Portner & Shure, P.A. — Workers' Compensation Team
Workers' Comp 101
Valuing a Claim
An onboarding walkthrough — how we think about value, settlement, and strategy in a Virginia workers' comp case.
The big picture
Every claim's value = three buckets
When we value a workers' comp case, the number is built from three pieces:
BUCKET 1
Medical Expenses
Past + future treatment.
BUCKET 2
Wage Loss
Time out of work — "TTD."
BUCKET 3
Permanency
Value of the injury — "PPD."
No pain & suffering. Unlike personal injury, pain & suffering is not part of a workers' comp claim. (We can use a client's hardship to argue for higher permanency, but it isn't its own bucket.)
Why it works this way
Workers' comp is a no-fault system
- Negligence isn't a factor. It doesn't have to be the employer's fault. WC was built so injured workers don't have to hire a lawyer and sue their employer.
- If you were doing your job and got hurt, you have a claim — you don't have to prove the employer messed up.
- The trade-off: because it cuts both ways, there's no pain & suffering.
Willful misconduct bars a claim. If you were told not to enter a room, you go in anyway and break your hand — it's denied.
Bucket 1
Medical expenses — past & future
- If the claim is accepted, workers' comp pays for the related medical treatment.
- Virginia uses a panel: the client picks a doctor from an approved panel (urgent care first is usually fine), then treats with that doctor — all approved by the Commission.
- Insurer slow to authorize? Tell the client they can treat using their own insurance — and we do our best to get them reimbursed later (treatment must be shown related to the accepted claim).
Treatment continues until the doctor declares MMI — Maximum Medical Improvement. That's the trigger to ask: what's the right resolution?
Bucket 2
Wage loss — "TTD"
- TTD = Temporary Total Disability — paid when the client can't work because of the injury.
- It's two-thirds of the average weekly wage (never the full wage). Two-thirds of AWW is also called the comp rate.
- The key to getting it: the doctor's medical notes holding the client out of work. At a hearing the commissioner will ask, "Did the doctor hold them out? Show me the notes."
Light duty & "marketing." If a client is on light duty and the employer can't accommodate, they can't just sit at home — they must make a good-faith effort to find another job ("marketing") to earn TTD.
Bucket 3
Permanency — "PPD"
- PPD = Permanent Partial Disability — the value of the lasting injury. (Total = PTD, rare.)
- Virginia has a schedule assigning a number of weeks to each body part (e.g., an arm = 200 weeks).
- We estimate an impairment percentage (full loss of the arm = 100%; a healed broken wrist might be ~15%).
PPD = Body-part weeks × Impairment % × Comp rate
Comp rate = Average Weekly Wage × ⅔
Example: Arm (200 wks) × 15% = 30 weeks. AWW $1,000 → comp rate $660. 30 × $660 ≈ $19,800 for that injury.
Cheat-sheet
The acronyms (WC loves them)
| Acronym | Means | In plain English |
|---|
| TTD | Temporary Total Disability | Wage-loss pay while out of work (⅔ of wage) |
| PPD | Permanent Partial Disability | Value of the lasting injury (Bucket 3) |
| PTD | Permanent Total Disability | Totally disabled (rare) |
| MMI | Maximum Medical Improvement | Doctor says treatment is done |
| IME | Independent Medical Evaluation | A non-treating doctor's exam/rating |
| AWW | Average Weekly Wage | Comp rate = AWW × ⅔ |
The rating problem
To win PPD at a hearing, you need a rating
- You can't get PPD at a hearing without a doctor's impairment rating — the commissioner won't estimate it. No rating = "go home, nothing to do here."
- Virginia prefers the treating physician's rating — and that doctor (who just "did a great job") often rates it low (e.g., 1%). Once it's in, it's very hard to beat.
- So we often get our own rating / IME — but defense gets theirs too, and you end up battling over ratings.
This is a big reason most cases settle instead of going to a hearing on PPD.
The strategy
Why we settle "full & final"
- Win PPD at a hearing and the medicals stay open — a "lifetime medical award." Sounds amazing to clients…
- …but in practice insurers deny future treatment anyway ("not related"). It's a hassle, and they hate the open-ended tail liability.
- Only a full & final settlement closes future medical liability — a commissioner can't.
- So insurers pay extra above the permanency value to close the case (e.g., a $1,000 impairment → $5,000 to close).
Win-win: the client gets more money (and can treat through their own insurance later), and the case is resolved. Exception: a client who likely needs future surgery and has no insurance of their own — don't leave them exposed.
Drafting
Building a demand
- Paralegals draft the demands (some use AI/ChatGPT to organize) and send them to you to review. The format/top is almost always the same.
- It walks through the three buckets: medicals (past + future), wage loss, and PPD with the math shown.
- We demand roughly 1.5×–2× the estimated value — defense typically cuts it in half. Better information → closer to 2×.
- Sometimes you send a demand just to get the ball rolling before a hearing, even without perfect info.
Worked example
A real demand, bucket by bucket
| Bucket | What's in it | Value |
|---|
| Medical | ~$4k outstanding + possible surgery | ~$15,000 |
| Wage loss (TTD) | Unpaid time out + ongoing pre-surgery | ~$20,000 |
| PPD — left arm | 200 wks × 10% × $1,054 comp rate | ~$21,000 |
| PPD — right arm | Less severe | ~$10,000 |
| Estimated case value | ~$66,000 |
Jordan pushed the PPD and future-medical estimates up (this client likely needs another surgery), and we sent the demand at $200,000 to open negotiations. Judgment matters — the math is the floor, not the ceiling.
Case review
At every hearing, ask: "Why are we here?"
- That's the first question in reviews. Walk the three buckets: any past-due medicals? Any wage loss owed? Is this purely a PPD case?
- If a paralegal says "we just need PPD" but there's no rating on file — that's the gap. No rating, no PPD at hearing.
- If only PPD is left and no rating: send a demand and try to settle. Not responding? Move it to mediation.
We love mediation — non-binding, shows what they'll offer, everybody can win (and defense likes it because they can bill).
Watch out
Claim-killers & the golden rule of injury description
Repetitive use is a claim-killer in Virginia. "I hammered all day and my arm hurt by evening" is not compensable.
The golden rule: a compensable injury must point to a definite time and a specific action. "How did it happen, and when?" Clients often want to list every time it hurt — that's the worst thing for their case. Prep them before any deposition.
Depositions
Depos: don't shoot yourself in the foot — move the ball
- Goal of a depo: understand next steps and move the case forward. Review the file first; know where the case is.
- Prep the client (a 15–20 min call) — especially how they describe the injury (time + action).
- If the client's done treating and there's no real dispute, talk to opposing counsel at the end ("free to talk 5 minutes?") — cases often resolve right there.
- Still treating? Make sure everything's moving: are they getting TTD? Should they be?
Lifecycle
Soup to nuts — how a case flows
- Case comes in → file the claim form on WebFile, enter our appearance, send the client a welcome letter.
- Client picks a panel doctor → treats (medicals paid; maybe TTD).
- Doctor reaches MMI → we ask: what's the right resolution?
- Value the three buckets → send a demand (~1.5–2×) → negotiate / mediate.
- Resolve full & final (closes future medicals). Settlement process ≈ 30–45 days.
Want to see one end-to-end? Ask Herless — he's very organized and can walk you through the filing process. (You don't need to know all the "sausage making," but it helps.)
Remember this
Key takeaways
- Three buckets: medical, wage loss (TTD), permanency (PPD). No pain & suffering.
- PPD = body-part weeks × impairment % × comp rate (AWW × ⅔). Need a doctor's rating to win it at hearing.
- Most cases settle full & final — insurers pay extra to close; clients get more and resolve cleanly.
- Timing: get the demand out around end of treatment; settlement runs ~30–45 days.
- Injury description is everything — definite time + action. Repetitive use kills claims.
- At every hearing ask "why are we here?" and walk the buckets. No rating → demand, settle, or mediate.