Filing Language Requirement
The Virginia Workers’ Compensation Commission can only accept filings submitted in English.

ADR Mediator Evaluation Form
Amputation Chart
Attending Physician's Report (Form 6)
Award Agreement
Certificate of Service
Claim Form
COLA Request Form (CA51)
Expedited Hearing Request Form
Fatal Award Agreement
Letter for Beneficiary in Fatal Case
Marketing/Job Search Form
Mediation Consent Form A - All Parties Have Legal Counsel
Mediation Consent Form B - All Parties Do Not Have Legal Counsel
Pneumoconiosis Claim Form
Request for Full and Final Mediation
Request for Issue Mediation
Sample Affidavit
Sample Informational Letter
Sample Order
Termination of Wage Loss Award Form
Transportation/Travel Expense Form