Whitt & Del Bueno, Attorneys at Law

Leaders in defending workers' compensation claims.


Commission’s Advice to Adjusters at VSIA Conference

By Ralph Whitt

At the Virginia Self-Insured Association conference recently, Commissioner Williams gave some advice to workers’ compensation claims adjusters that bears your consideration:

1. When filing quarterly and suspension reports, need to put the cumulative total for all payments for that claim during the life of the claim and not just payments for that quarter.

2. When submitting “party information”, if self-insured, list the company as employer, carrier and Claims Administrator; if self-insured association, list employer as employer and association as carrier and Claims Administrator.

3. If a claim has already been set up with a JCN before you can file the FROI, such as when the claimant files a claim first, be sure to list that first JCN on the FROI; otherwise, a second JCN for the same file will be created by the VWC when the FROI is submitted, causing some problems.

4. When submitting information, if you do not know certain information, such as the claimant’s address, do not enter “unknown” – just leave it blank. VWC cannot edit bad data or information submitted to it, only the Claims Administrator (CA) can, so it will send the CA a correction notice if it sees “bad” or incorrect date is submitted.

5. Use “old” forms for all claims with dates of accident before 10/1/08 and which have not yet migrated into EDI.

6. If claimant amends agreement form in any way, don’t just sign and file it with VWC. If you agree with amendment, then initial the change and file; if you don’t agree with change, then try to resolve differences with claimant and if not, then don’t submit form.

7. VWC prefers wage chart over pay stubs.

8. When VWC requests “total paid on claim”, just put the total dollar figure; don’t send payment history.

9. Give the VWC the adjuster direct contact phone number, if possible.

10. Submit doctor’s report(s) when filing agreement forms for PPD benefits.

11. For claims in WebFile, use WebFile to file things and don’t in addition fax or mail the filing to the VWC. It creates duplicates.

12. The VWC has now four teams to resolve undisputed claims, such as the claimant won’t sign the return to work form, so call the VWC and request one of the teams to help resolve these types of claims without a hearing.