| ADR Mediator Evaluation Form |
| Amputation Chart |
| Annual Payroll Report of City, Town or County Operating as a Self-Insurer (Form 26C) |
| Annual Report of Premiums, Assessments, Etc., Received by Insurance Carriers (Form 26A) |
| Annual Report of Self-Insurer's Payroll (Form 26) |
| Annual Report of Self-Insurer's Payroll by City, Town or County School Boards (Form 26B) |
| Application for Individual Self-Insurance (Form 20) |
| Attending Physician's Report (Form 6) |
| Award Agreement |
| Certificate of Service |
| Certificate of Workers' Compensation Insurance (Form 61A) |
| Certificate of Workers' Compensation Insurance (Form 61A) - ONLINE |
| Change In Condition Claims Response Form |
| Claim Form |
| Claim Summary Addendum for 2025 Annual Survey |
| COLA Request Form (CA51) |
| Detailed Claims Addendum for Claims in Excess of $100000 |
| Employer's Application for Hearing (Form 5A) |
| Expedited Hearing Request Form |
| Fatal Award Agreement |
| First Report of Injury |
| Informational Letter where Employee is NOT Represented by Counsel |
| Letter for Beneficiary in Fatal Case |
| Letter of Credit |
| Marketing/Job Search Form |
| Mediation Consent Form A - All Parties Have Legal Counsel |
| Mediation Consent Form B - All Parties Do Not Have Legal Counsel |
| Medical Care Provider Application Response Form |
| Medical Fee Schedule Dispute Request Form |
| Medical Fee Schedule Dispute Response Form |
| Medical Provider Inquiry |
| Notice Terminating Prior Rejection of Coverage (Form 17A) |
| Notice Terminating Prior Rejection of Coverage (Form 17A) - ONLINE |
| Parental Guarantee (Form 22) |
| PEO Access Form |
| PEO Parental Guarantee |
| Petition for Medical Treatment |
| Petition Under Virginia Birth-Related Neurological Injury Act (Form BR1) |
| Pneumoconiosis Claim Form |
| Pre Mediation Statement Form (Awarded Claim) |
| Pre-Mediation Statement Form (All Claims) |
| Pre-Mediation Statement Form (Contested Original Claim) |
| Referral for Lack of Coverage |
| Referral for Lack of Coverage - ONLINE |
| Rejection of Coverage (Form 16A) |
| Rejection of Coverage (Form 16A) - ONLINE |
| Request for Full and Final Mediation |
| Request for Issue Mediation |
| Sample Affidavit |
| Sample Informational Letter |
| Sample Order |
| Self-Insurance Bond (Form 21A) |
| Subpoena Duces Tecum - Attorney Issued |
| Supplemental Agreement Form Varying Wage Benefits |
| Termination of Wage Loss Award Form |
| Transportation/Travel Expense Form |
| Wage Chart (Form 7A) |
| Waiver of Occupational Disease (Form 9A) |
| WebFile Attorney Registration Form |
| Witness Subpoena - Attorney Issued |
