When an individual has experienced an injury or an occupational disease in the workplace, it is important to give
immediate notice to the employer about the injury. Employers are required to le a First Report of Injury (FROI) within
ten (10) days of having knowledge of any injury.
Pursuant to Va. Code §65.2-601, a claim for specic benets must be led within two (2) years from the date of injury.
Even if the Claim Administrator is voluntarily paying benets, rights are not protected unless there is an Award
If the Claim Administrator accepts the claim, an Award Agreement is sent to the injured worker. Once signed by all
parties, the Award Agreement must be led with the Commission for entry of the Award Order. An Award Order protects
the injured worker’s rights to benets.
Alternative Dispute Resolution (ADR)
Mediation is a voluntary and condential informal dispute resolution process where a neutral third party (mediator)
facilitates communication to assist the parties in mediating an agreeable solution. The purpose of mediation is to identify
issues, clarify misunderstandings, explore solutions and mediate an agreement. For further information, contact the
ADR Department at 804-205-3139.
A hearing may be necessary to resolve disputed issues. A completed Claim Form and medical records* to support the
claim must be led for this to occur. The primary objective is to hear and decide disputed claims and issues arising
under the Virginia Workers’ Compensation Act in a prompt, fair and impartial manner.
• Lifetime Medical - payment for medical treatment/expenses for the injury or occupational disease, now and in the future.
• Temporary Total Disability - wage loss replacement while completely out of work. Must be medically authorized.
• Temporary Partial Disability - wage loss replacement while partially out of work, or working light duty. Must be medically authorized.
• Permanent Partial Disability - compensation for loss of use of a body part, amputation, disfigurement/bodily scarring, loss of hearing,
loss of vision or lung disease. Must be medically supported.
• Medical Expenses - payment/reimbursement of medical bills, or out of pocket expenses, such as prescription and mileage/transportation.
Must provide bills, receipts and/or mileage logs.
• Death Benefits - payment/reimbursement of funeral/transportation expenses or wage loss replacement for surviving spouse, children,
or certain other dependents. Death Certificate, Marriage License and/or Birth Certificate(s) must be provided.
• Other - benefits not previously mentioned (vocational rehabilitation, specific medical treatment/procedure, panel of physicians, etc).
Benets Covered under the Virginia Workers’ Compensation Act
*Medical Records & Subpoenas
Copies of medical records may be obtained from the physician. However, if copies of medical records and/or bills
cannot be obtained, a subpoena can be requested by sending the name and address of the medical provider to the
Clerk of the Commission. A $12 money order made payable to the Sheri of the city or county where the medical
provider is located must be included for each subpoena.
Have questions about the Virginia Workers’ Compensation Commission and no lawyer? Call the Ombuds Department
at 833-448-1681, or email email@example.com. We cannot give legal advice, but all conversations will
be kept condential.
Toll-Free: 877-664-2566 | Online: workcomp.virginia.gov | Mail: 333 E. Franklin St., Richmond, Virginia 23219
Claim Form Process & Instructions