Mediation Consent Form B - All Parties Do Not Have Legal Counsel

Download Mediation Consent Form B - All Parties Do Not Have Legal Counsel

 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).

All parties and their counsel (if any), as well as any other attendees who will be present at the mediation -- for example, a family member or legal assistant -- must read, sign, and provide this form to the ADR Department or mediator before the mediation may proceed. The mediator will discuss the form’s provisions with all attendees and address any questions they may have prior to the start of mediation.

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 804-823-6904
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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.