News: E-Blast

Effective July 17, 2025, Centers for Medicare & Medicaid Services (“CMS”) will no longer review a Medicare Set-Aside (“MSA”) recommendation for a “zero-dollar allocation.” This change comes as an acknowledgement that the significant time and expense of reviewing these zero-dollar MSAs is of little benefit to the Medicare Trust Fund. What this means is that, going forward, Virginia employers are no longer required to submit for CMS approval an MSA in which Medicare’s interests are valued at $0 (Section 8.1, WCMSA Reference Guide). This is a significant change, given the difficulty in recent years in obtaining zero-dollar allocation approval from...

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On September 21, 2023, I published an article on a recent ruling from the Commission that delved into the horseplay/assault dichotomy. The case was Ocasio v. Camping World RV Sales, LLC, JCN VA00001870099 (Sept. 11, 2023) and the Commission’s ruling further entrenched already established black-letter law: The dispositive factor in distinguishing between horseplay and assault is the perpetrator’s intent. If the intent was to simply play a prank, with no intention of causing bodily harm, it’s horseplay (and vice versa for assault). The distinction between horseplay and assault is significant because categorizing a case as a horseplay case or an...

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The Full Commission’s decision in the case of Carballo-Cruz v. JC Brothers Construction, LLC, JCN: VA00002155780 (March 27, 2025) illustrates the limits of employer’s ability to argue the defense of unauthorized treatment. In Carballo-Cruz the employer did not present a panel to the claimant but the claimant did begin treatment with a physician and establish a course of care with that physician. The claimant then decided to abandon care with that physician and selected a different doctor, Dr. Malek, for ongoing treatment. The Deputy Commissioner held that, even though the defendants never provided a panel, the claimant entered a course...

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Earlier this year I authored an article entitled, “Virginia’s Employee Misclassification Law.” As I noted in that article, the Virginia General Assembly passed legislation in 2020 to deter companies from misclassifying their employees and to penalize those employers for having misclassified their workers.  This legislation was in response to a study in Virginia that revealed approximately 214,000 Virginia workers that were misclassified as independent contractors. Independent contractors that have been misclassified often have the following additional claims: 1. Claim For Failure to Pay Overtime The Fair Labor Standards Act (“FLSA”) is a federal statute enacted to ensure that employees are...

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We are pleased to announce we now have you covered in North Carolina, as well as Virginia and Washington D.C.! More information to come!

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In January of this year, the Commission issued an opinion that illustrates the importance of ensuring an injured worker’s injury occurs while engaged in an activity that is indeed a risk common to the neighborhood. In this case, a school bus driver was driving his bus route, which included a stop at a recreational center. When he arrived at the recreational center, the driver parked and exited his bus and began walking towards the building to use the bathroom. As he was walking, he felt a severe pain in his left knee and foot and was thereafter unable to walk....

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Click here to watch this month’s one minute adjuster tip that is on the topic of:  Permanent Total Disability

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In the most recent session of the General Assembly, Democrats controlled both the Senate and House of Delegates, checked by the Republican Governor. This dynamic resulted in only a single change to the Virginia Workers’ Compensation Act (Title 65.2). However, there are multiple failed bills that bear analysis for the insight they provide into the thought processes of our legislators and the direction workers’ compensation law may take in the future. The sole bill that passed is HB1933/SB920, which alters the cancer presumption in 65.2-402. Part C under 65.2-402 provides that a variety of types of cancer, including throat cancer,...

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Click here to watch this month’s one minute adjuster tip that is on the topic of:  Compensable Consequences

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The Virginia adjuster should be mindful that fall from step cases are extremely fact-specific and can be tricky. The recent Full Commission decision of McKoy v. Fairfax County Government, JCN: VA00002159978 (February 3, 2025) illustrates this point. In McKoy the Full Commission affirmed the finding of the Deputy Commissioner that that claimant did not establish a compensable injury “arising out of” the employment. Claimant, a trash collector, was required to stand on a metal step on the back of his garbage truck, that was 17 inches off the ground. On the day of his accident, the claimant was standing on...

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