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Find helpful workers compensation guides and resource for Virginia employers and employees in our forms library.  We provide free access to the most common VA comp forms for your convenience.  Please contact us if you have questions about our forms or coverage, or if you need assistance locating a form.

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VA Comp Forms

 

Virginia Workers Compensation Forms

VA Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in Virginia.

Virginia First Report of Injury Form

VA First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

Virginia Agency Change of Address Form

VA Agencies should complete this form to update their contact information in the state of Virginia.

Virginia Agency Contact Addition-Change Form

Agencies should complete this form to add new contacts and update contact information.

VA Electronic Data Interchange Implementation Guide

This Implementation Guide is designed to assist Insurers, Self Insurers, and Claim Administrators with the transition from paper filing to electronic filing of first and subsequent reports of injury.

Virginia LLC Rejection of Workers' Compensation Coverage

This form allows LLC members to reject workers comp coverage for the state of Virginia.

Virginia Drug-Free Workplace Certification Checklist

Complete this form to apply for the Drug-Free workplace premium reduction.

Facts for Injured Workers in Virginia

Information about workers' compensation in Virginia for Injured Workers.

Employers Guide to Workers' Compensation

Information from The Virginia Workers' Compensation Commission about workers' compensation for employers in Virginia.

Workers' Compensation Notice

Information from the Virginia Workers' Compensation Commission about the filing process for compensation claims.

Irrevocable Letter of Credit

A publication by the VA Division of Workers' Compensation about the states Second Injury Fund.


Virginia State Resources

Virginia Workers' Compensation Commission

1000 DMV Drive
Richmond, VA 23220
877-664-2566
http://www.workcomp.virginia.gov

Virginia is under the State Jurisdiction of the National Council for Compensation Insurance and NCCI administers the assigned risk pool for the state of Virginia.

Our agency can help employers find state fund coverage in VA.

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Virginia Compensation Laws

Virginia employers who fail to provide workers compensation coverage may be assessed a civil penalty up to $5,000 and other damages resulting from an employee injury.  Continued failure can result in prosecution and business shut-down.

 

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