Virginia Workers’ Compensation Commission to Increase Fines for Failure to File Appropriate EDI Transactions

Since 2016, the Virginia Workers’ Compensation Commission has issued fines and penalties to Employers/Insurers for failure to file the appropriate EDI transactions under § 65.2-902 of the Code of Virginia which states:

§ 65.2-902. Failure to make required reports; civil penalty.

Any employer, insurance carrier, self-insurer, group self-insurance association, or third-party administrator who fails to make any report required by the Commission pursuant to this title shall be assessed a civil penalty of not more than $500 for each failure. If the Commission determines that any such failure is willful, it shall assess a civil penalty of not less than $500 and not more than $5,000. The civil penalty herein provided may be assessed by the Commission in an open hearing with the right of review and appeal as in other cases.

  The original fine was $250 per occurrence and included the failure to file the following documents:

1.      First Report of Injury

2.      Failure to File Initial SROI reporting payments due pursuant to an Award Order, Judicial Opinion, Stipulated Order, etc.

3.      Failure to File Subsequent SROI reporting additional payment/activity

4.      Failure to File Requested Transaction, including but not limited to;

a.      Correction Required letters in which the Commission is requesting a data change to an existing claim

b.      Corrected transaction resulting from an EDI rejection.

Effective December 1, 2024, these fines will be increased from $250 to $500 per occurrence.  The Commission will continue to follow the same procedures prior to levying any fines.  These procedures include the following:

1.      When a transaction becomes past due, a letter will be issued by the Commission directing that the specific transaction be filed.  If after the said transaction is not filed and no response is received, an Order will be issued directing the same.  

2.      After 14 days, the JCN will be re-reviewed and should the necessary transaction not be received, a personal contact will be made via email or phone call to the person listed as Primary Business Contact for the Employer/Insurer.

3.       The case will be reviewed one final time 7 days later.  If no transaction or communication is received, a Penalty Order will be issued levying a fine.

 Please note that any party can appeal the fine assessment.  However, the Commission may ultimately increase the fine up to $5,000.00 after a hearing.

Please feel free to reach to one of our Virginia lawyers for further questions or concerns regarding the potential exposure to penalties and fines. 

Sarah M. Burton