News

Limiting Exposure to Contested Medical Bills – The Effect of Denial

Dealing with medical providers can prove difficult at times, especially when it comes to agreeing on reasonable prices for the services they render. In a recent decision, Roanoke Ambulatory Surgery Center v. Bimbo Bakeries USA, Inc. , 2019 Va. App. LEXIS 21, the Court of Appeals added an extra layer of difficulty by expanding the time a medical provider has to file an application contesting the sufficiency of payment. Va. Code § 65.2-605.1(F) provides the statute of limitations for medical providers to bring a claim contesting payment for health care services provided to a claimant. Such a claim cannot be heard unless...

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Terminate the Award Order and Save Thousands of Dollars

An award order is a legal directive issued by the Virginia Workers’ Compensation Commission (“Commission”) requiring the employer and insurance carrier to pay workers’ compensation benefits to a Claimant. However, during the life of a claim, a Claimant’s condition may change warranting a termination of the award order which could lessen the overall exposure of the claim. How do you terminate an award order? There must be a basis to move the Commission to terminate the existing award. The following conditions can form a basis for termination: Claimant returned to pre-injury work; Claimant was released to full-duty work; Claimant returned...

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Commission Releases Proposed Regulations for e-billing

In June, the Commission released a set of preliminary regulations for E-Billing with the aim of having a final rule in place this year, with an implementation date of January 1, 2019. The Commission had a working session in August and received comments from interested parties. On September 18, 2018, the Commission issued its proposed final E-Billing regulations, along with a Companion Guide.   The most noticeable change the Commission made was to move the implementation date back six months to July 1, 2019. All non-exempt providers and payers will be expected to be ready to send and receive bills and payment electronically by that date. In addition, the Commission...

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A Primer to Understanding Hearing Loss Claims in Virginia

While somewhat infrequent, hearing loss claims do arise from time to time. Thus, it is important that the Virginia adjuster understands how to analyze these claims. It is important to note that these claims, depending upon the facts, may be considered as (1) an injury by accident; (2) a compensable consequence or (3) an ordinary disease of life. The first two require proof by the claimant by a preponderance of the evidence, and the third requires proof by claimant by clear and convincing evidence and not a mere probability. The   Macudzinski v. Omniplex World Service, Inc., VWC File No. 218-73-91 (Feb. 21, 2007) decision is an example of a...

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VWC Releases 2017 Annual Report

On September 13, 2018, the Commission issued its Annual Report for the year 2017.  In its report, the Commission highlighted several updates to their operations and new programs implemented over the previous year. The Chairman of the Commission, Wesley Marshall, in his Chairman’s Statement pointed out that this year, 2018, marks the 100th Anniversary of Workers’ Compensation in Virginia. He also mentioned the relocation of the Richmond headquarters, and the Manassas and Virginia Beach offices to new locations and the resulting improvement in information security, which allowed the Commission to meet or exceed all of the Virginia Information Technology Agency’s information security standards. Commissioner Marshall made special...

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The Medical Fee Schedule is Finally Here!

Few topics have garnered as much attention and anticipation as the medical fee schedule that was recently enacted. In the 2016 regular session, the Virginia General Assembly proposed a major change to the landscape of medical payments under the Virginia Workers’ Compensation Act. Thereafter, on March 7, 2016, then Governor Terry McAuliffe signed a bill to implement a medical fee schedule to take effect on January 1, 2018. The new legislation is covered in Virginia Code Section 65.2-605.

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A recent Virginia Circuit Court case raises concern as to the steps required by the employer and carrier to protect a third party lien.

A recent Virginia Circuit Court case, Spicer v. Robinson (Circuit Court of Buckingham County, Case No. 16-99), raises concern as to the steps required by the employer and carrier to protect a third party lien. In Spicer the Circuit Court Judge held that a voluntary lump-sum settlement payment to the claimant should not be included as part of the employer’s lien under Virginia Code Sections 65.2-309, -309.1 and -310. The Court noted its reliance on Noblin v. Randolph Corp., 180 Va. 345 (1942) and Slusher v. Paramount Warrior, 336 F. Supp. 1381 (W.D. Va. 1971) in reaching this decision. The Circuit...

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Highlights of New Laws for 2018

Below is a summary of each bill. If you want to see the actual text and how it is integrated into the Code/Act, click on the header and go to PDF link next to “Governor: Acts of Assembly” (for bills that passed only). Bills that Passed: HB 1023 Foreign subpoenas; issuance by circuit court clerk of court.  Provides that no foreign subpoena issued in the Commonwealth pursuant to the Uniform Interstate Depositions and Discovery Act (§ 8.01-412.8 et seq.) may be issued by any person other than the applicable circuit court clerk of court in the Commonwealth. This bill is...

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Occupational Diseases and Mental Health Claims – How Exposure Outside the Workplace Constitutes “Employment”

In 2005, Hurricane Katrina devastated the Gulf Coast with unprecedented flooding and damage. In its’ aftermath, individuals from across the country went to New Orleans to assist with relief efforts. Thirteen years later, Hurricane Katrina’s impact is now being felt in the Virginia Workers’ Compensation community. The Virginia Workers’ Compensation Commission recently issued an Opinion that concerned a claimant firefighter paramedic who alleged post-traumatic stress disorder (PTSD) as an occupational disease in Munker v. City of Norfolk, JCN VA00001035404 (May 17, 2018).The claimant, while employed as a paramedic for the City of Norfolk, traveled to New Orleans to provide relief...

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