on the Record
Rules text
When it appears that there is no
material fact in dispute as to any contested issue, determination
will proceed on the record. After each party has been given the
opportunity to file a written statement of the evidence supporting
a claim or defense, the Commission shall enter a decision on the
record.
- Written Statements. - - When the Commission
determines that decision on the record is appropriate, the parties
shall be given 20 days to submit written statements and evidence.
Ten additional days shall be given to respond. For good cause
shown additional time may be allowed. Copies of all written statements
and evidence shall be furnished to the Commission and all parties.
- Review. - - Request for review of decision
on the record shall proceed under § 65.2-705 of the Code of Virginia
and Rule 3.
2.2 Evidentiary Hearing
Rules text
An evidentiary hearing by the Commission
shall be conducted as a judicial proceeding. All witnesses shall
testify under oath and a record of the proceeding shall be made.
Except for rules which the Commission promulgates, it is not bound
by statutory or common law rules of pleading or evidence nor by
technical rules of practice.
The Commission will take evidence
at hearing and make inquiry into the questions at issue to determine
the substantial rights of the parties, and to this end hearsay evidence
may be received. The party having the burden of proof shall have
the right to open and close. Each party shall be allowed 20 minutes
in which to present evidence unless prior arrangement is made through
the Commission to extend hearing time.
- Continuances. - The parties should be prepared
to present evidence at the time and place scheduled for hearing.
A motion to continue will be granted only when it appears that
material or irreparable harm may result if not granted.
- Evidence.
- Stipulations to agreed facts shall be included
in the record. Each exhibit offered shall be marked and identified,
and the record shall show whether it was admitted in evidence.
- Reports and records of physicians and reports
of medical care directed by physicians may be admitted in evidence
as testimony by physicians or medical care providers. Upon timely
motion, any party shall have the right to cross-examine the
source of a medical document offered for admission in evidence.
- The parties shall specifically designate, by
author, deponent and date, medical reports, records or depositions
to be received in evidence. Those portions of a deposition to
be included in the record must be specifically identified by
page and line.
- Medical reports, records or deposition portions
designated by the parties or included by the Commission will
be admitted into evidence.
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2.3 Expedited Hearing
Rules text
An employee may request an expedited hearingbefore the Commission when
the employer has submitted an Application for Hearing pursuant to Rule
1.4 and probable cause has been found to suspend benefits pending a hearing
on the matter. An employee may also seek expedited determination of any
disputed claim arising after the initial compensability of the accident
has been determined by the Commission.
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Written Request. - An employee seeking an expedited
hearing must file a written request with the Clerk's office, and a
copy of the request shall be sent to the employer. The request must
include, by way of description, attachment or enclosure, evidence
sufficient to find that, without an expedited proceeding to determine
the merits of the dispute, the employee will be caused to suffer severe
economic hardship. What constitutes severe economic hardship will
be determined by the Commission on a case-by-case basis. A copy of
the employee's accepted request will be sent to the employer's counsel
of record, the designated third-party administrator and the carrier,
along with a Notice of Request For Expedited Hearing, by priority
mail.
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Loss of Income. - When the employee alleges that
he/she is not receiving compensation benefits, and is unemployed,
unable to work, or only partially employed because of an injury compensable
under the Act, the employee must establish that failure to grant an
expedited hearing will result in severe, immediate economic hardship.
In this regard, the Commission will consider, but is not limited in
considering the following evidence:
- Whether, and to what extent, the employee is presently employed,
and what other sources of income are available to support the employee;
- Whether the employee has dependents for whom the employee’s
wages, salary and/or other income were the sole or primary source
of financial support;
- Whether the employee has received notices of imminent or threatened
foreclosure or eviction actions, or the employee is in a state of
homelessness;
- Whether the employee has received notices of imminent repossession
of personal vehicles necessary for employment or medical treatment
visits;
- Whether the employee’s financial difficulties were caused
by the termination of workers’ compensation benefits by prior
adjudication, caused by other circumstances, or both; and
- Any other evidence demonstrating that the employee’s immediate
ability to provide food, clothing and shelter will be threatened
by failure to grant an expedited hearing.
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Medical Expenses. - When the employee seeks an
expedited hearing, asserting that authorization of, or payment for
recommended medical treatment has been denied by the employer or insurer,
the employee must establish that failure to grant an expedited hearing
will result in severe economic hardship. In this regard, the Commission
will consider, but is not limited in considering the following evidence:
1. The general nature of the employee’s injuries;
2. Whether, if authorization is being sought for
recommended treatment not already obtained, the employee’s physician
has stated that the procedure must be performed on an emergent basis,
and failure to do so will threaten the employee’s life or result
in immediate and severe deterioration of the employee’s physical
or mental condition;
3. Whether, if payment or reimbursement for medical
expenses already incurred is being sought, reasonable and necessary
ongoing medical treatment will be withheld for failure to pay for
prior medical treatment, and that the withholding of such treatment
will threaten the employee’s life or result in immediate and
severe deterioration of the employee’s physical or mental condition;
4. The cost of the medical treatment in dispute,
and the employee’s ability to pay for it; and
5. Any other evidence demonstrating that failure
to grant an expedited hearing on this issue will result in severe
economic hardship.
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Employer Response. - Upon receipt of the Commission’s
Notice of Request for Expedited Hearing, the employer shall have fourteen
(14) days to investigate the basis for the employee’s expedited
hearing request. Prior to, or at the expiration of the fourteenth
day, the employer shall file with the Commission, by hand-delivery
or certified mail, a written statement indicating whether the employer
will or will not agree to the employee’s request for expedited
hearing. If the employer will not agree to proceed on an expedited
basis, it must state, with specificity, the basis for its inability
to proceed pursuant to an expedited hearing schedule. Filing shall
be effective upon receipt by the Commission, or by placing the statement
in certified mail.
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Informal Conference - Once the Commission has received
the employer’s response statement, or fourteen (14) days pass
without a filed response from the employer, the Commission shall schedule,
as expeditiously as possible, an informal conference with the parties,
whether in person, by teleconference or by other electronic transmission.
With regard to expedited claims for payment of medical expenses pursuant
to Rule 2.2 (D), no informal conference will be scheduled until the
employee submits medical evidence to the employer and the Commission
supporting both the underlying claim and the necessity of expedited
proceedings. During the informal conference, the Commission will discuss
issues relevant to the grant or denial of an expedited hearing including,
but not limited to, discovery between the parties, the timing and
scheduling of depositions and the parties’ ability to secure
other relevant evidence in an expedited manner. The Commission will
discuss the issues raised by the claim, and try to limit the scope
of any matter ultimately referred to the expedited hearing docket
by facilitating agreements between the parties. The Commission will
confer with the parties about scheduling a hearing date at the informal
conference, or by teleconference after the informal conference.
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Grant or Denial of Expedited Hearing. - During the
informal conference, or within seven (7) days of its completion, the
Commission will determine whether the claim underlying the request
for expedited hearing is appropriate for the expedited hearing docket.
If the request for an expedited hearing is granted, the Commission
will advise the parties of this decision during the informal conference,
or in writing within seven (7) days, by priority mail. If the Commission
determines that the matter is not appropriate for the expedited docket,
the parties will be advised of the Commission’s determination,
and the matter will be referred for regular processing.
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Scheduling and Continuances. - The matter will be
set for a hearing no less than ten (10) days, and no more than twenty-eight
(28) days after the expedited hearing was granted. Ordinarily, once
the matter is set down for an expedited hearing, neither party will
be granted a continuance. A continuance will be granted only for good
cause shown, involving exceptional circumstances beyond the control
of the party, or the party’s attorney. Any claim pending on
the expedited docket that is continued or non-suited at the request
of the employee will be removed from the expedited docket, and shall
not be reinstated for expedited proceedings.
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Closing the Record. - The record shall close at the
end of the expedited hearing unless, for good cause shown, one or
both parties are unable to present necessary medical or factual evidence.
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Decision. - The Deputy Commissioner hearing the case
will issue an opinion within fourteen (14) days after the record closes
in an expedited hearing proceeding. The opinion shall be sent to the
parties by priority mail.
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Expedited Review. - Either party may seek an expedited
Review of the decision to grant or deny an expedited hearing. Parties
seeking expedited Review must file a written request within seven
(7) days of receipt of the decision to grant or deny an expedited
hearing. The written request must include a statement explaining the
grounds for review, and must enclose all information the party believes
is necessary for consideration of the request. A copy of the Request
for Expedited Review shall be furnished to the opposing party. The
Commission shall provide Notice of the request for expedited review
within three (3) days of its receipt. The opposing party shall have
seven (7) days from receipt of the Commission’s Notice to file
a written statement addressing the merits of the review request, and
enclosing all information it believes is necessary for consideration
on review. The Commission shall review the decision to grant or deny
an expedited hearing, and will issue a decision by Order within seven
(7) days.
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Review After Expedited Hearing. - Review of a Deputy
Commissioner’s decision following an expedited hearing shall
proceed according to the provisions of Rule 3.1 and § 65.2-705
of the Code of Virginia.
Rule 3.
Posthearing Procedures.
3.1 Request for Review
Rules text
A request for review of a decision or
award of the Commission shall be filed by a party in writing with the
Clerk of the Commission within 20 days of the date of such decision
or award.
A request for review should assign as
error specific findings of fact and conclusions of law. Failure of a
party to assign any specific error in its request for review may be
deemed by the Commission to be a waiver of the party's right to consideration
of that error. The Commission may, however, on its own motion, address
any error and correct any decision on review if such action is considered
to be necessary for just determination of the issues.
A copy of the request for review shall
be furnished to the opposing party. Upon request to the Clerk, a party
may obtain a copy of the hearing transcript subject to an appropriate
charge.
3.2 Written Statements
Rules text
The Commission will advise the parties
of the schedule for filing brief written statements supporting their
respective positions. The statements shall address all errors assigned,
with particular reference to those portions of the record which support
a party's position.
3.3 Additional Testimony
Rules text
No new evidence may be introduced by
a party at the time of review except upon agreement of the parties.
A petition to reopen or receive after-discovered evidence may be considered
only upon request for review.
A petition to reopen the record for
additional evidence will be favorably acted upon by the full Commission
only when it appears to the Commission that such course is absolutely
necessary and advisable and also when the party requesting the same
is able to conform to the rules prevailing in the courts of this State
for the introduction of after-discovered evidence.
3.4 Oral Argument
Rules text
A party may request oral argument at
the time of application for review. Otherwise, the review shall proceed
on the record.
If oral argument is requested and the
Commission considers it necessary or of probable benefit to the parties
or to the Commission in adjudicating the issues, the parties will be
scheduled to present oral argument.
Any party may request the Commission
to schedule argument by telephone conference by giving notice to the
Clerk of the Commission and to opposing counsel at least five days before
the scheduled date for argument.
Each side will be limited to no more
than 15 minutes for presentation of oral argument.
If oral argument is requested and the
requesting party fails to appear in person or by scheduled telephone
conference, the Commission may impose sanctions in the absence of good
cause shown.
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Rule 4. Filing
Documents.
4.1 Agreements
Rules text
All agreements as to payment of compensation
shall be reduced to writing by the employer and promptly filed with
the Commission. If the claim is denied the employer shall notify the
employee and the Commission promptly in writing.
4.2 Medical Reports
Rules text
Each party shall promptly provide the other parties with copies of any medical records they receive as they receive them. Unless otherwise directed by the Commission or these Rules, the parties shall not file medical records with the Commission until a hearing request is filed. The requesting party shall promptly file medical records supporting the request, if applicable. After a hearing request has been filed, the parties shall file with the Commission only medical records that are related to the hearing request. These records shall be filed upon receipt by the party filing them, and are required reports subject to the provisions of 65.2-902. A party is not required to file copies of medical records that another party has already filed.
A medical care provider attending an injured employee shall, upon request from an employer or an employee, furnish a copy of required reports, at no cost except for a nominal copying charge.
A medical care provider is entitled to a reasonable fee for preparation of a narrative report written in response to a request from a party if the report requires significant professional research or preparation.
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Rule 5. Cost
of Medical Services.
Rules text
A claimant under an award shall not
be liable for the cost of medical services payable under the Act.
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Rule
6. Award of Attorney's Fees Under § 65.2-714 of the Code of Virginia.
6.1 Agreement Between Parties as
to a Fee
Rules text
An attorney's fee shall be awarded from
sums recovered for the benefit of a third-party insurance carrier or
a health care provider pursuant to § 65.2-714 of the Code of Virginia,
if agreement is reached and an order, endorsed by counsel and the carrier
or provider, identifying the amount of medical charges recovered and
the agreed fee, is submitted to the Commission.
6.2 Parties Fail to Agree on a Fee
Rules text
- An Attorney's fee shall be awarded from sums recovered
for the benefit of a third-party insurance carrier or a health care
provider pursuant to § 65.2-714 of the Code of Virginia, if the parties
cannot agree, upon filing of a statement including the name and address
of each carrier or provider from whom the fee is requested, the amount
of the medical charge recovered for each carrier or provider and the
amount of the fee requested, and certification that:
- The claim was contested or that the defense was
abandoned;
- Prior to the filing of a request with the Commission
the attorney and carrier or provider made a reasonable good faith
effort to resolve the matter;
- The insurance carrier or health care provider was
given reasonable notice that a motion for an award of such fee would
be made;
- A copy of the motion has been sent to each carrier
and health care provider identified.
- If the request is referred to the evidentiary hearing
docket, counsel must provide notice of the hearing to each carrier
or provider. The notice must state the amount of the medical charge
recovered for the carrier or provider, the amount of the attorney's
fee requested and the time and place of the hearing.
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Rule 7. Employer
Responsibilities.
7.1 Proof of Insurance Coverage
Rules text
Every employer subject to the Act shall
file with the Commission proof of compliance with the insurance provisions
(§§ 65.2-800 and 65.2-801) of the Act. A notice from the insurer (Form
No. 45F) certifying this fact will be received as acceptable proof.
7.2 Posting Notices
Rules text
Every employer subject to the Act shall
post and keep posted, conspicuously, in the plant, shop or place of
business at a location frequented by employees, notice of compliance
with the provisions of the Act. Such notice shall follow substantially
the form prescribed by the Commission. The Commission will supply employers
with printed notices upon request. Failure by an employer to give such
notice to an employee may constitute waiver of the notice defense pursuant
to § 65.2-600 of the Code of Virginia.
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Rule 8.
Self-Insurance.
8.1 The Commonwealth of Virginia,
Its Municipalities and Political Subdivisions
Rules text
Permission for self-insurance will be
granted by the Commission to the Commonwealth and its political subdivisions
and to Virginia municipalities upon application for certification, without
submission of proof of financial ability and without deposit of bond
or other security. However, the premium tax provided for in § 65.2-1006
of the Act shall be paid.
8.2 Confidentiality of Self-Insurer
Information
Rules text
No record of any information concerning
the solvency and financial ability of any employer acquired by a Commissioner
or his agent by virtue of his powers under the Act shall be subject
to inspection; nor shall any information in any way acquired for such
purposes by virtue of such powers be divulged by a Commissioner or his
agent, unless by order of the court, so long as said employer shall
continue solvent and the compensation legally due from him, in accordance
with provisions of the Act, shall continue to be paid.
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Rule 9. Payment
of Compensation.
9.1 Waiting Period
Rules text
If the employee is not paid wages for
the entire day on which the injury occurred, the seven-day waiting period
prescribed by the Act shall include the day of injury regardless of
the hour of the injury.
All days or parts of days when the injured
employee is unable to earn a full day's wages, or is not paid a full
day's wages, due to injury, shall be counted in computing the waiting
period even though the days may not be consecutive.
9.2 Direct Payment
Rules text
All compensation due an injured employee
or compensation awarded on account of death under the Act must be paid
directly to the beneficiary in accordance with the award. This ruling
applies whether or not the employee is represented.
Compensation awarded shall be paid promptly
and in strict accordance with the award issued by the Commission. When
an award provides for an attorney fee, the employer shall pay the fee
directly to the attorney unless there is alternative provision in the
award.
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Rule 10. X-ray
Evidence for Coal Workers' Pneumoconiosis Claims.
10.1 Limitation on X-ray Submissions
Rules text
In any claim for first, second, or third
stage pneumoconiosis under § 65.2-504 of the Code of Virginia, the employer
and the employee each shall be limited to submission of not more than
three medical interpretations (readings) of x-ray evidence without regard
to the number of x-rays. For good cause shown, additional interpretations
may be received as evidence if deemed necessary by the Commission.
10.2 Reading by Pulmonary Committee
Rules text
Any party to a contested claim, or the
parties upon agreement, may submit the x-ray evidence to the Commission
for interpretation by the Pulmonary Committee. If a party agrees to
accept the x-ray reading of the Pulmonary Committee as the binding classification,
the costs of evaluation shall be borne by the Commission.
10.3 Appointment of Pulmonary Committee
Rules text
The Commission shall appoint a Pulmonary
Committee to be composed of at least three qualified physicians certified
as B readers under standards promulgated by the International Labour
Organization (ILO).
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Rule 11. Pneumoconiosis
Table.
Rules text
A table for conversion of medically-classified
categories of pneumoconiosis (under ILO standards) into stages of pneumoconiosis
shall be promulgated by the Commission and information from the table
shall be the basis for determining the amount of compensation due, if
any, under § 65.2-504 of the Code of Virginia for coal workers' pneumoconiosis
and under § 65.2-503 of the Code of Virginia for other pneumoconioses.
TABLE
Medical interpretations of radiographic
evidence, for the purpose of conversion to stages under this table,
shall be based upon the ILO 1980 International Classification of Radiographs
of the Pneumoconioses.
| First Stage: |
Category |
1 and 2 p,s |
| |
" |
1 q,t |
| Second Stage: |
Category |
3 p,s |
| |
" |
2 and 3 q,t |
| |
" |
1, 2 and 3 r,u |
| Third Stage: |
Category |
A, B and C |
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Rule 12.
Hearing Loss Table.
Rules text
A table for determining compensable
percentage of hearing loss shall be promulgated by the Commission.
All determinations are to be made (i)
without the use of a hearing aid; and (ii) with a pure-tone audiometer
by air conduction alone.
Hearing loss in decibels is to be recorded
at 500, 1,000, 2,000 and 3,000 cycles per second. The audiometer must
be calibrated to the ANSI 1969 standard.
The average decibel loss is to be translated
into percentage of compensable hearing loss of each ear according to
the following table:
| Average
Decibel
Loss |
Percent
of
Compensable
Hearing Loss |
Average
Decibel
Loss |
Percent
of
Compensable
Hearing Loss |
| 27
|
0.8
|
60
|
55.0
|
| 28
|
2.2
|
61
|
56.7
|
| 29
|
3.6
|
62
|
58.3
|
| 30
|
5.0
|
63
|
60.0
|
| 31
|
6.7
|
64
|
61.7
|
| 32
|
8.3
|
65
|
63.3
|
| 33
|
10.0
|
66
|
65.0
|
| 34
|
11.7
|
67
|
66.7
|
| 35
|
13.3
|
68
|
68.3
|
| 36
|
15.0
|
69
|
70.0
|
| 37
|
16.7
|
70
|
71.7
|
| 38
|
18.3
|
71
|
73.3
|
| 39
|
20.0
|
72
|
75.0
|
| 40
|
21.7
|
73
|
76.4
|
| 41
|
23.3
|
74
|
77.8
|
| 42
|
25.0
|
75
|
79.2
|
| 43
|
26.7
|
76
|
80.6
|
| 44
|
28.3
|
77
|
82.0
|
| 45
|
30.0
|
78
|
83.4
|
| 46
|
31.7
|
79
|
84.8
|
| 47
|
33.3
|
80
|
86.2
|
| 48
|
35.0
|
81
|
87.6
|
| 49
|
36.7
|
82
|
89.0
|
| 50
|
38.3
|
83
|
90.4
|
| 51
|
40.0
|
84
|
91.8
|
| 52
|
41.7
|
85
|
93.2
|
| 53
|
43.3
|
86
|
94.6
|
| 54
|
45.0
|
87
|
96.0
|
| 55
|
46.7
|
88
|
97.4
|
| 56
|
48.3
|
89
|
98.8
|
| 57
|
50.0
|
90
|
|
| 58
|
51.7
|
and
|
|
| 59
|
53.3
|
over
|
100
|
No allowance for presbycusis is to be
made
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Rule 13. Table
of Percentage of Loss of Visual Acuity.
Rules text
SNELLEN'S CHART
| Snellen's
Chart
Readings |
Percentage
of Loss of Visual Acuity |
| 20/20
|
0
|
| 20/25
|
5
|
| 20/30
|
10
|
| 20/40
|
20
|
| 20/50
|
25
|
| 20/60
|
331/2
|
| 20/70
|
40
|
| 20/80
|
50
|
| 20/90
|
621/2
|
| 20/100
|
75
|
| 20/110
|
80
|
| 20/120
|
85
|
| 20/130
|
87
|
| 20/140
|
89
|
| 20/150
|
91
|
| 20/160
|
93
|
| 20/170
|
95
|
| 20/180
|
97
|
| 20/190
|
99
|
| 20/200
|
100
|
Any other deviation from normal vision
caused by the injury shall be considered.
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Rule 14.
Definition of Community.
Rules text
For purposes of Code of Virginia Section
65.2-605, the word "community" shall mean one or more planning districts
as set forth below:
| Community
|
Planning
District(s) |
| 1
|
Districts 1 &
2 |
| 2
|
District 3
|
| 3
|
District 4
|
| 4
|
District 5
|
| 5
|
District 11 &
13 |
| 6
|
District 12
|
| 7
|
District 6
|
| 8
|
District 7
|
| 9
|
District 16
|
| 10
|
District 9 &
10 |
| 11
|
District 8
|
| 12
|
District 17 &
18 |
| 13
|
District 22 &
23 |
| 14
|
District 14 &
15 |
| 15
|
District 19
|
Virginia Planning District
Map
Whenever an employee receives treatment
outside of the Commonwealth, the Commission will determine the appropriate
community in the state or territory where the treatment is rendered
upon application of either the employee, employer (or its representative),
or medical provider.
When the commission deems appropriate,
it may consider additional data to determine the prevailing community
rate.
(Effective July 1, 1996.)
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