What is a Hearing?

Step 1: Notice of Hearing or Show Cause Order
Step 2: Hearing Held
Step 3: Written Decision Issued (available on WebFile for paperless parties or mailed to others)

Please note: More than one of these may apply, and these are not the only reasons for a hearing.

Claim Denial:

• Cause of Injury/Disease: Employer or insurance carrier denies that the injury or disease occurred because of the job.
• Timely Filing: Insurance carrier denies the claim was filed on time.

Disputes:

• Benefits: The injured worker may disagree with the type or amount of benefits to be paid, such as whether wage replacement benefits should be paid or whether specific medical treatment is needed due to the work injury.
• Agreement: The injured worker may disagree with the terms of an Award Agreement offered by the carrier.

Insurance Coverage:

An employer may be required to attend a hearing to determine whether the business was obligated to maintain workers’ compensation insurance during a period when coverage was not in place.

Permanent Disability:

A hearing can be held to determine the extent of an injured worker’s permanent loss or loss of use of a body part.

An employee, employer, or insurance carrier can request a hearing with the Virginia Workers' Compensation Commission if a dispute arises from a workers’ compensation claim.

For Injured Workers:

A written claim must be filed with the Commission prior to requesting a hearing after a denial of benefits. Here is a Claim Form that may be used.

For Employers (injury or disease cases):

A hearing may be initiated through the Employer’s Application for Hearing Form.

For Employers (insurance coverage cases):

• The Show Cause Hearing is initiated by the Virginia Workers’ Compensation Commission.
• Appealing the penalty assessed for failing to respond to an Order to Respond when an administrative waiver of the fine has been denied: A hearing may be initiated by the employer filing a written request for a hearing.

Expedited Hearing:

A faster hearing may be available for injured workers who already have an Award Order in cases when the employer or insurance company has stopped lost wages benefits or medical treatment AND the injured worker will suffer severe economic hardship from not having the income or if not having the medical treatment threatens the life of the injured worker.

Procedure for requesting an expedited hearing:

1. Determine that your case is eligible for an expedited hearing:
   
   • Injured worker must have an existing Award.
   • The injured worker’s continuing benefits have been stopped, or a request for additional benefits or medical treatment was denied, causing the injured worker severe economic hardship, which can be proven.
2. File a written request
   
   • The Expedited Hearing Request Form may be used.
   • Provide all information requested and provide evidence of severe economic hardship or need for medical treatment.
3. Response from employer/insurance company
   
   • The other party will be allowed to send a letter indicating whether they agree or disagree with an expedited hearing.
4. Informal Conference
• The Commission may hold an informal conference to discuss the issues and decide on the request.
5. Be ready for the hearing
   
   • If an expedited hearing is approved, the hearing will be scheduled 10 to 28 days after the decision to approve. Everyone must be ready to prove their case on the date the hearing is set.

Petition for Medical Treatment (PMT):

The Virginia Workers’ Compensation Commission’s PMT Program assists in speeding up decisions on the delivery of medical care. The program is available when all of the conditions below are met:

• An Award has been entered
• A treating physician is established
• The employer is represented by counsel
• The request is for medical care or treatment only
• Must be a WebFile user

A Petition for Medical Treatment may be filed when the above conditions are met.

The petitioning party (usually the injured worker) must include documentation supporting the requested care (surgery, diagnostic tests, physical therapy, medication, etc.). The respondent (usually the employer or insurance carrier) has 7 calendar days to advise the Commission and requesting party of whether the care requested is approved or denied.

If no response is received, a telephone conference will be scheduled with the Commission’s Chief Deputy Commissioner (or designee), claimant’s counsel (or the claimant if unrepresented) and defense counsel. See the instructions included with the form to determine if a case is eligible for the program.

Parties unrepresented by an attorney may direct questions to the Commission’s Ombuds Department: 833-448-1681; ombuds@workcomp.virginia.gov. Please note that the Commission cannot give legal advice. All conversations will be kept confidential.

Evidentiary Hearing:

An Evidentiary hearing is a formal hearing in which the parties personally appear before a Deputy Commissioner. Witnesses can testify and physical evidence is presented to resolve legal and factual disputes.

Show Cause Hearing:

A formal hearing held by order of the Commission directing a party to appear on a certain date to show cause or explain why the Commission should not issue a specific order or make a certain finding. Example: To show cause why an employer with no workers’ compensation coverage should not be assessed a monetary penalty for failure to insure for workers’ compensation. A Show Cause Hearing can also be requested to enforce a previous order.

On-the-Record Hearing/Review:

An On-the-Record hearing is a hearing in which there appear to be no material facts in dispute as to any contested issue. The parties do not personally appear before a Deputy Commissioner. After each party has been given the opportunity to file a position statement of the evidence supporting a claim or defense, the Commission enters a decision on the record.