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Do not just accept an insurance carrier’s denial of your claim because they say it is a “pre-existing condition.”  Even if you have a pre-existing injury or condition related to the same body part injured in a work accident, you may still be entitled to medical benefits related to the work accident.  For instance, say (hypothetically) you had a sore knee over the course of a few weeks/months and decide to see a physician.  Your physician says you have degenerative arthritis and advises you to do home stretching exercises.  A few days later, you slip on an oil slick at work and hear (and feel) a “pop” in your knee.  You are seen by a physician shortly after and are advised that you have suffered an exacerbation of your condition and are now unable to work, or can only work in a restricted capacity.  Assuming the slip/accident at work is arising out of your employment (compensable as a work accident), your exacerbated knee injury should be covered by your employer’s workers’ compensation carrier. Remember, the injured worker has the burden to prove they sustained a compensable injury by a preponderance of the evidence.    The injured worker must show four things: 1) an identifiable incident; 2) that occurred at some reasonably definite time; 3) an obvious sudden change or mechanical or structural change in the body; and 4) a causal connection between the incident and the bodily change.”  Assuming you show these elements, you should prevail if you challenge the comp carrier’s denial of your claim. As always, make sure you contact a competent, knowledgeable workers’ compensation lawyer to discuss your claim.  You have rights under the law, don’t be fooled by the workers’ comp carrier. The statements contained herein are for general information purposes only and are not considered specific legal advice regarding your situation as Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information from you personally. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with Darren Shoen by phone or in-person consultation, visit his website at shoenlaw.com, or call 540-586-5003.

Are you wondering if you can get a settlement for your work injury? This blog can help you understand the Virginia workers’ compensation settlement process & hopefully get a better idea of what you should do.   A “settlement” of your claim can mean different things.  Some workers mistakenly think that when they get payment towards permanent partial disability (PPD), they have settled their claim, and it is all over.  Not true.  If you have a lifetime medical award or are on a wage award, your claim is still open.   In other situations, the insurance adjuster and/or case nurse may say they have “closed their file” and lead the injured worker to believe there is nothing they can do, and their case is over.  This is WRONG!  If you have an Award Order from the Virginia Workers’ Compensation Commission, your case is likely open unless YOU have agreed to a full and final settlement which has closed your claim regardless of what the insurance carrier says.   A full and final settlement usually is a situation where you receive an agreed upon amount of money in exchange for closing out your workers’ compensation claim.  If it is a complete and full settlement of your medical award and wage award, your case is over after the settlement is final.  In this case, you would no longer be eligible for ongoing medical or wage benefits from the insurance carrier even if you had a “Lifetime Medical Award.”  However, even if the case is fully settled, the insurance carrier may still be responsible for medical bills incurred before the settlement, if they have not been paid before the settlement.   In some instances, just the “wage” part of the award is settled separately from a medical award.  In this case, the injured worker would still be eligible for related medical benefits and expenses related thereto.   Most injured workers do not know how much compensation they should get for settling their claim.  If they do not have an experienced, knowledgeable attorney helping them, they are at the mercy of the “good will” of the insurance carrier.  No matter how nice the insurance adjuster may seem, you can rest assured they are not looking out for the interests of the injured worker.  Their goal is to save money.   A fair settlement should consider the severity of the injury and future medical costs, the amount of wages the worker is eligible for and how long they might receive wage benefits, and other potential future costs for which the carrier might be responsible.  Unfortunately, injured workers are not entitled to money for “pain and suffering” as they might be in a personal injury case.  Personal injury settlements and workers’ compensation settlements are different and take into account different factors. The statements contained herein are for general information purposes only and are not considered specific legal advice regarding your situation as Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information from you personally. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with Darren Shoen by phone or in-person consultation, visit his website at shoenlaw.com, or call 540-586-5003.

For police officers, firefighters, and other types of first responders in Virginia, the Workers’ Compensation Act creates a presumption that hypertension or heart disease causing total or partial disability is presumed to be an occupational disease suffered in the line of duty.  As such, medical and wage loss benefits may be awarded to the officer/firefighter or other person listed in §65.2-402 (B) of the Code of Virginia.  This is an additional occupational benefit given by the citizens of the Commonwealth to these workers due to the stressful nature of their job.  This is essentially a “thank you” to workers that put their life on the line every day for the rest of us.  These are inherently stressful jobs that only a select few of us are willing or able to do.   However, it is important to note that this presumption can be rebutted/overcome by the insurance company if it can be shown that the heart disease in question is unrelated to the officer or fireman’s employment.  Insurance companies often challenge these claims by trying to show that there are other causes of the heart condition.  If you are pursuing a claim for medical and/or wage benefits for hypertension or heart disease, you will likely be asked to provide your past medical history, details about your lifestyle, job history, and other intimate questions.   Additionally, the worker/officer/firefighter must also show that the heart condition is disabling in some way.  Just having hypertension or other heart disease, alone, might not result in receiving a medical and/or wage award.   If you are considering filing a claim based on a diagnosis of hypertension or heart disease, you should consult with an experienced workers’ compensation attorney.  The Law Office of Darren Shoen has extensive experience in representing police officers, firefighters, first responders, and other injured workers throughout the Commonwealth of Virginia.  Call today for a free consultation. These statements are for general information purposes only and not considered specific legal advice. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult an attorney directly for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with a lawyer, visit their website at shoenlaw.com.

Sometimes, even injuries that occur after normal work hours can be covered by workers’ compensation.  As usual, it depends on the situation.  For instance, if your employer is sponsoring a party or event and you are encouraged to attend, and it benefits the employer, it is more likely that an injury occurring at the event would be covered by workers’ compensation as “arising out of employment.”  If it is a purely voluntary event and not designed to encourage business growth or otherwise business related, an injury occurring at such an event is less likely to be covered by workers’ compensation.  These types of injuries are almost always challenged by the workers’ compensation insurance carrier, so it is important to gather as much information as possible about the accident and the circumstances such as location, time, and nature of the event.   Never just accept the insurance company’s decision.  Check with an experienced workers’ compensation lawyer before deciding whether to pursue a claim for workers’ compensation benefits. The statements contained here are for general information purposes only. This information is not specific legal advice to your situation. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice. To learn more about the Law Office of Darren Shoen and its services, visit shoenlaw.com. For more information on Virginia laws: vwc.state.va.us shoenlaw.com

There are some injuries that occur where an injured worker cannot remember what caused their injury.  For instance, a construction worker is working at a height and next remembers waking up on the ground or in an ambulance.  A nurse is working on a tile floor and next remembers waking up in a hospital.  If there are no witnesses to an accident, and the injured worker has limited or no memory of the fall, insurance companies will not hesitate to deny the claim.  This can be devastating for injured workers in need of wages and medical benefits related to their injury.  To make matters worse, these workers often suffer from traumatic brain injuries which only compounds the difficulty in trying to deal with an insurance adjuster.   Fortunately, with the help of an experienced workers’ compensation lawyer, injured workers can get help in these situations.  There may be unknown witnesses or other evidence that can be found and presented to a judge to help win these cases.  A recently waxed floor, a defective floor, or many other circumstances that could convince a judge that the injury arose out of employment.  Do not give up if this has happened to you or someone you know.   Call an experienced workers’ compensation lawyer for help as soon as possible. The statements contained here are for general information purposes only. This information is not specific legal advice to your situation. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice. To learn more about the Law Office of Darren Shoen and its services, visit shoenlaw.com. For more information on Virginia laws: vwc.state.va.us shoenlaw.com

If you have a workers comp. injury in Virginia, you are entitled to medical care for your injury.  Virginia Code §65.2-603 requires the employer (usually through its workers’ comp insurance carrier) to furnish medical attention for compensable work injuries.  All too often, however, the injured worker is denied medical care and does not know their rights or what they can or should do when treatment is denied.  The best option is to find and get the help of a competent, qualified, and experienced workers’ compensation lawyer to fight back against the insurance carrier.  You have the right to have your claim heard before the Virginia Workers’ Compensation Commission.  Be persistent in pursuing your claim.   You have rights.  Also, check the website of the Virginia Workers’ Compensation Commission at workcomp.virginia.gov.  This is a very useful resource. These statements are for general information purposes only and not considered specific legal advice. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult an attorney directly for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with a lawyer, visit their website at shoenlaw.com.

If you have a compensable workers’ comp. injury in Virginia, you are entitled to medical care for your injury.  Virginia Code §65.2-603 requires the employer (usually through its workers’ comp insurance carrier) to furnish medical attention for compensable work injuries. Assuming you have been awarded benefits by the Virginia Workers’ Compensation Commission for your injury but are still working and need to go to a medical appointment, you should get paid for the time off from work by workers’ comp in most situations.  However, as is often the case in legal matters, whether you get paid depends upon the facts of your specific situation.  For instance, if the medical appointment can reasonably be scheduled at a time outside of working hours without too much inconvenience, you might not be eligible to receive workers’ comp wage benefits for the time spent travelling and receiving medical treatment. If the workers’ comp insurance adjuster denies payment, the injured worker may have to prove that they could not have reasonably scheduled the appointment at a time outside of work hours. This might require an appearance before a workers’ compensation judge (Deputy Commissioner) in which the worker may need to testify and present evidence for the judge to consider in deciding if the worker should have tried to receive the medical care outside of work hours. Do not hesitate to reach out to an experienced, knowledgeable workers’ compensation attorney for help with your situation.  The workers’ compensation laws can be confusing and difficult to navigate for injured workers.  Don’t forget, you have the right to have your claim heard before the Virginia Workers’ Compensation Commission.  Be persistent in pursuing your claim.   You have rights. These statements are for general information purposes only and not considered specific legal advice. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult an attorney directly for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with a lawyer, visit their website at shoenlaw.com.

Ok, you got a letter saying you have to appear for a “deposition” in your workers’ comp case.  What to do?  Well, first of all, make sure you show up.  You can lose your case if you don’t cooperate.  Second, find a competent, experienced workers’ compensation lawyer to help you with your claim.   If you are unrepresented, the lawyer for the insurance carrier may take advantage of your inexperience and uncertainty about the situation. Though I can’t give specific legal advice since I do not know your case, if you have been unable to get legal help, a few tips might help.  Such as: Do not lie. Only answer the question asked. Do not hide your medical history. Dress nicely for the deposition and look your questioner in the eyes. Do not let them get you mad. You are not on trial at the deposition. Try not to use phrases such as, “I’ll be honest with you” or, “honestly,……” You do not need to emphasize what you are saying by using these phrases.  You are ALWAYS honest, right? You have the right to read the transcript of the deposition for accuracy once the court reporter transcribes it. While I’m sure there are more tips that could be given to help you prepare for a deposition, again, you would be wise to seek the help of an experienced, competent, workers’ compensation lawyer to assist you with your claim. The statements contained herein are for general information purposes only. This is NOT to be considered specific legal advice to your situation as Mr. Shoen would need to meet with you individually to ensure the client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice.

If you have an injury that is both a work injury, and a personal injury claim (caused by a third party), you may have two separate injury claims you can pursue simultaneously.  However, please proceed very carefully if you are pursuing both claims. First, what is meant by an injury caused by a “third party”?  A good way to explain this is by an example.  Let’s say you are driving a delivery vehicle for your employer.  While on the road for your employer, you have an accident resulting in injury to yourself that was caused by another driver (a “third party”).  Assuming this accident arises out of your employment, you may also have a personal injury claim against the driver (the “third party”) that caused your injuries. However, this can very get complicated when you try to settle your personal injury claim.  If the workers’ comp insurance carrier has been paying benefits for medical and/or wage loss, there is a strong likelihood that they have a lien on any personal injury claim related to the work accident.  You should never settle your personal injury claim without taking into consideration the workers’ compensation carrier’s potential lien on any personal injury settlement.  The result can be catastrophic for your workers’ compensation claim. In these scenarios, it is very helpful to have an experienced workers’ comp lawyer help and advise you through this process.  You may be able to significantly reduce the workers’ compensation lien upon the personal injury settlement or completely settle the workers’ compensation claim in a way that results in no lien at all.  There are various ways to approach these situations and it is important to have someone with in-depth knowledge of the Virginia Workers’ Compensation Act assist you in this process. These statements are for general information purposes only and not considered specific legal advice. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult an attorney directly for legal advice.

In a workers’ compensation case out of Idaho, the Supreme Court of Idaho reaffirmed a long-standing principle in workers’ comp law that post-injury weight gain by an injured worker does not relieve the insurance carrier from having to provide medical care related to the injury, even if the weight gain has exacerbated the work-related injury.  The exception to this principle would be in a case where an injured worker sets out intentionally or with “deliberate” disregard of the risk involved in gaining weight. That situation is highly unlikely to ever happen, although it would be interesting to see it attempted.   This case out of Idaho is substantially similar to the approach to the law in Virginia.  Often, injured workers are unable to move around and/or exercise due to their injury.  If they are unable to work due to their injury, overeating can sometimes occur due to boredom or as a form of “self-medicating.”  It is not uncommon for this to happen.  Unfortunately, even more self-harming behaviors often arise out of a work injury.  It doesn’t help the situation when the insurance adjuster, claims manager and/or case nurse places blame on the injured worker for these negative side-effects arising out of a work injury.  The comp carrier might be wise to invest in weight loss counseling and/or other types of therapies for injured workers as this could improve the chances of recovery and reduce the insurance carrier’s costs in the long term.   So, if you’ve been injured at work and are being bullied and blamed by the insurance carrier for gaining weight, or are suffering mentally from your condition, remember, the insurance carrier might try to use this as an excuse to cut off your treatment and benefits. Fight back & make them provide complete health care related to your injury, including counseling and/or other therapies to help you cope with your situation. These statements are for general information purposes only and not considered specific legal advice. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult an attorney directly for legal advice.

Like most legal questions, the answer to this question depends on your specific situation.  However, I know one thing for certain, don’t rely on an insurance adjuster to make the final decision.  If an insurance company denies your claim, that doesn’t necessarily mean your claim is denied!  HUH?  That’s right, you may very well be covered.  Remember, the insurance company is in business for what reason?  *Sound the Jeopardy theme*…..TO MAKE MONEY.  THEY DON’T MAKE MONEY BY PAYING FOR YOUR INJURY.  The insurance company will only do what they have to do, not what they should do. You have rights under the law in Virginia (and in every state in the U.S.A.).  In Virginia those rights are enforced by the Virginia Workers’ Compensation Commission.  Demand a hearing before the Virginia Workers’ Compensation Commission.  They have judges that make the final decision as to whether your injury is covered by the workers’ compensation insurance company.  You can file a claim for benefits using the following link (the whole website is very helpful too): https://workcomp.virginia.gov/content/injured-workers These statements are for general information purposes only and not considered specific legal advice. Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult an attorney directly for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with a lawyer, visit their website at shoenlaw.com.

LIFETIME MEDICAL CARE The doctor said there is nothing more he can do but I am still in pain.  What can I do? If you received a lifetime medical award from the Virginia Workers’ Compensation Commission, you have the right to reasonable, necessary and related medical care for your injury.  This can include a wide range of treatments including physical therapy, medication, pain management, as well as alternative treatments in certain situations.  If the medical provider you have been treating with refuses to continue to treat you or recommend another physician or other alternative treatment, it is very important that you persist in demanding continued care.  I like to use the phrase, “the squeaky wheel gets the grease” in these situations. If the workers’ comp carrier/adjuster refuses to respond to you (“ghosting”) or otherwise refuses to help you, do not hesitate to contact the Virginia Workers’ Compensation Commission and let them know what is happening.  Ideally, you should try to get help from an experienced workers’ compensation attorney to help you through this process.  These situations are very common in the workers’ comp world.  People often assume that the insurance adjuster will “do the right thing.”  Unfortunately, this is often not the case. In some situations, it may be wise to seek treatment on your own if you are in pain and/or otherwise need treatment quickly.  Do not wait for the workers’ comp carrier to help you if they continue to delay and not respond.  It is imperative to get medical care when needed, regardless of the behavior of the adjuster.  You can tell the Virginia Workers’ Compensation Commission that you want to have a hearing before a judge (Deputy Commissioner) and make the workers’ comp carrier pay for your medical bills and continued treatment.  In some situations, they might be forced to pay for a doctor of YOUR choosing! The statements contained herein are for general information purposes only and are not considered specific legal advice to your situation as Mr. Shoen would need to meet with you individually to ensure client confidentiality and would need additional information not provided in this article. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice. To learn more about the Law Office of Darren Shoen, or to speak with a lawyer, visit their website at shoenlaw.com.