Attorneys

On September 26, 2023 the Commission approved the use of a new form for Petitions for Medical Treatment (PMT). If a case is eligible for the PMT Pilot Program, use of this form is encouraged. See the instructions which accompany the form to determine if a case is eligible for the Program.

This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It has been designed for use in a case where the original claim for benefits is contested. It may be uploaded as an ADR Confidential Document via Web File, or faxed to the ADR Department at 804-823-6904.

This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It is designed for use in any claim. It may be uploaded as an ADR Confidential Document via Web File, or faxed to the ADR Department at 804-823-6904.

This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It is designed for use in a case in which an award has been entered. It may be uploaded as an ADR Confidential Document via Web File, or faxed to the ADR Department at 804-823-6904.

 This form may be used by legal counsel to request Full and Final Mediation by a Commission mediator as a means of reaching a compromise settlement. Filing instructions are included on the form. Once the form is received, ADR Department staff will contact all other parties to confirm whether they are also interested in mediating the dispute.

 This form may be used by injured workers, deceased worker claimants, medical provider claimants, employers, insurers, claim administrators, and legal counsel to request Issue Mediation by a Commission mediator as a means of resolving a claims dispute. Filing instructions are included on the form. Once the form is received, ADR Department staff will contact all other parties to confirm whether they are also interested in mediating the dispute.

The treating physician completes this form to provide information to support an injured worker’s claim which resulted in amputation to the foot, toes or metatarsal bones and/or hand, fingers or metacarpal bones.

The physician should complete this form with a straight line drawn at the exact point of amputation. Circles are not acceptable. This will allow the Commission to determine an accurate entitlement of permanent partial disability benefits.

Va. Code § 65.2-400 defines occupational disease as a “disease arising out of and in the course of employment, but not an ordinary disease of life to which the general public is exposed outside of employment.” When an individual has received a communication of diagnosis of occupational disease, it is important to give immediate notice to the employer.

 This form describes the mediation process and related Code of Virginia provisions. When one or more parties to a mediation does not have legal counsel to represent them at the mediation, Mediation Consent Form B is used, which requires a neutral facilitation style by the mediator (see paragraph 7).