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Virginia workers compensation 2026

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The document outlines the process for terminating a Wage Loss Award under Virginia Workers' Compensation. It includes sections for employer and employee information, terms of agreement regarding compensation payments, and instructions for completing the form. The document emphasizes that signing is not required for payment and details the conditions under which claims can be reopened.

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Click ‘Get Form’ to open the Virginia Workers' Compensation form in the editor.
Begin by filling in the insurer's information at the top right, including the VWC file number and insurer code. This section is crucial for processing your claim.
Next, provide details about the employer and employee. Include names, addresses, phone numbers, and Social Security Numbers where required.
In the 'Terms of Agreement' section, indicate the reason for termination of wage loss benefits. Specify if the employee returned to work at a pre-injury wage or a lower wage.
Complete the payment details by listing total compensation paid and any cost-of-living adjustments. Ensure accuracy to avoid delays.
Finally, both the employee and an authorized representative must sign and date the form before submission.

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