Virginia Workers' Compensation Information



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

Chapter 16 Electronic Medical Billing (10-80)

Chapter 30 Designated Representatives: Virginia Workers' Compensation (10-20)

Chapter 50- Rules of the Commission (1-14)

Chapter 91 Claims Reporting (10-20)

Chapter 110 Medical Fee Schedules Regulations (10-40)

Petitions and Order Requirements

Chapter 1 Definitions And General Provisions (65.2-100 through 65.2-107)

Chapter 2 Virginia Workers' Compensation Commission (65.2-200 through 65.2-205)

Chapter 3 Application And Effect Of Title (65.2-300 through 65.2-323)

Chapter 4 Occupational Diseases (65.2-400 through 65.2-.407)

Chapter 5 Compensation And Payment Thereof (65.2-500 through 65.2-531)

Chapter 6 Notice of Accident; Filing Claims; Medical Attention and Examination (65.2-600 through 65.2-607)

Chapter 7 Procedure In Connection With Awards (65.2-700 through 65.2-715)

Chapter 8 Insurance And Self-Insurance (65.2-800 through 65.2-824)

Chapter 9 Reports And Records (65.2-900 through 65.2-903)

Chapter 10 Administrative Fund And Tax Therefore (65.2-1000 through 65.2-1008)

Chapter 11 Second Injury Fund (65.2-1100 through 65.2-1106)

Chapter 12 Uninsured Employer's Fund (65.2-1200 through 65.2-1206)

Chapter 13 Peer Review Of Medical Costs (65.2-1300 through 65.2-1310) Repealed