• Premium News Login
  • WorkCompResearch Member Login
  • Solutions
    • WorkCompResearch
    • Virtual Claims Kit
    • FlashFormSSL
    • Advertising, Branding and Promotional Services
    • CompEvent Conference Registration
  • News, Blogs & Events
    • News Center Home Page
    • View All Articles
    • Featured News
    • The Experts View
    • Current News
    • From Bob's Cluttered Desk
    • Workers' Comp Blog Wire
    • Workers' Comp Best Blogs
      • 2019 Best Blogs
      • Workers' Comp Best Blogs 2018
      • Workers' Comp Best Blogs 2017
      • Workers' Comp Best Blogs 2016
    • Calendar of Events
  • State Info
  • Forums
  • Kid's Chance

  • WorkCompResearch Login
  • Premium News Login
  • Request a Demo






Simplifying the Work of Workers' Compensation



Vermont 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 Vermont Workers' Compensation.


Vermont Workers' Compensation Telephone Directory


Department of Labor and Industry: 802-828-2286

Workers' Compensation & Safety : 802-828-2138

Administrative Law Judge Beth DeBernardi (Formal Hearings): 802-828-2996

Fraud: 802-828-2286

Administrative Law Judge Stephen Brown (Formal Hearings): 802-828-4043

Records Request (VDOL): 802-828-4391

Department of Labor - Mailing Address: 802-828-4000

Records Request (VDOL): 802-828-4204

Vocational Rehabilitation: 802-828-2991

VOSHA - Toll Free Main Number: 800-287-2765

VOSHA Program Manager: 802-828-5084

Vocational Rehabilitation : 866-VRWORKS

Vocational Rehabilitation Division Director: 866-879-6757

Project WorkSAFE: 888-723-3937

Project WorkSAFE Program Manager: 802-595-2521

Project WorkSAFE Safety & Health Consultant: 802-505-1291

Project WorkSAFE Safety & Health Consultant: 802-989-9363

Media Inquiries/Communication Coordinator : 802-461-8807

Workers' Compensation Safety Director: 802-828-2138

WC Claim's Specialist I General Qustions, Denials,& Compensation Agreement: 802-828-2993

WC Administration Form 5's Contact: 802-828-2286

WC Coverage Tracking, Exclusions: 802-828-2287

WC Coverage Tracking, Exclusions - 2nd Number: 802-828-2991

WC Administration Support Staff: 802-828-2149

WC Claims Specialist - General Questions, Denials, Compensation Agreement: 802-828-2206

WC Claims Specialist II - Disputed Claims, Compensability, Form 27's & Form 2 Denials: 802-828-0441

WC Claims Specialist - General Questions, Denials, Compensation Agreement: 802-828-2995

WC Claims Specialist II - Disputed Claims, Compensability, Form 27's & Form 2 Denials: 802-828-2742

WC Claims Specialist II - Disputed Claims, Compensability, Form 27's & Form 2 Denials: 802-828-1345

WC Claims Specialist II - Disputed Claims, Compensability, Form 27's & Form 2 Denials: 802-828-1119

WC Claims Specialist II - Disputed Claims, Compensability, Form 27's & Form 2 Denials: 802-828-4362

Workplace Safety Contact Information : 800-287-2765

Dept. of Financial Regulation - Insurance Division Deputy Commissioner Kevin Gaffney: 802-828-3301

Dept. of Financial Regulation - Insurance Division - Toll Free: 833-337-4685

Insurance Division (State) Consumer Services Section: 800-964-1784

Electronic Data Interchange (EDI) (Claims must be submitted through EDI) Info: 802-828-2991

VOSHA Workplace Safety Contact: 800-287-2765

VOSHA Project Work Safe: 888-723-3937

OSHA Vermont State Plan applies to Public/Private Employment - Montpelier Office: 802-828-2765

Forms & Publications


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,600 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

Try a Forms Membership! If you have an ongoing need for multiple forms, and want complete and unrestricted access to our entire 3,000 "Type & Save" Forms Library, you may register for immediate access here. Annual subscribers to this service get the benefit of our forms updating system, making sure the forms they use are the most current available.

= Indicates this Type & Save form is available for individual purchase.

= FlashFormSSL Enabled.
Click here to learn more about auto-populating forms with FlashForm SSL.



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

(Form01) Employees Claim and Employer First Report of Injury 9/11
(Form02) Denial of Workers" Compensation Benefits 4/18
(Form04) Report of Fatal Accident 9/11
(05) Employees Notice of Injury and Claim for Compensation 9/11
(Form06) Notice and Application for Hearing 9/11
(Form07) Medical Authorization 1/17
(Form08) Notice of Intent to Change Health Care Provider 9/11
(10) Certificate of Dependency and Concurrent Employment 9/11
(13) Report of Benefits and Related Expenses Paid 9/09
(13a) Aggregate Annual Reporting Form -- Reporting Period 7/01 -- 6/30 8/16
(16) Settlement Agreement 7/14
(20) Work Capabilities Form 12/10
(22) Agreement for Permanent Partial Disability Compensation 9/11
(23) Agreement for Compensation in Fatal Cases 9/13
(25) Wage Statement 6/10
(25s) Weekly Net Income Worksheet 9/09
(Form25 070108) Wage Statement 1/18
(27) Employer's Notice of Intention to Discontinue Payments 5/18
(28fy23) Notice Of Change in Compensation Rate 6/22
(28fy22) Notice Of Change In Compensation Rate 6/21
(28afy22) Notice Of Change In Compensation Rate 6/21
(28fy21) Notice of Change in Compensation Rate 6/20
(28afy21) Notice of Change in Compensation Rate 6/20
(28fy20) Notice Of Change in Compensation Rate 6/19
(28afy20) Notice Of Change in Compensation Rate 6/19
(28fy19) Notice Of Change In Compensation Rate 5/18
(28afy19) Notice Of Change In Compensation Rate 5/18
(28fy18) Notice of Change in Compensation Rate 6/17
(28afy18) Notice of Change in Compensation Rate 6/17
(28fy17) Notice of Change in Compensation Rate 6/16
(28afy17) Notice of Change in Compensation Rate 6/16
(28fy16) Notice of Change in Compensation Rate 6/15
(28afy16) Notice of Change in Compensation Rate 6/15
(28fy15) Notice of Change in Compensation Rate 6/14
(28afy15) Notice of Change in Compensation Rate 6/14
(28fy14) Notice of Change in Compensation Rate 6/13
(28afy14) Notice of Change in Compensation Rate 6/13
(28fy13) Notice of Change in Compensation Rate 6/12
(28afy13) Notice of Change in Compensation Rate 6/12
(29) Application for Exclusion from the Provisions of the Vermont Workers" Compensation Act 2/13
(30) Application for Self Insurance N/D
(32) Agreement for Temporary Compensation 12/17
(vr227) Vocational Rehabilitation Denial / Discontinuance 9/11
(SIbond) Bond Form for Self-Insured 6/05
(AssumptionandGuarantee) Assumption and Guarantee Form N/D
(selfinsured) Self-Insured Report 2/17
(assessment20) Workers Compensation Administration Fund Quarterly Assessment Statement 2020-2021
(assessment19) Workers Compensation Administration Fund Quarterly Assessment Statement 2019-2020
(assessment18) Workers Compensation Administration Fund Quarterly Assessment Statement 2018-2019
(assessment17) Workers' Compensation Administration Fund Quarterly Assessment Statement 2017-2018
(assessment) Workers' Compensation Administration Fund Quarterly Assessment Statement 2016-2017
(wcinstructions) Quarterly Assessment Statement Submission Instructions N/D
(reconstmt) Insurer's Reconciliation Statement N/D
(noinsurance) Report of Employer Conducting Business Without Workers" Compensation Insurance - Last Revised 4/08
(fraud) Report of Suspected Workers 4/08
(preauth) Medical Provider Preauthorization Request 12/20
(healthreport) HCP1 Health Care Provider Report 7/13
(disputeresolution) Workers' Compensation Alternative Dispute Resolution Report N/D
(25m) Memorandum of Payment 1/15
(VRannualreport) Vocational Rehabilitation Annual Survey Form 1/07
(VRForm1) Vocational Rehabilitation Referral Form 8/13
Cover Page 2/07
(VRdiscontinuance) Vocational Rehabilitation Discontinuance Report 2/07
(VRentitlementassess) Entitlement Assessment 2/07
(Return To Work Plan) Return to Work Plan 2/07
(VRprogressrpt) Vocational Rehabilitation Progress Report 2/07
(VRdisclosure) Vocational Rehabilitation Disclosure Statement 12/14
(VRchangeprov) Notice of Intent to Change Vocational Rehabilitation Provider 8/13
(VRSelfemploymtwkbk) Self-Employment Workbook 9/08
(VRApplication) Application for Vermont Certification as a Vocational Rehabilitation Counselor or Intern 11/13
(VRrenewalapp) Renewal Application for Vermont Certification Vocational Rehabilitation Counselor or Job Developer/Intern 7/13
(VRScreening) Vocational Rehabilitation Screening Notice and Response Form 9/08
(jobsearch) Job Search Tool N/D
(milereimb) Mileage Reimbursement Tool N/D
  • Vermont Rules
  • Vermont Statutes

Administration Rules

Administrative Citations and Penalties


  • Section 1. Scope

  • Section 2. Authority

  • Section 3 Issuance of Administrative Citation

  • Section 4 Hearing on Citation and Proposed Penalty

  • Section 5 Administrative Penalty

  • Section 6 Severability Clause

  • Section 7 Effective Date

  • Adminstrative Fund Rules
  • Rules 1-27 Workers' Compensation and Occupational Disease


  • Rule 1.0000 PURPOSE AND CONSTRUCTION

  • Rule 2.0000 DEFINITIONS

  • RULE 3.0000 REPORTING THE INJURY AND ADJUSTING CLAIMS

  • RULE 4.0000 CHOICE OF PHYSICIAN; TRAVEL AND MEALS; WAGES WHILE UNDERGOING MEDICAL TREATMENT OR EXAMINATION

  • Rule 5.0000 RESOLVING MEDICAL DISPUTES

  • Rule 6.0000 INDEPENDENT MEDICAL EXAMINATIONS

  • Rule 7.0000 PRE-AUTHORIZATION OF PROPOSED MEDICAL TREATMENT

  • Rule 8.0000 CALCULATING AVERAGE WEEKLY WAGE AND COMPENSATION RATE

  • Rule 9.0000 TEMPORARY TOTAL AND TEMPORARY PARTIAL DISABILITY BENEFITS

  • Rule 10.0000 PERMANENT PARTIAL DISABILITY, PERMANENT TOTAL DISABILITY AND DEATH BENEFITS

  • Rule 11.0000 DENYING BENEFITS

  • Rule 12.0000 DISCONTINUING BENEFITS

  • Rule 13.0000 LUMP SUM PAYMENTS AND COMPROMISE AGREEMENTS

  • Rule 14.0000 REQUESTING A HEARING IN A CONTESTED CLAIM

  • Rule 15.0000 REPRESENTATION IN A CONTESTED CLAIM; ASSISTANCE BY BARGAINING UNIT REPRESENTATIVE

  • Rule 16.0000 THE INFORMAL DISPUTE RESOLUTION PROCESS

  • Rule 17.0000 FORMAL HEARING PROCEDURE; APPEALS

  • Rule 18.0000 MEDIATION

  • Rule 19.0000 ARBITRATION OF INSURANCE DISPUTES

  • Rule 20.0000 COSTS AND ATTORNEY FEES; ATTORNEY LIENS

  • Rule 21.0000 THIRD PARTY LIABILITY ACTIONS

  • Rule 22.0000 REPORTING BENEFIT AND EXPENSE PAYMENTS

  • Rule 23.0000 COMPLIANCE STATEMENTS

  • Rule 24.0000 FILING CERTIFICATES OF INSURANCE, NOTICES OF CANCELLATION OR NONRENEWAL AND ANTI-FRAUD REPORTS; INVESTIGATING CLAIMS OF FRAUD

  • Rule 25.0000 EXCLUDING CORPORATE OFFICERS AND LLC MANAGERS AND MEMBERS FROM COVERAGE

  • Rule 26.0000 SELF-INSURANCE

  • Rule 27.0000 APPLICATION AND EFFECT OF RULES, SEVERABILITY, EFFECTIVE DATE
  • Rule 45 Rules for Administrative Citations and Penalties, Stop Work Orders and Debarment.


  • 45.1000. Rules for Administrative Citations and Penalties, Stop Work Orders and Debarment.

  • 45.2000. Authority to Adopt Rules.

  • 45.3000. Issuance of Administrative Citations.

  • 45.3200. Service of Citation.

  • 45.3300. Response.

  • 45.3400. Enforcement Authority Not Limited

  • 45.3500. Investigations And Determinations Under 21 VSA 663b

  • 45.4000. Administrative Citation and Penalty Hearing.

  • 45.4200. Hearing Notice.

  • 45.5000. Administrative Penalties.

  • 45.5100. False Statement or Representation.

  • 45.5160. Penalty Reduction Factors.

  • 45.5200. Forfeiture of Benefits.

  • 45.5220. Partial Forfeiture of Benefits.

  • 45.5300. Referral to Department of Financial Regulation.

  • 45.5400. Debarment; False Statement or Representation.

  • 45.5500. Administrative Penalty; Failure to Insure.

  • 45.5520. Penalty Reduction Factors.

  • 45.5560. Failure to Insure; Stop-Work Order.

  • 45.5580. Debarment; Violation of Stop-Work Order.

  • 45.6600. Other Penalties.

  • 45.6630. Penalty; Failure to Submit Forms or Reports; Technical Violations

  • 45.7000. Violations of 21 VSA 690(b)

  • 45.72200. Penalty Reduction Factors

  • 45.7300. Falsifying Compliance Statement

  • 45.8000. Severability

  • 45.9000. Effective Date:
  • Rules 50-58 Vocational Rehabilitation.


  • Rule 50.0000 VOCATIONAL REHABILITATION. PURPOSE.

  • Rule 51.0000 DEFINITIONS For the purposes of these rules:

  • Rule 52.0000 REQUESTING VOCATIONAL REHABILITATION SERVICES

  • Rule 53.0000 IDENTIFICATION AND REFERRAL

  • Rule 54.0000 ENTITLEMENT

  • Rule 55.0000 RETURN TO WORK PLAN

  • Rule 56.0000 VOCATIONAL REHABILITATION DISPUTE RESOLUTION

  • Rule 57.0000 QUALIFYING CRITERIA FOR REHABILITATION PROFESSIONALS

  • Rule 58.0000 Vocational Rehabilitation Fee Schedule
  • Title 8 - Chapter 117: Workers' Compensation Insurance


  • 4361. Mutual Associations Authorized

  • 4362. Commissioner's Approval Required

  • 4363. Membership

  • 4364. Control Of Association

  • 4365. Policies

  • 4366. Officers And Voting Rights

  • 4367. Power To Prescribe And Enforce Safety Rules

  • 4368. Premium Rates

  • 4369. Reserve Requirements

  • 4370. Assessments

  • 4371. Investments

  • 4372. Approval Of Premiums, Liabilities, Assessments, And Dividends

  • 4373. Bylaws And Regulations

  • 4374. Appeals To Supreme Court
  • Title 8 - Chapter 128: Property And Casualty Insurance Rate RegulationRegulation


  • 4687 Workers' compensation and employers' liability insurance; uniform administration of classifications; reporting of rates and other information.

  • 4692 Joint underwriting; pool and residual market activities.

  • 4693 Agreements to adhere.

  • 4694 Residual market mechanism status.

  • 4695 Exemptions.

  • 4696 Mandatory market participation.
  • Title 8 - Chapter 141: Captive Insurance Companies


  • 6001 Definitions.

  • 6002 Licensing; Authority.
  • Title 13 - Chapter 47: Frauds


  • 2024 Workers' compensation fraud.

  • 2025 Employers without workers' compensation insurance; criminal sanction.

  • 2031. Insurance fraud
  • Title 21 Labor

    Chapter 9. Employer's Liability And Workers' Compensation


  • 601. Definitions

  • 602. Process And Procedure

  • 603. Witnesses, Oaths, Books, Papers, Records

  • 604. Manner Of Trying Causes; Evidence

  • 605. Testimony Of Person Without The State, How Taken

  • 606. Determination Of Questions

  • 607. Decisions; Enforcement; Appeals

  • 608. Application Of Chapter When State Not An Employer

  • 610. Election By State As Employer

  • 616. Employments Covered

  • 618. Compensation For Personal Injury

  • 619. Injuries Outside State

  • 620. Worker Hired Outside State

  • 621. Interstate Commerce

  • 622. Right To Compensation Exclusive

  • 623. Contracts To Work Outside State

  • 624. Dual Liability; Claims, Settlement Procedure

  • 625. Contracting Out Forbidden

  • 632. Compensation To Dependents; Burial And Funeral Expenses

  • 633. Apportionment Of Compensation

  • 634. Dependents; Construction

  • 635. Periods Of Compensation

  • 636. Compensation For Unexpired Period; Determined

  • 637. Death Benefits; Rival Claimants

  • 639. Death, Payment To Dependents

  • 640. Medical Benefits; Assistive Devices; Home And Automobile Modifications

  • 640a. Medical Bills; Payment; Dispute

  • 640b. Request for preauthorization to determine if proposed treatment is necessary

  • 641. Vocational Rehabilitation

  • 642. Temporary Total Disability Benefits

  • 642a. Temporary Total; Insurer Review

  • 643. Period Of Payments

  • 643a. Discontinuance Of Benefits [Section 643a repealed effective July 1, 2023; see also section 643a effective July 1, 2023 below.]

  • 643a. Discontinuance of benefits [Section 643a effective July 1, 2023; see also section 643a effective until July 1, 2023 .]

  • 643b. Reinstatement; Seniority And Benefits Protected

  • 643c. Commissioner To Provide Notice; Monitoring

  • 644. Permanent Total Disability

  • 645. Amount Payable

  • 646. Temporary Partial Disability Benefits

  • 647. Period Of Payment

  • 648. Permanent Partial Disability Benefits

  • 649. Injuries Not Covered; Burden Of Proof

  • 650. Payment; Average Wage; Computation

  • 651. Voluntary Payments

  • 652. Periodical Payments; Lump Sum Payments

  • 654. Trustee In Case Of Lump Payments; Appointment; Expense

  • 655. Procedure In Obtaining Compensation; Medical Examination; Video And Audio Recording

  • 655a. Release of relevant medical records by health care providers; Department to oversee release and use of relevant medical information

  • 656. Notice Of Injury And Claim For Compensation

  • 657. After Court Judgment Against Employee

  • 658. Form Of Notice And Claim

  • 659. Giving Of Notice And Making Of Claim

  • 660. Sufficiency Of Notice Of Injury

  • 661. Limitation Of Time As Regards Minors And Persons With A Mental Condition Or Psychiatric Disability

  • 662. Agreements; Required Payments In Absence Of

  • 663. Hearings, Where Held; Decision

  • 663a. Workers' compensation dispute mediation

  • 660a. Electronic Filing Of Reports Of Injury

  • 664. Trial And Award

  • 666. Manner Of Giving Notice Of Hearing

  • 667. Examination By Independent Medical Examiners

  • 668. Modification Of Awards

  • 669. Finality Of Award

  • 670. Appeals To Superior Court

  • 671. Jurisdiction; Findings For New Award

  • 672. Appeals To The Supreme Court

  • 673. Appeal In Case Of Fraud, Accident, Or Mistake

  • 674. Service Of Petition

  • 675. Enforcement Of Award

  • 676. Revision Of Decrees

  • 677. New Hearings; When Granted; Procedure

  • 678. Costs; Attorney's Fees

  • 679. Fees Of Sheriffs And Witnesses

  • 680. Preferences

  • 681. Claims Not Assignable

  • 682. Liens Against Compensation

  • 687. Security For Compensation

  • 687a. Self-insurance By Associations

  • 688. Administrative Penalties; Insurance Company's License Suspended

  • 689. Employer Compelled To Insure

  • 690. Certificate, Form; Copy Of Policy

  • 691. Posting Of Notice Of Compliance

  • 692. Penalties; Failure To Insure; Stop Work Orders

  • 693. The Insurance Contract

  • 694. Knowledge Of Employer To Affect Insurance Carrier

  • 695. Insolvency Of Employer Not To Release Insurance Carrier

  • 696. Cancellation Of Insurance Contracts

  • 697. Notice Of Intent Not To Renew Policy

  • 698. Insurance By State And Municipalities

  • 699. Employees Not To Pay For Insurance

  • 700. Examination Of Policy

  • 701. Reports Of Accidents By Employers

  • 702. Contents; Penalty

  • 703. Reports Of Payments Made By Employers

  • 704. Reports, Penalty

  • 705. Registration, Penalty

  • 706. Construction

  • 708. Penalty For False Representation

  • 709. Rules Of Construction

  • 710. Unlawful Discrimination

  • 711. Workers' Compensation Administration Fund
  • Chapter 12. Employee Leasing Companies


  • 1037 Workers Compensation.
  • Title 29 - Chapter 55: State Insurance


  • 1408 Workers' compensation insurance.
  • Misc. Related Statutes


  • 780. Definitions

  • 787. Employer's responsibility; compensation




  • WorkersCompensation.com, LLC. | All Rights Reserved
    About Us | Advertise with Us | Contact Us | WorkCompResearch.com | Privacy Policy | Terms | Advertiser Login