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Simplifying the Work of Workers' Compensation



Virginia Workers' Compensation Information

  • Home
  • States
  • Workers' Compensation Information


  • State Telephone Numbers
  • State Forms
  • State Rules & Statutes

Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for Virginia Workers' Compensation.


Virginia Workers' Compensation Telephone Directory


Workers' Compensation Commission - Richmond Central Office: 877-664-2566

Regional Office - Bristol : 276-889-7644

Clerk's Office: 804-205-3569

Claims Services Department : 877-664-2566

Judicial Department - Clerk of the Commission: 804-205-3569

Alternative Dispute Resolution (ADR): 804-205-3139

Administration Department: 804-205-3060

Criminal Injuries Compensation Fund: 800-552-4007

EDI Quality Assurance Department: 804-205-3104

Financial Services Department: 804-823-3186

Insurance Department - PEO Registration Information: 804-205-3586

Employer's Applications: 877-664-2566

Fairfax Regional Office: 703 207-7152

Regional Office - Harrisonburg : 540-433-7701

Regional Office - Manassas : 703-257-7994

Regional Office - Roanoke : 540-776-2700

Regional Office - Virginia Beach : 757-552-1117

Self Insured Program: 804-205-3599

Mediation: 804-823-6904

Vocational Rehabilitation Information: 877-664-2566

Judicial Assistant to R. Ferrell Newman, Chairman: 804-205-3129

Judicial Assistant to Commissioner Wesley G. Marshall: 804-205-3127

Judicial Assistant to Commissioner Robert A. Rapaport: 804-205-3135

Judicial Assistant to Chief Deputy Commissioner James J. Szablewicz (Richmond): 804-205-3097

Judicial Assistant to Deputy Commissioner Frederick M. Bruner (Richmond): 804-205-3138

Judicial Assistant to Deputy Commissioner Angela F. Gibbs (Richmond): 804-205-3249

Judicial Assistant to Deputy Commissioner Brooke Anne C. Hunter (Richmond): 804-205-3131

Judicial Assistant to Deputy Commissioner Andrea White Lee (Richmond): 804-205-3058

Judicial Assistant to Deputy Commissioner R. Temple Mayo (Richmond): 804-205-3141

Judicial Assistant to Deputy Commissioner P. Randolph Roach, Jr. (Richmond): 804-205-3111

Judicial Assistant to Deputy Commissioner Linda M. Gillen (Richmond): 804-205-3120

Judicial Assistant to Deputy Commissioner Christen Burkholder (Bristol): 276-415-3022

Judicial Assistant to Deputy Commissioner D. Edward Wise, Jr. (Bristol): 276-415-3030

Judicial Assistant to Deputy Commissioner Susan E. Cummins (Fairfax): 703-269-2276

Judicial Assistant to Deputy Commissioner William R. Culbreth (Harrisonburg): 540-615-4981

Judicial Assistant to Deputy Commissioner R. Jason Cording (Harrisonburg): 540-615-4986

Judicial Assistant to Deputy Commissioner Jimese P. Sherrill (Manassas): 703-334-2601

Judicial Assistant to Deputy Commissioner W. Geovanni Munoz (Manassas): 703-334-2610

Judicial Assistant to Deputy Commissioner William T. Kennard (Manassas): 703-334-2617

Judicial Assistant to Deputy Commissioner Deborah W.Blevins (Roanoke): 540-776-2700

Judicial Assistant to Deputy Commissioner Robert M. Himmel (Roanoke): 540-283-5003

Judicial Assistant to Deputy Commissioner Linda Slough (Roanoke): 540-283-5001

Judicial Assistant to Deputy Commissioner Lynne M. Ferris (Virginia Beach): 757-648-7111

Judicial Assistant to Deputy Commissioner Terry Jenkins (Virginia Beach): 757-648-7109

Judicial Assistant to Deputy Commissioner Lee E. Wilder (Virginia Beach): 757-648-7108

Bureau of Insurance (Manages Self Insurance): 804-371-9063

Judicial Assistant to Deputy Commissioner John S. Nevin (Fairfax): 703-269-2279

Judicial Assistant to Deputy Commissioner Dana L. Plunkett (Fairfax): 703-334-2602

Fraud: 877-62FRAUD

Fraud (Insurance State Police Program): 804-674-2769

Bureau of Insurance (State): 804-371-9741

Bureau of Insurance (State) Commissioner Scott A. White: 804-371-9608

Managed Care Ombudsman: 877-310-6560 #1

OSHA Virginia State Plan applies to Public/Private Employment - Headquarters: 804-371-2327

Forms & Publications


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Some "Revision Dates" may be displayed as part of the Description.

(3) First Report of Injury 10/08
(4) Award Agreement 11/21
(5) Claim for Benefits 11/09
(7a) Wage Chart 11/21
(9a) Waiver of Occupational Disease 5/20
(35) Fatal Award Agreement 11/21
(46) Termination of Wage Loss Award 11/21
(6) Attending Physician's Report 11/21
(amputation) Amputation Chart 11/21
(50) Request for Peer Review N/D
(medprovinq) Medical Provider Inquiry N/D
(ca51) Cost of Living Adjustment Request Form 10/21
(siapplication) Application for Individual Self-Insurance 11/17
(SIbond) Self Insurance Bond 01/92
(loc) Irrevocable Letter of Credit 7/07
(22) Parental Guarantee 8/15
(23A) Annual Self-Insurance-Survey-Commercial 1/19
(23B) Annual Self-Insurance Survey - Public 10/18
(26) Annual Report of Self-Insurer's Payroll 10/12
(16a) Officer/Manager Rejection of Coverage 2/22
(17a) Notice Terminating Prior Rejection of Coverage 10/17
(26A) Annual Report of Premiums, Assessments, Etc., Received by Insurance Carriers 11/12
(26B) Annual Report of Self-Insurer's Payroll by City, Town or County School Boards 7/11
(26C) Annual Payroll Report of City, Town or County Operating as a Self-Insurer 7/11
(CA51A) Fatal SSA Verification 4/12
(silargeloss.xlxs) Detailed Claims Addendum for Claims in Excess of $100,000 4/20
(webfileattyreg) WebFile Attorney Registration Form N/D
(infoltrnocounsel) Informational Letter Where Employee IS NOT Represented by Counsel N/D
(fatalformltr) Letter for Beneficiary in Fatal Case Informational Form Letter for a BENEFICIARY who is NOT Represented by Counsel N/D
(sheriff ltr) Letter to Sheriff N/D
(issuemed) Request For Issue Mediation 5/19
(finalmed) Request For Full And Final Mediation 5/19
(requestmediation) Request for Mediation N/D
(mediationconfirm) Mediation Confirmation Form N/D
(mediationconsent) Mediation Consent Form A - All Parties Have Legal Counsel 4/17
(mediationconsentb) Mediation Consent Form B - All Parties Do Not Have Legal Counsel 4/17
(adreval) ADR Mediator Evaluation Form N/D
(premedall) Full and Final Pre-Mediation Statement (All Claims) N/D
(premedaward) Full and Final Pre-Mediation Statement (Awarded Claim) N/D
(premedcontest) Full and Final Pre-Mediation Statement (Contested Claim) N/D
(5a) Employer's Application for Hearing 11/21
(req4hearing) Expedited Hearing Request Form 11/21
(prehearingmotion) Pre-Hearing Motions Order N/D
(prehearingclaimant) Pre-Hearing Statement Order - Claimant's Claim for Benefits N/D
(prehearingemployer) Pre-Hearing Statement Order-Employer's Application N/D
(prehearingmedcare) Pre-Hearing Statement Order-Medical Care Provider's Application N/D
(sample-info-letter-fatal) Sample-Informational-Letter-Fatal-Case N/D
(sampleaffidavit) Sample Affidavit N/D
(sample-order) Sample Order N/D
(claims response form) Change in Condition Claims Response Form N/D
(subpductec req party) Subpoena Duces Tecum - Requesting Party N/D
(subpoena duces tecum) Subpoena Duces Tecum - VWC Issued N/D
(subp depos) Subpoena for the Taking of Deposition N/D
(ADPA2) Subpoena Duces Tecum -Attorney Issued N/D
(witn atty) Subpoena for Witness - Civil - Attorney Issued N/D
(wit subpoena) Subpoena for Witness - VWC Issued N/D
(61a) Contractor's Certificate of Workers' Compensation Insurance 11/17
(Claimants-Affidavit) Claimants Affidavit N/D
(BR1) Petition Under the Virginia Birth-Related Neurological Injury Compensation Act 7/05
(62) Referral for Lack of Coverage Form N/D
(peoparental) PEO Parental Guarantee 8/15
(si23) Overview of Self-Insurance Requirement 12/21
(si23a.xlsx) Claim Summary Addendum for 2019 Annual Survey 5/15
(si23a2022.xlsx) Claim Summary Addendum for 2022 Annual Survey N/D
(medproviderapp) Medical Care Provider Application Response Form N/D
(GSIA) Application for License as Group Self-Insurance Association N/D
(95) PEO Web File Access Request Form N/D
(Transmission-Profile) Electronic Transmission Profile Receiver's Specifications 2003
(Trading-Partner-Profile) Electronic Trading Partner Profile 2004
(Trading-Partner-Agreement) Electronic Partnering Agreement 2003
(coalclaimform) Coal Workers' Pneumoconiosis Claim Form 11/21
(claimform) Claim for Benefits Form 6/21
(jobsearch) Marketing/Job Search Form 11/21
(expenseform) Transportation/Travel Expense Form 11/21
  • Virginia Rules
  • Virginia Statutes

Chapter 16 Electronic Medical Billing (10-80)


  • 16VAC30-16-10. Effective Date.

  • 16VAC30-16-20. Definitions.

  • 16VAC30-16-30. Formats for Electronic Medical Bill Processing.

  • 16VAC30-16-40. Billing Code Sets.

  • 16VAC30-16-50. Electronic Medical Billing, Reimbursement, and Documentation.

  • 16VAC30-16-60. Employer, Insurance Carrier, Managed Care Organization, or Agent's Receipt of Medical Bills from Health Care Providers.

  • 16VAC30-16-70. Communication Between Health Care Providers and Payers.

  • 16VAC30-16-80. Medical Documentation Necessary for Billing Adjudication.

  • Documents Incorporated by Reference (16VAC30-16)
  • Chapter 30 Designated Representatives: Virginia Workers' Compensation (10-20)


  • 16VAC30-30-10. Order.

  • 16VAC30-30-20. Designated representatives.
  • Chapter 50- Rules of the Commission (1-14)


  • 16VAC30-50-10. Definitions.

  • Rule 1 Prehearing Procedures

  • Rule 2 Hearing procedures

  • Rule 3 Posthearing procedures

  • Rule 4 Filing documents

  • Rule 5 Cost of medical services

  • Rule 6 Award of attorneys fees

  • Rule 7 Employer responsibilities

  • Rule 8 Self-insurance

  • Rule 9 Payment of compensation

  • Rule 10 X-ray evidence for coal workers pneumoconiosis claims

  • Rule 11 Pneumoconiosis table

  • Rule 12 Hearing loss table

  • Rule 13 Table of Percentage of loss of visual accuity

  • Rule 14 Definition of community
  • Chapter 91 Claims Reporting (10-20)


  • 16VAC30-91-10. Definitions.

  • 16VAC30-91-20. Procedures for Filing Claims Reports.

  • FORMS (16VAC30-91).

  • Forms
  • Chapter 110 Medical Fee Schedules Regulations (10-40)


  • 16VAC30-110-10. Definitions

  • 16VAC30-110-20. Applicability of Fee Schedules and Ground Rules; Determination of Communities.

  • 16VAC30-110-30. Disputes

  • 16VAC30-110-40. Periodic Review of Fee Schedules.

  • Forms (16VAC30-110-9999)
  • Petitions and Order Requirements


  • General Requirements

  • The Commission's Processing Procedure

  • Indemnification provisions concerning Medicare set-aside issues

  • Ancillary agreements

  • Preparation Requirements for the Petition and Order

  • Documents Required in Addition to the Petition and Order

  • Structured or Deferred Settlements for Payment Under an Annuity

  • Structured or Deferred Settlements for Payment Without an Annuity
  • Chapter 1 Definitions And General Provisions (65.2-100 through 65.2-107)


  • 65.2-100. Short title.

  • 65.2-101. Definitions.

  • 65.2-101.1 Certified mail; subsequent mail or notices may be sent by regular mail.

  • 65.2-102. Coverage of firefighters and law-enforcement officers in off-duty capacity.

  • 65.2-103. Coverage of members of the Virginia National Guard or Virginia Defense Force during response to orders.

  • 65.2-104. Coverage of first responders in off-duty capacity during state of emergency.

  • 65.2-105 Presumption that certain injuries arose out of and in the course of employment.

  • 65.2-106. Criminal justice training academy trainees.

  • 65.2-107. Post-traumatic stress disorder incurred by law-enforcement officers and firefighters.
  • Chapter 2 Virginia Workers' Compensation Commission (65.2-200 through 65.2-205)


  • 65.2-200. Industrial Commission continued as the Virginia workers' Compensation Commission; number, election and terms of members; vacancies; Chairman; members to devote entire time to office.

  • 65.2-201 General duties and powers of the Commission.

  • 65.2-202 Subpoena powers of the Commission; production of records and papers.

  • 65.2-203 Powers and duties of deputy commissioners and bailiffs.

  • 65.2-204. Administrative provisions: offices, meetings, travel, salary, and expenses.

  • 65.2-205. Ombudsman program; confidentiality.
  • Chapter 3 Application And Effect Of Title (65.2-300 through 65.2-323)


  • 65.2-300. Presumption of acceptance of provisions of title; exemptions; notice and rejection.

  • 65.2-301 Victims of sexual assault.

  • 65.2-301.1 Public safety officers.

  • 65.2-301.2. Employee classification; disaster; personal protective equipment not considered.

  • 65.2-302 Statutory employer.

  • 65.2-303 Recovery from subcontractor; proceedings against owner or contractor.

  • 65.2-304 Indemnity of principal from subcontractor.

  • 65.2-305 Voluntary subjection to provisions of title; effect of taking out insurance or qualifying as self-insurer.

  • 65.2-306 When compensation not allowed for injury or death; burden of proof.

  • 65.2-307 Employee's rights under Act exclude all others; exception.

  • 65.2-308 Discharge of employee for exercising rights prohibited; civil action; relief.

  • 65.2-309 Lien against settlement proceeds or verdict in third party suit; subrogation of employer to employee's rights against third parties; evidence; recovery; compromise.

  • 65.2-309.1 Creation of lien and subrogation of employer to employee's rights to recover uninsured or underinsured motorist benefits pursuant to insurance coverage carried by and at the expense of employer.

  • 65.2-310 Protection of employer when employee sues third party.

  • 65.2-311 Expenses and attorney's fees in action under 65.2-309 or 65.2-310.

  • 65.2-312 False statements, representations, etc., in connection with an award; penalties.

  • 65.2-313. Method of determining employer's offset in event of recovery under 65.2-309 or 65.2-310.
  • Chapter 4 Occupational Diseases (65.2-400 through 65.2-.407)


  • 65.2-400 "Occupational disease" defined.

  • 65.2-401 "Ordinary disease of life" coverage.

  • 65.2-402. Presumption as to death or disability from respiratory disease, hypertension or heart disease, cancer.

  • 65.2-402.1. Presumption as to death or disability from infectious disease.

  • 65.2-403. Provisions in respect to injury by accident, etc., applicable to occupational disease.

  • 65.2-404. What employer and carrier liability.

  • 65.2-405. Notice to be given.

  • 65.2-406. Limitation upon claim; diseases covered by limitation.

  • 65.2-407. Waiver.
  • Chapter 5 Compensation And Payment Thereof (65.2-500 through 65.2-531)


  • 65.2-500. Compensation for total incapacity; computation of average wage; exclusion of AmeriCorps members, certain Food Stamp Employment and Training Program participants, and certain Temporary Assistance for Needy Families participants.

  • 65.2-501. Incapacity after permanent loss.

  • 65.2-502. Compensation for partial incapacity; exclusion of AmeriCorps members, certain Food Stamp Employment and Training Program participants, and certain Temporary Assistance for Needy Families participants.

  • 65.2-503. Permanent loss.

  • 65.2-504. Compensation for disability from coal worker's pneumoconiosis; insurance of coal operator.

  • 65.2-505. Injuries in different employments; injury to employee with disability; subsequent permanent injury by accident in service to employer.

  • 65.2-506. Compensation after second injury in same employment.

  • 65.2-507. Same employment; when both injuries permanent.

  • 65.2-508. Foreign injuries.

  • 65.2-509. Commencement of compensation.

  • 65.2-510. Refusal of employment; compensation for partial incapacity.

  • 65.2-511. Compensation to employee's distributees upon his death from any other cause.

  • 65.2-510.1. Employee imprisonment; suspension of benefits.

  • 65.2-512. Compensation to dependents of an employee killed; burial expenses.

  • 65.2-513. Compensation for death from coal worker's pneumoconiosis; determining whether death was due to pneumoconiosis or any chronic occupational lung disease.

  • 65.2-514. Special provisions for coal worker's pneumoconiosis claims for total disability or death.

  • 65.2-515. Persons conclusively presumed to be wholly dependent.

  • 65.2-516. Other cases of dependency.

  • 65.2-517. Termination of dependency.

  • 65.2-518. Limitation upon total compensation.

  • 65.2-519. When limitations inapplicable to injuries arising out of pneumoconiosis.

  • 65.2-520. Voluntary payment by employer.

  • 65.2-521. Time of payment.

  • 65.2-522. Lump sum payments, generally.

  • 65.2-523. Lump sum payments to trustees.

  • 65.2-524 Failure to pay compensation within two weeks after it becomes due.

  • 65.2-525 Who may receive payment and receipt therefor.

  • 65.2-526 Payment to junior dependents in good faith.

  • 65.2-527 When employee's rights exercised by guardian or trustee.

  • 65.2-528 Time limitations on persons under disability.

  • 65.2-529 Joint service.

  • 65.2-530 Preferences and priorities.

  • 65.2-531 Assignments of compensation; exemption from creditors' claims.
  • Chapter 6 Notice of Accident; Filing Claims; Medical Attention and Examination (65.2-600 through 65.2-607)


  • 65.2-600. Notice of accident.

  • 65.2-601. Time for filing claim.

  • 65.2-601.1 Effect of filing claim; stay of debt collection activities by health care providers.

  • 65.2-601.2. Notice to employee of employer's intent.

  • 65.2-602 Tolling of statute of limitations.

  • 65.2-603 Duty to furnish medical attention, etc., and vocational rehabilitation; effect of refusal of employee to accept.

  • 65.2-603.1. Use of therapeutically equivalent drug products required.

  • 65.2-604 Furnishing copy of medical report.

  • 65.2-605 Liability of employer for medical services ordered by Commission; fee schedules for medical services; malpractice; assistants-at-surgery; coding.

  • 65.2-605.1. Prompt payment; limitation on claims.

  • 65.2-605.2. Biennial peer-reviewed studies.

  • 65.2-606 Physicians for medical examination.

  • 65.2-607. Medical examination; physician-patient privilege inapplicable; autopsy.
  • Chapter 7 Procedure In Connection With Awards (65.2-700 through 65.2-715)


  • 65.2-700. Jurisdiction of Commission.

  • 65.2-701 Agreement as to compensation; penalty.

  • 65.2-702 Disagreement on compensation; venue.

  • 65.2-703 Interrogatories and depositions.

  • 65.2-704 Hearing; award or opinion by Commission.

  • 65.2-705 Review of award; rehearing.

  • 65.2-706 Conclusiveness of award; appeal.

  • 65.2-706.1 Estoppel effect of a Virginia workers' Compensation Commission determination of employment status.

  • 65.2-706.2. Claims not barred.

  • 65.2-707 Interest on appealed award.

  • 65.2-708 Review of award on change in condition.

  • 65.2-709 Cost of living supplements for total incapacity and dependents of deceased.

  • 65.2-710 Enforcement, etc., of orders and awards.

  • 65.2-711 Reporting of address change by employee; suspension of payment of benefits.

  • 65.2-712. Reporting incarcerations, change in earnings, remarriage, change in student status; recovery of payments procured by fraud, misrepresentation, or unreported change in condition.

  • 65.2-713 Costs.

  • 65.2-714 Fees of attorneys and physicians and hospital charges.

  • 65.2-715. Providing written information.
  • Chapter 8 Insurance And Self-Insurance (65.2-800 through 65.2-824)


  • 65.2-800. Duty to insure payment of compensation; effect of insurance.

  • 65.2-801. Insurance or proof of financial ability to pay required.

  • 65.2-802. Requirements for licensure as group self-insurance association; annual assessment.

  • 65.2-803. Administrator and service company affiliation prohibited; exception.

  • 65.2-803.1. Requirements for registration as professional employer organization; annual assessment.

  • 65.2-804. Evidence of compliance with title; notices of cancellation of insurance.

  • 65.2-805. Civil penalty for violation of 65.2-800, 65.2-803.1, and 65.2-804.

  • 65.2-806. Criminal penalties.

  • 65.2-807. Cost of insurance may not be deducted from wages.

  • 65.2-808. Self-insurance certificate.

  • 65.2-809. Constructive notice to, jurisdiction of, and awards, etc., binding upon insurer.

  • 65.2-810. How formal notice may be given.

  • 65.2-811. Liability of insurer.

  • 65.2-812. Subrogation of insurance carrier to employer's rights; compromise.

  • 65.2-813. Insurance deemed subject to title; approval of forms.

  • 65.2-813.1. Insurers offering policies with deductibles.

  • 65.2-813.2 Premium discounts; drug-free workplace programs.

  • 65.2-814. Insurer to furnish written evidence of coverage on request.

  • 65.2-815. Group self-insurance association required to furnish written evidence of membership.

  • 65.2-816. Title not applicable to boiler, etc., insurance.

  • 65.2-817. Rates; cooperation between State Corporation Commission and workers' Compensation Commission.

  • 65.2-818. Minimum standards of service for insurers.

  • 65.2-819. Penalty for violation of certain provisions.

  • 65.2-820. Application to State Corporation Commission for assignment of risk; insurer assigned risk to issue policy.

  • 65.2-821. State Corporation Commission to make rules and regulations, and establish rating schedules and rates.

  • 65.2-821.1. Payment and reimbursement practices; prohibitions.

  • 65.2-822. Action by State Corporation Commission upon application.

  • 65.2-823. Information filed with State Corporation Commission by insurance carrier to be confidential; exception.

  • 65.2-824. Disclosures not required of State Corporation Commission; liability for acts or omissions.
  • Chapter 9 Reports And Records (65.2-900 through 65.2-903)


  • 65.2-900. Records and reports of accidents.

  • 65.2-901. Report of number of employees, hours of work, etc.

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

  • 65.2-903. Records not public.
  • Chapter 10 Administrative Fund And Tax Therefore (65.2-1000 through 65.2-1008)


  • 65.2-1000. Tax for administrative fund.

  • 65.2-1001. Returns.

  • 65.2-1002. Payment of tax.

  • 65.2-1003. Failure to file return.

  • 65.2-1004. Withdrawal from business or failure to pay tax.

  • 65.2-1005. Tax exclusive of other taxes.

  • 65.2-1006. Payroll reports of self-insurers and tax thereon; withholding or providing false or misleading information.

  • 65.2-1007. Disposition of fund.

  • 65.2-1008 When fund in excess of requirement.
  • Chapter 11 Second Injury Fund (65.2-1100 through 65.2-1106)


  • 65.2-1100 Fund created.

  • 65.2-1101. Funding.

  • 65.2-1102 Disability defined.

  • 65.2-1103 When awards entered.

  • 65.2-1104 Award for compensation, medical treatment and vocational rehabilitation.

  • 65.2-1105 Payments by fraud, mistake or improper processing of claim; recovery.

  • 65.2-1106 Claims and hearings.
  • Chapter 12 Uninsured Employer's Fund (65.2-1200 through 65.2-1206)


  • 65.2-1200 Fund created.

  • 65.2-1201 Financing; tax.

  • 65.2-1202 Defense of claims against fund by Attorney General.

  • 65.2-1203 Awards.

  • 65.2-1204 Subrogation and recoupment.

  • 65.2-1205 Notification of change in earnings; change in award.

  • 65.2-1206 Payments procured by fraud, mistake or unreported change in condition; recovery.
  • Chapter 13 Peer Review Of Medical Costs (65.2-1300 through 65.2-1310) Repealed


  • Chapter 13. Peer Review of Medical Costs [Repealed]




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