Claims Kit

Physician Selection 65.2-603

The employee must select a doctor from a panel of three physicians provided by the employer/carrier.

Whenever an employer furnishes an employee the names of three physicians pursuant to this section, and the employer also assumes all or part of the cost of providing health care coverage for the employee as a self-insured or under a group health insurance policy, health services plan or health care plan, upon the request of an employee, the employer will also inform the employee whether each physician named is eligible to receive payment under the employee's health care coverage provided by the employer.

If the injured employee has an injury which may be treated within the scope of practice for a chiropractor, then the employer or insurer may include chiropractors on the panel provided the injured employee.

Reporting of Claim by Employer  65.2-900

Every employer must keep a record of all injuries or deaths of its employees which occur in the course of employment. Within 10 days after the occurrence of the injury or death, and knowledge of injury, a report of the injury or death must be made and transmitted to the Commission by the employer, its representative or, in the case of an insured employer, its insurance carrier.

Accidents need to be reported via a completed First Report of Injury (Form 3) within 10 days of knowledge of the accident. If an accident is "minor," then it must be reported within 30 days of knowledge of the accident. A "minor" accident is one which meets none of the following criteria:

• Lost time exceeds 7 days;
• Medical expenses exceed $1,000;
• Compensability is denied or Issues are disputed;
• Accident resulted in death or Permanent disability or disfigurement may be involved; or
• A specific request is made by the Virginia Workers' Compensation Commission.

The above FROI (Form 3), and many other, claim filings are due to be submitted to the Commission via Electronic Data Interchange (EDI). The use of EDI via an accepted trading partner is mandatory in Virginia. See Electronic Data Interchange (EDI) for further related commentary.

Posting Requirements  16VAC30-50-80. Rule 7 (B)

Every employer bound by the Act--either automatically or after voluntarily electing coverage--must post and keep posted notice of compliance with the insurance provisions of the Act. This must be posted conspicuously in the plant, shop, or place of business at a location frequented by employees. The following posters are to be used to ensure compliance with the above. 

Workers' Compensation Notice (Form 1, English; Form 1, Spanish) 

Penalties for Late Reporting  65.2-902  

Any employer, insurance carrier, self-insurer, group self- insurance association, or third party administrator who fails to make any report required by the Commission will be assessed a civil penalty up to $500 for each failure. If the Commission determines that the failure is willful, it will assess a civil penalty of $500 to $5,000. 

On October 2, 2025, the Commission reiterated its ability--and intention--to levy civil penalties of no less than $500 for any instances of an insurer failing to comply with posted reporting requirements. The Commission will redouble its efforts on this front as of January 1, 2026.

VIRGINIA:

IN THE WORKERS’ COMPENSATION COMMISSION ORDER WHEREAS, in order to accommodate appropriate social distancing necessary during the COVID-19 pandemic, on March 26, 2020, the Commission entered an Order waiving the requirement of Commission Rule 1.7(C)(3) that the claimant’s affidavit for a compromise settlement be notarized; and WHEREAS, social distancing requirements and other precautions to stop the spread of COVID-19 now have been relaxed;

IN CONSIDERATION WHEREOF, it is hereby Ordered that the requirement of Commission Rule 1.7(C)(3) that the claimant’s affidavit for a compromise settlement be notarized shall be reinstated and remain in effect for all compromise settlements filed with the Commission for review and approval on or after August 1, 2021.

Entered this 16th day of June, 2

12/20

There are two ways to report a possible COVID-19 workers’ compensation case to the Commission. 1) An injured worker or his/her attorney can file a Claim for Benefits noting COVID-19 as the Nature of Injury. 2) A Claim Administrator who was made aware of a possible COVID-19 workers’ compensation case, can file an EDI FROI transaction noting COVID-19 as the Nature of Injury

New Codes – COVID-19 WCIO now has new Nature & Cause of Injury Codes for the COVID-19 Pandemic. A new Cause of Injury Code (DN0037) - 83 for “Pandemic” and a new Nature of Injury Code (DN0035) - 83 for “COVID-19” were approved. The Commission began accepting the codes on April 1, 2020 as requested by the IAIABC.

The Commission’s Clerk’s Office is closed, parties may continue to file documents by fax or WebFile. However, in accordance with Va. Code Sec. 1-210(B) the filing deadline for any item required to be filed with the Commission during the period in which the Clerk’s Office is closed is extended to the next business day on which the Clerk’s Office is open.

During this time, VWC is continuing to serve ourcustomers:

• Our Customer Contact Center is open Monday through Friday from 8:30 a.m.– 4:45 p.m. at 1-877-664-2566
• Employees are teleworking, continuing as many business operationsas possible
• Our WebFile system remains operational
• We are working closely with stakeholders to accommodate upcoming hearingand mediation schedules
• Please check our website for important updates