We help business owners navigate Virginia workers' comp rules.

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

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Virginia Workers Compensation Insurance 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.

Workers' Comp Exemption

Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.

Waiver of Subrogation

A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.

Certificate of Insurance

A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.


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State Resources for Virginia

Virginia Workers' Compensation Commission

1000 DMV Drive
Richmond, Virginia 23220
877-664-2566
Virginia Workers' Comp Commission

VA Bureau of Insurance (BOI)

Tyler Building
1300 E Main Street
Richmond, VA 23218
800-552-7945
State Corporation Commission

Workers compensation insurance is required by law for Virginia employers.

Virginia forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers compensation form your need for Virginia. We make every effort to keep forms updated but cannot guarantee any form is the latest version available.

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Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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