This form is for medical providers seeking claim status of their workers’ compensation patients.
Please fill in the patient’s names, SSN, date of injury, and nature of injury. Once completed fax the inquiry form to 804-418-4920 .
This form is for medical providers seeking claim status of their workers’ compensation patients.
Please fill in the patient’s names, SSN, date of injury, and nature of injury. Once completed fax the inquiry form to 804-418-4920 .