Virginia Workers’ Compensation Rules (2025) – The Complete Practitioner’s Guide

 

One slight procedural misstep can tank your case. And the only way to avoid any mistakes is to learn the Rules of the Virginia Workers’ Compensation Commission (effective January 2024), or to hire a top-rated workers’ comp lawyer who already knows them.

 

These workers’ compensation rules aren’t suggestions; they’re mandatory procedures you must follow to secure workers’ comp benefits. Insurance companies know these rules. You should, too.

 

With this article, I translate the Virginia Workers’ Compensation Rules into plain English, providing strategies for complying with and using them to your advantage.

 

Are you unsure whether to continue reading? Here’s an image that might stick with you:

 

A few years ago, I agreed to coach my son’s youth basketball team. At the first practice, I asked, “Who’s played before?” No hands went up.

 

When no one knows the game, you don’t run a complex motion offense — you start with the basics. Where to stand. Which basket to shoot at. How many points you get for a layup.

 

Virginia workers’ compensation is like that. Before you can “win,” you need to know the rules. Trust me, your opponent does. Insurers have played this game for years, and they’re good at it. 

 

 

Why the Rules Matter

 

The Commission’s own website calls its rules “mandatory procedures” that all parties must follow. And Virginia Code Section 65.2-201, which gives the Commission power to make, interpret, and enforce its own rules, and appellate courts support this statement.

 

In several judicial opinions, the Court of Appeals of Virginia and the Supreme Court of Virginia have upheld the Commission’s interpretation of a rule unless it’s so unreasonable that it’s arbitrary and capricious.” That’s a high bar.

 

Despite the case law, insurers sometimes challenge how the Commission interprets the workers’ compensation rules it created. But they rarely get far. I recently had a case where an insurance company attempted to apply a rule against my client in a way the Commission didn’t intend. We won before the Commission, and the appellate court agreed. This victory led to a six-figure settlement. ‘

 

So, ignore the rules at your own risk. You may end up losing your case and the benefits that come with it because:

 

• • Deadlines don’t forgive.
  • Following the rules can ensure your day in court or a fair settlement. Ignoring the rules gives the insurer a way to prevent you from even having a trial.
  • The rules can change depending on the stage of the process. Merely knowing one or two rules is insufficient; you need to understand all of them to identify which apply.
  • Simply saying, “I didn’t know” won’t cut. The Commission won’t waive the rule just because you didn’t know them. ‘

 

To go back to the sports metaphor –

 

Your competition, the insurance company and its legal team, already know the Virginia Workers’ Compensation Rules inside and out.

 

I don’t like that you – the person who got hurt – will start the process with much less knowledge than the claim adjuster or insurance defense attorney assigned to your case.

 

So, join me on this walk through the Rules of the Virginia Workers’ Compensation Commission, where I will explain what each rule means and how it may apply to you.

 

Once you finish, you can dig deeper with my Answers to 200+ Virginia Workers’ Compensation FAQs, where I give tips for specific injuries, employers, and insurers. Read the linked articles, and you’ll be in good shape to negotiate a workers’ comp settlement.

 

Let’s Learn the Virginia Workers’ Compensation Rules, One-by-One

 

The Rules of the Virginia Workers’ Compensation Commission cover a lot of territory. Let’s start from the beginning.

 

Rule 1 – Prehearing Procedures 

 

Rule 1.1 – What Your Initial Claim Needs

 

The first claim you file with the Commission must include specific details found in this rule.

 

If your original claim lacks necessary details, the Commission may find that it wasn’t a claim at all. And I’ve seen that create big problems.

 

Suppose you think you’ve filed a claim, but don’t realize until later that the Commission deems it insufficient (often after the insurer argued it did not give them specific notice of what happened and what you want). You can fix this problem if you are still within the two-year statute of limitations to file a claim. But if not, you may be time-barred.

 

The easiest way to avoid this scenario is review the Commission’s template Claim for Benefits form, then read my article on how to file a workers’ compensation claim for tips on starting the process strong.

 

Rule 1.2 – Change in Condition & the 90-Day Rule

 

It’s ok to feel relieved after the Commission awards benefits.

 

But beware, your case isn’t over. Often you have to keep fighting to get and keep what the award promises.

 

I’ve seen cases heat up months, years, or even decades after the injury. A few years ago, I negotiated a settlement for a cervical spine injury that occurred thirty years ago. The employee needed a revision and extension of an earlier spinal fusion.

 

Sometimes, cases escalate becaues the insurer doesn’t think your wage loss benefits should continue, denies that a new injury is a compensable consequence, or has an IME doctor say that your prescribed surgery isn’t reasonable or necessary.

 

The starting point for these ongoing battles is this rule, which explains how to reopen your workers’ compensation case, and how the 90-Day Rule limits retroactive pay if you wait to seek reopening. So, file the change-in-condition claim promptly to avoid giving up months of back pay you’re entitled to.  

 

Rule 1.3 – Evidence Filing Deadline

 

You don’t have to have all of your evidence when you file a claim or a change-in-condition application. But you must submit some supporting evidence within 90 days of filing it.

 

Usually this means uploading your medical records to the Commission’s file. Just one doctor’s note can be enough.

 

If you ignore this rule, the insurer can move to dismiss your claim.  

 

The solution is to file medical reports with the Commission as soon as you receive them. Or, if you have enough time before the statute of limitations expires and do not have financial urgency, request all your reports before filing the claim.

 

Rule 1.4 – Employer’s Application for Hearing

 

Assume the insurer is looking for ways to stop paying if you receive ongoing temporary total disability benefits. It’s what they do. 

 

When they find what they think is a reason to stop payments, expect to see an Employer’s Application for Hearing.

 

You’ll find some due process protections in this rule, although not as much as I would like. The insurer must overcome these hurdles before the Commission permits the suspension of payments pending a hearing.

 

You can sometimes defeat an application by comparing the payment dates on the application to the pay stubs showing when you last received a wage loss check. If the insurer didn’t pay through the date the rule required, the Commission will reject the application.

 

Rule 1.5 – Employer Response & Your 15-Day Window 

 

The Commission can order the employer to say if it accepts your claim or to explain why not. Use this explanation to build your case.

 

Next, the Commission gives you just 15 days to submit evidence opposing an application to stop or reduce your benefits. Staying on top of the available evidence throughout your claim is the only way to submit a solid response this quickly.

 

Finally, the Commission tells the parties it will explain why it accepted or rejected an application. Sometimes, the explanations help you know how to attack docketing on appeal. But other times the explanation is vague and unhelpful.

 

Rule 1.6 – Requesting a Review

 

If the Commission docketed the employer’s application, you have a limited period to challenge that decision with a formal request for review.  

 

On the other hand, if you successfully defeated the employer’s application, this rule confirms that the insurer must pay out penalties and interest.

 

Rule 1.7 – Settlement Papers

 

Unlike car accident settlements that can settle with a one-page relief, settling workers’ compensation claims take longer. And more paperwork.

 

No settlement is final without the Commission’s approval. And you must submit several different documents before the Commission will even review the proposed deal.

 

Rule 1.8 – Discovery Rules

 

The discovery process lets parties obtain information from one another and others who have relevant documents. Discovery sounds dry, and often is dry, but it’s where you win claims and build your case’s value. 

 

Multiple subparts cover the different discovery tools: subpoenas, depositions, interrogatories, requests for production of documents, requests for admissions, and the production of wage information. They also explain how to get a protective order or when the Commission will sanction a party for ignoring or abusing discovery.

 

Here’s something I’ve learned from experience: Insurance defense attorneys love to use the discovery tools to hassle claimants and their attorneys. They’ll request every piece of paper you’ve ever signed, then they’ll allege you haven’t produced everything or answered completely. But you have the same ability to conduct extensive discovery. Use it.

 

These tools can compel the employer and insurer to disclose all relevant information. And you just may find that they would rather make a reasonable settlement offer than go through the time and expense of extensive discovery. Discovery is expensive and time-consuming, and defendants in workers’ comp claims usually have way more paperwork to produce than claimants do.

 

Rule 1.9 – Issue Mediation

 

The Commission has one of the best alternative dispute resolution (ADR) programs in the country. Its goal is to help the parties resolve problems without a formal hearing, and this rule tells what disputes are most likely to benefit.

 

I’ll be honest. I don’t like issue mediation because many disputes are “all or nothing.” How do you split the difference on whether the insurer has to pay for a total knee replacement?

 

But I do like full and final settlement mediation, though. And many of my clients have benefited from it.

 

Rule 1.10 – Willful Misconduct Defense

 

Although you can get workers’ compensation benefits if your negligence caused the injury, you can’t get them if you were hurt because you intentionally harmed yourself, attacked someone, were drunk or high, or willfully violated a safety rule that you knew about.

 

 

In recent years, insurers have increasingly raised this defense, often in cases where it is unwarranted or just plain dumb. It’s often a sign they don’t have a strong defense to the claim. For example, a major hospital claimed that its injured nurse had violated a safety rule because she did not use proper ergonomics when lifting a patient. But no rule would have helped because the psychiatric patient bucked violently mid-transfer, and the insurer dropped this defense shortly before trial. 

 

If they intend to raise this defense, insurers must give written notice to the Commission at least 15 days before the hearing. And vague descriptions won’t cut it. You have the right to know the specific ac the insurer relies on.

 

So, keep an eye on the calendar and the specific notice. Sometimes insurers blow it by raising the defense too late or being too generic in their description.

 

Rule 1.11 – Prehearing Statements

 

Many deputy commissioners require you to fill out this form with the details of the claim, defenses, and witnesses. It is a “cheat sheet” for the judge to reference during the hearing.

 

Rule 1.12 – Sanctions

 

The Commission may impose a fine or order the payment of the other party’s attorney’s if it find you in contempt of the workers’ compensation rules.

 

 Rule 1.13 – Meet-and-Confer

 

The commission requires attorneys to certify they attempted to resolve a dispute before filing a motion.

 

Rule 2 – Hearing Procedures

 

Rule 2.1 – Decisions on the Record

 

You don’t always need an in-person trial. Like a motion for summary judgment in state and federal courts, the Commission’s “on-the-record” hearings allows you to submit your claim “on the briefs.”

 

Some attorneys rave about decisions on the record because they can save time. But I avoid them, and opt for my clients to tell their story in person. ‘

 

I’ve lost count of how many times I’ve read this section before a  workers’ compensation hearing. It explains the how to admit testimony and documents into evidence at trial.

 

Rule 2.2(B)(3) is the most important part because it tells you exactly how to submit medical evidence, which is often critical to winning, at the hearing.

 

Rule 2.3 – Expedited Hearings

 

The gaps without pay while you wait for a hearing challenge every one.

 

Some of you may be able to shorten the gap by asking for an expedited hearing. This request must include proof of financial hardship.

 

But don’t expect the insurer to agree to an expedited hearing. They see your hardship as an opportunity to negotiate a low settlement amount.

 

 Rule 2.4 – Video Hearings

 

WebEx video hearings became popular during the COVID-19 pandemic. They’ve dropped off some, but have hung around.

 

Personally, I’d rather not have a video hearing unless my client faces great inconvenience traveling to the trial.

 

If you have a video hearing, read how to submit or object to evidence beforehand, as well as the technical requirements for your laptop or computer.

 

Rule 3 – Post-hearing Procedures 

 

Rule 3.1 – Appeal Deadlines

 

Seek review of a Commission decision within 30 days. State the specific findings of fact and conclusions of law that were wrong. Conclusory statements won’t cut it.

 

Rule 3.2 – Written Statements

 

Written arguments decide most appeals; you won’t have another hearing. So, focus on the brief.

 

Rule 3.3 – No New Evidence

 

You have to put on the best evidence you have at trial. If you don’t have it at the time you request review, the Commission won’t consider it here.

 

Rule 3.4 – Oral Argument Requests

 

Oral argument happens, but it’s rare. I’ve only had one case where the Commission ordered oral argument, and neither party had even asked for it.

 

Rule 4 – Filing Documents 

 

Rule 4.1 – Filing Agreements

 

No agreement to pay compensation is official unless it’s in writing.

  

More importantly for injured workers, this rule says that insurers must file any agreements to pay that you sign within 14 days of receiving it, or reject the agreement in writing.  

 

Don’t rely on handshake deals or telephone promises. Demand the forms.

 

 Rule 4.2 – Medical Records

 

This is one of my favorite Virginia Workers’ Compensation Rules because it helps you get evidence for free (or at a minimal cost). Under this rule, parties must share medical reports as they receive them, and health care providers must send you their records if you ask for them. Usually insurance defense attorneys subpoena your reports from doctors, then send you copies.

 

Rule 5 – Cost of Medical Services

 

I’ve seen doctors try to bill injured employees when the insurer refused to pay the full amount. It happens more than it should.

 

They can’t do this if you have an award of medical benefits. Remind the doctor or debt collector of this rule if you get harassing calls or letters. 

 

Rule 6 – Attorney’s Fees Under § 65.2-714 

 

These rules don’t affect you directly. They cover attorney’s fees owed by medical providers who benefited from your claim.

 

It’s mainly relevant for attorneys collecting fees from healthcare providers. Skip it unless you’re curious.

 

Rule 7 – Employer Responsibilities 

 

Employers must give proof of insurance coverage to the Commission and post notice of their compliance with the law in places where employees can see it. 

 

Check whether your employer has posted the required workers’ compensation notices if the insurer argues that you waited too long to report your injury or filed a claim after the statute of limitations had passed. Otherwise, this rule will not affect your case.

 

Rule 8 – Self-Insurance

 

Large employers can self-insure, but they must meet specific requirements and file financial documents with the Commission. These papers remain confidential.

 

If your employer self-insures, they still have to provide the same benefits as employers who purchase insurance. Don’t let them tell you otherwise. I’ve seen self-insured employers try to claim they have different rules. They don’t.

 

Rule 9 – Payment of Compensation 

 

Rule 9.1 – Waiting Period

 

Virginia has a seven-day waiting period. You must miss seven days of work before the insurer has to pay wage loss benefits.

 

What’s helpful is that dayys when you can’t earn full wages count toward the waiting period. So if your medical work restrictions limit you to part-time work, and your employer accommodates that restriction, you can use that day toward the waiting period.

 

Rule 9.2 – Direct Payment

 

Benefits go directly to you, while awarded attorney’s fees go straight to your lawyer.

 

Rules 10–13 – Special Tables & Occupational Disease Claims

 

These rules apply to specific occupational illnesses. You won’t need to know them if you had a workplace injury, rather than a work-related exposure that led to disease. 

 

Rule 10 – X-Ray Evidence for Black Lung (Rules 10.1 to 10.3)

 

The Commission sets procedures for Pulmonary Committee reviews and the number of X-ray readings allowed.

 

Rule 11 – Pneumoconiosis Table

 

This rule provides a table to convert radiographic evidence into a severity rating (stage) for the disease.

 

Rule 12 – Hearing Loss Table

 

This table calculates hearing loss percentages.

 

Rule 13 – Vision Loss Table

 

This table sets compensation for vision loss using Snellen Chart readings.

 

What Now? Know the Rules!

 

You may not think of yourself as a “rule follower,” but you must follow the Virginia Workers’ Compensation Rules — and all related workers’ compensation procedures in Virginia — if you want to win your case.

 

You can spend the time to learn the framework of these rules.

 

Or you can call my law firm to see if we will accept representation.

 

Contact us today to discuss your claim and how we can use the rules to protect your benefits.