Workers’ Compensation Benefits

Workers’ compensation covers various benefits, detailed below.

If a claim is approved for medical benefits, the employer may be responsible for providing medical treatment through an insurance carrier. Approved coverage, for as long as necessary, includes but is not limited to:

  1. Mileage reimbursement for travel to and from authorized doctor visits
  2. An authorized primary doctor and specialist(s) when medically necessary
  3. Approved coverage will be for reasonable and necessary medical treatment that is due to the work injury from the authorized doctor for as long as necessary. This medical treatment includes, but is not limited to:
    • Mileage reimbursement for travel to and from authorized doctor visits
    • Doctor’s visits
    • Hospitalization
    • Physical therapy
    • Medical tests
    • Prescription drugs
    • Prostheses
  • An employer should provide the injured worker with a list of at least three doctors from which to choose to receive treatment. That doctor then becomes the authorized treating physician.
  • If the employer does not offer three medical providers to choose from after notice of the accident, the injured worker may seek treatment from any physician.
  • The approved treating physician may refer the injured worker to other doctors as needed. Once treatment begins, the doctor cannot be changed without agreement between the injured worker and the employer/carrier, or after a hearing by the Commission.
  • The injured worker must cooperate with medical treatment, otherwise benefits may be suspended.
  • The Commission does not schedule medical appointments. This is the responsibility of the injured worker.
  • A doctor should not bill the injured worker directly. This is the responsibility of the employer’s insurance carrier.
  • Neither the Commission nor the employer pays benefits or medical bills directly to injured workers. Those payments are made by the employer’s insurance carrier.
  • If a claim is approved by the Commission, an Award will be entered by the Commission, and the employer will be responsible for providing medical treatment. This may be through an insurance carrier.

Benefit options that may provide wage loss benefits while the injured worker is out of work or earning less money because of the work injury. There does need to be a doctor’s note or report that supports the benefit requested.

Temporary Disability Benefits

Two temporary benefit options are available as the injured worker recovers from a work-related injury or illness. These are:

  1. Temporary Partial Disability (TPD):

    Temporary total disability covers the injured worker’s wage loss if they cannot do their job either because their doctor took them out of work or because their doctor gave them restrictions that prevent them from being able to do their job. The amount is subject to a statewide maximum reimbursement amount. There is also a minimum compensation rate that may apply.

  2. Temporary Total Disability (TTD):

    Temporary partial disability replaces wage loss that happens if the injured worker is earning less money because of the work injury when they have work restrictions or medical appointments that cannot be scheduled outside of work hours. This benefit supplements any loss of earnings due to the restricted work status.

    Injured workers released to light-duty work who are not under an award for the wage loss benefits being requested must prove that they are actively looking for a light duty job, even if they expect to return to their regular job. They must accept all suitable positions offered, or risk suspension of benefits. Additional details are available on the Marketing Guidelines page.

Please note:

  • No wage loss compensation is payable for the first seven days of loss, (the days do not need to be consecutive), until the loss continues for more than 21 days, then compensation for the first seven days is payable.
  • Injured workers released to light-duty work who do not have an Award for lost wages must prove that they are actively looking for a light-duty job, even if they expect to return to their regular job. They must accept all suitable positions offered, or risk losing wage loss benefits.

Permanent Disability Benefits

Two benefit options are available if a medical provider determines that the injured worker has a permanent work-related injury or illness. These are:

  1. Permanent Partial Disability (PPD)
    • Compensation benefits may be awarded if a doctor determines that an injury to a body part specifically listed in Virginia Code § 65.2- 503 has reached a state of maximum medical improvement and is not expected to improve significantly. These benefits may be awarded based on one of the following: loss of use of an extremity, disfigurement, amputation, loss of vision or hearing, or lung disease.
    • If claiming PPD for a loss of use, it is required to include (1) a medical report from the authorized treating physician which sets forth a percentage of loss of use to a ratable body part pursuant to Virginia Code § 65.2-503, and (2) a statement showing that maximum medical improvement has been reached.
    • If filing a claim for PPD benefits for disfigurement/scarring, it is required that several clear, color photos of the well-healed scarred areas must be provided, along with a statement from the authorized treating physician to show that maximum medical improvement has been reached.
    • If filing a claim for PPD benefits due to amputation, an amputation chart completed by the authorized treating physician must be included. The exact point of amputation must be clearly marked.
  2. Permanent Total Disability (PTD)
    • Lifetime wage replacement may be awarded if the injured worker is totally paralyzed, suffers a loss of use more than one of the following body parts: hand, arm, feet, legs, eyes, or suffers a head injury so severe that the worker is permanently unable to work.
    • Permanent total disability benefits are paid for the rest of the injured workers life.

    Please note- Benefits paid as temporary total disability, temporary partial disability, and permanent partial disability are limited to a total of 500 weeks.

The purpose of the COLA benefit is to ensure, as much as possible, that the value of compensation paid under the Virginia Workers’ Compensation Act does not diminish due to inflation. An injured worker or beneficiary who is receiving temporary total, permanent total or death benefits may be entitled to a COLA. It is the obligation of the injured worker or beneficiary to file for this benefit with the Commission each year and submit certain required information.

View/Download the COLA Request Form.

Learn about the COLA / Benefits calculator.

Services available include vocational evaluation, counseling, job coaching, job development, education, job placement, on-the-job training, and where appropriate, retraining. Review the Guidelines for Vocational Rehabilitation.

In cases where injury or occupational disease results in death, benefits may include payment of funeral/transportation costs and wage loss benefits. Wage loss benefits may be awarded to a surviving spouse, children under the age of 18 (or under 23 if enrolled in an accredited educational institution), or certain other dependents. A copy of the death certificate must be provided. If seeking wage loss benefits, the claim must also include the marriage certificate of the surviving spouse and/or the birth certificate(s) of any children claiming as dependents.