Case Result | Virginia Workers’ Compensation | Knee & Ankle Injury | Suffolk, Virginia

 

In Virginia workers’ compensation, being right on the facts isn’t enough. You have to be right on the rules.

 

The Suffolk City School Board and its claim administrator, Sedgwick Claims Management Services, had an opportunity to cut their financial losses. Their employee had received a full-duty medical release in March 2025 and retired. Under normal circumstances, either of these scenarios ends an employer’s obligation to continue paying wage-loss benefits under an award. They held the cards on the merits. But they lost their ability to use them in the paperwork.

 

We settled at mediation for $135,000.00, plus the payment of medical treatment through the date the Virginia Workers’ Compensation Commission approves the settlement. The school board’s procedural failure increased the settlement value significantly compared to what this case was worth on the merits alone.

 

The Injury and the Awards

 

My client worked for the Suffolk City School Board and suffered an injury to her left lower extremity (including the knee and ankle) in June 2022.

 

The claim proceeded smoothly, at least initially: the employer agreed to a medical-only award, then an award for ongoing temporary total disability (TTD) benefits when the treating doctor with Tidewater Orthopaedics provided work restrictions. These awards are not suggestions. They are orders. And when an order is in place, the employer cannot unilaterally decide when it ends.

 

The Setup: A Defensible Case

 

Eventually, my client received a full-duty medical release and retired.

 

Under normal circumstances, these are exactly the kind of changes in conditions that give an employer an easy path to suspend or terminate benefits. A full-duty release from the authorized treating physician, combined with voluntary retirement, is almost always a slam dunk for the defense side. I know – I spent years representing local governments, school boards, and insurers before switching to representing injured workers.

 

The school board had the substantive argument. What they didn’t have was the discipline or organization to file the right paperwork before they stopped paying.

 

The Big Mistake: Stopping Payments Without Filing an Application

 

Instead of following the proper process, the school board decided on its own to stop paying benefits. No motion. No application. No notice to the Commission. No notice to my client. They made a unilateral business decision and presumably thought nothing of it.

 

Here was the problem with that approach:

 

Under Virginia Code § 65.2-708 and Commission Rule 1.4, the Commission will not accept an employer’s application to modify or terminate an existing award unless the employer files the application within two years from the date compensation was last paid under an award. A full-duty release and retirement don’t automatically close the award or relieve the employer of its obligation to continue payments under the award. Instead, these facts provide the evidence to support an employer taking the procedural steps necessary to stop payments.

 

Stopping payments without that process doesn’t close the case. It just creates leverage for the claimant.

 

The Technical Rejection

 

When the school board eventually filed an application to suspend benefits, it hit a procedural wall. And it had no one to blame but itself.

 

Commission rules require an employer to certify the date it last paid benefits when submitting an application to suspend or terminate an open award. Because the school board had already stopped paying outside the proper process, they could not certify those payments. Unsurprisingly, the Commission issued a technical rejection, stating that “Compensation has not been paid through the correct date.”

 

That rejection mattered more than most people realize. It wasn’t a delay. It was a lock. The technical rejection deprived the school board of the ability to litigate the substantive defenses it actually had. The full-duty release, the retirement, the changed condition – all of it became legally irrelevant because they couldn’t get through the procedural front door. Their own filing failure shut them out of the case.

 

From Technical Rejection to $135,000

 

Once the Commission rejected the application, the school board’s negotiating position tumbled. They were sitting on an active award with no legal pathway to stop payments, no ability to take the case to a merits hearing, and ongoing indemnity exposure with no end date in sight.

 

Then settlement discussions began.

 

I see this pattern regularly. An employer thinks stopping payments will force a resolution. What it actually does is freeze the award in place, strip the employer of its best defenses, and hand the claimant negotiating leverage that the underlying facts do not support.

 

In this case, the school board paid significantly more than the claim was likely worth on the merits because of a filing failure it could have prevented with a single, timely application. We went to mediation, where the parties agreed to settle the case for $135,000.00, plus the payment of my client’s medical expenses through the date of settlement approval.

 

If your benefits have stopped and you haven’t received anything from the Commission, call me at (804) 251-1620. I’ll review your award status and tell you what your options are.

 

What This Means If Your Benefits Stop Suddenly

 

If your employer stops paying workers’ compensation benefits and you haven’t received any paperwork from the Commission – no notice, no order, no suspension application – that is not normal. And it violates an active award order from the Commission.

 

But there is a silver lining. This act may be your greatest source of leverage.

 

Virginia law does not allow employers or their insurance carriers to terminate an active award unilaterally. They must go through the Commission. If they haven’t, the award stays alive. The longer they wait to file correctly, the worse their procedural exposure becomes – and the stronger your position in any settlement negotiation.

 

Call me at (804) 251-1620 if your benefits have stopped without explanation. We can tell whether you have grounds to move for a penalty or can increase your settlement value by laying low before acting.

 

Related Resources

 

 

Frequently Asked Questions

 

Can my employer stop paying workers’ comp benefits without filing anything?

No. Under Virginia Code § 65.2-708 and Commission Rule 1.4, an employer obligated to pay benefits under an active Commission award must file a formal Application for Hearing to suspend or terminate benefits based on a change in condition. Simply stopping payments – without a filing and without Commission approval – violates the award and keeps the employer legally exposed for ongoing obligations.

 

What is a technical rejection by the Virginia Workers’ Compensation Commission?

A technical rejection means the Commission refused to process an application or decide whether probable cause exists to refer it for a hearing because it failed to meet mandatory procedural requirements -such as certifying the date payments continued through. If the Commission dismisses the application before reviewing the merits, the employer loses the ability to litigate its substantive defenses without making additional payments or curing the defect.

 

Does a full-duty release automatically end my workers’ comp benefits?

No. A full-duty release is evidence – not a termination order. An employer must present that evidence through a proper Commission application. Until the Commission modifies the award, the employer’s payment obligations continue regardless of what the doctor’s note says.

 

Results described represent an actual case outcome. Past results do not guarantee a similar outcome in your case. Every workers’ compensation claim involves unique facts, evidence, and applicable law.