Virginia Workers' Compensation Commission Forms

This form is used for reporting the first injury that occurred in Virginia. It must be completed and submitted to the Virginia Workers' Compensation Commission.

This Form is used for the CSD-50 Award Agreement in Virginia, which outlines the agreement to pay benefits.

This document is used for responding to a dispute regarding medical fee schedules in Virginia.

This Form is used for reporting and requesting reimbursement for transportation and travel expenses incurred in Virginia.

This document guarantees the responsibilities and obligations of a parent in Virginia. It ensures the well-being and support of a child.

This document is for preparing a final statement in a pre-mediation process for all claims in the state of Virginia.

This form is used for terminating a wage loss award in Virginia.

This form is used for reporting the annual payroll of a self-insurer in Virginia. It is required by the Virginia Workers' Compensation Commission.

This document is a full and final pre-mediation statement related to an awarded claim in the state of Virginia. It provides a comprehensive overview of the claim and its resolution prior to mediation.

This form is used for parental guarantee in Virginia for the Virginia Workers' Compensation Commission.

This Form is used for employers in Virginia to apply for a hearing.

This document is a wage chart used in Virginia for VWC Form 7A. It provides information on different wage rates for different job categories.

This Form is used for contractors in Virginia to provide proof of workers' compensation insurance coverage.

This form is used for disputing medical fee schedules in Virginia.

This Form is used for officers or managers in Virginia to reject coverage under VWC Form 16A.

This document is a subpoena issued by an attorney in Virginia for the production of specific documents or evidence in a civil case.

This Form is used for filing a petition under the Virginia Birth-Related Neurological Injury Compensation Act in Virginia.

This document is used to legally compel a witness to provide testimony or evidence in a civil case. It is issued by an attorney in the state of Virginia.

This document is used for submitting a claim for benefits related to pneumoconiosis (lung diseases caused by inhalation of certain dust particles) in the state of Virginia.

This form is used for waiving occupational disease coverage in Virginia.

This form is used for requesting mediation to help resolve a dispute in the state of Virginia. Mediation can be a helpful tool for resolving conflicts without going to court.

This Form is used to request a Cost-of-Living Adjustment (COLA) in Virginia. It allows individuals to request an increase in their income or benefits to account for changes in the cost of living. This document is important for individuals living in Virginia who need a financial adjustment due to rising expenses.

This document is a profile for electronically transmitting workers' compensation data in the state of Virginia.

This document is used for making inquiries about medical providers in the state of Virginia.

This form is used for reporting the annual payroll of self-insurers by city, town, or county school boards in Virginia.

This form is used for insurance carriers in Virginia to report their annual premiums, assessments, and other financial information. It helps ensure transparency and regulation in the insurance industry.

This type of document is used in Virginia to revoke a prior rejection of coverage by an officer or manager.

This type of document, called an affidavit, is commonly used in the state of Virginia. It is a written statement made under oath that is used as evidence in legal proceedings.

This document is used to establish an electronic partnership agreement in the state of Virginia.

This form is used for an informational letter in Virginia when an employee is not represented by counsel. It provides important information to the employee regarding their rights and responsibilities in a legal matter.

This form is used for requesting full and final mediation in the state of Virginia.

This form is used for mediation proceedings in the state of Virginia. It allows parties involved to provide their evaluation and feedback on the mediator and the mediation process.

This Form is used for reporting a patient's medical information by their attending physician in the state of Virginia.

This document provides information about the different levels and types of amputations in the state of Virginia.

This Form is used for an Irrevocable Letter of Credit issued in Virginia.

This document is a pre-mediation statement used in Virginia for contesting an original claim. It provides a comprehensive and final overview of the disputed claim before entering into mediation.

This Form is used for responding to a change in condition claim in the state of Virginia.

This Form is used for healthcare providers in Virginia to respond to an application for medical care provider enrollment.