Employer's Application for Hearing (Form 5A)

Download Employer's Application for Hearing (Form 5A)

In Virginia, when a claimant is under an open or ongoing Award of compensation benefits, an employer who wishes to suspend or terminate the payment of such benefits must file an application and/or termination of wage loss form with the Commission. Failure to do so could result in the employer/insurer being required to pay additional compensation benefits along with penalties and/or other sanctions.

This form is for use by the self-insured employer, insurer, claim administrator or their legal counsel to complete and submit to the Commission along with the required documentary evidence in order to suspend or terminate an injured worker’s compensation benefits under an existing Award of the Commission based upon a change in condition.

The form must be signed, under penalty of perjury, and sent to the Virginia Workers’ Compensation Commission with supporting documentation. This form, with electronic signature and supporting documentation, may be filed with the Commission via a WebFile account at https://webfile.workcomp.virginia.gov. (See Virginia Code Section 65.2-101 for the complete definition of filed.) At the time the application is filed with the Commission, a copy of the application and the supporting documentation must be sent to the employee and to the employee’s attorney, if represented. Upon filing the application, compensation payments must be made to the employee in accordance with Commission Rule 1.4(C). The general rule is compensation must be paid through the date the application is filed with the Commission. Exceptions to this rule include instances of a return to work, refusal of selective employment or refusal of medical treatment. Issues concerning a credit, change in treating physician or pre-injury average weekly wage typically do not permit suspension of compensation. If the Applicant certifies that compensation benefits continue to be paid, the application will be accepted and referred to the hearing docket under the provisions contemplated by Commission Rule 1.4(F).

This form may be filed with the Commission in the following ways:

  • ONLINE: WebFile users may upload this form through their account. Click here to learn more about WebFile.
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  • FAX: Fax the complete form to 804-823-6956.
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  • MAIL: Mail the completed form to 333 E. Franklin St., Richmond, VA 23219.
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  • IN PERSON: Bring the completed form to any of our VWC Office Locations.

For questions, please contact the Commission toll-free at 1-877-664-2566 or by email at Questions@workcomp.virginia.gov.