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Click ‘Get Form’ to open it in the editor.
Begin by entering the locality issuing your business license. Specify whether it's a city, town, or county and provide the business license number.
Fill in the Business Owner/Contractor’s name, including their home mailing address and phone number. Ensure all information is complete and legible.
Input the complete name of your business along with any trade name used. If your business address differs from your home address, include that as well.
Provide your Business Federal Employer ID (FEIN) or Tax ID Number. If you are a sole proprietor without one, list your social security number.
Indicate the legal status of your business (e.g., LLC, Sole Proprietorship).
Enter the type of trade or industry for your business and provide a contact phone number and email address if available.
If you have workers' compensation insurance, check the appropriate box and enter details about your insurance carrier, policy number, and effective dates.
If you do not have workers' compensation insurance, answer the additional questions regarding employee count and subcontractors.
Finally, ensure that you sign the form, print your name below the signature, and date it before submission.
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Under Virginias Workers Compensation Act, employers must provide workers comp to their legally hired employees, but they are not required to cover contractors. Independent contractors and subcontractors usually have to shoulder their own workers comp insurance.
How much does workers compensation pay in Virginia?
Recall that your compensation rate is two-thirds of your average weekly wage. If you calculate your compensation rate and it is higher than the maximum set for that year, you receive only the maximum rate even though it would be less than two-thirds of your average weekly wage. In 2023, the maximum rate was $1,343.00.
What is the average workers comp settlement in Virginia?
In 2021, the Virginia Workers Compensation Commission approved 4,839 settlements with a total aggregate value of $253,600,035. Therefore, the average workers comp settlement payout in Virginia was $52,407.53.
How long do I have to sue for work-related injuries in Virginia?
Employees who suffer on-the-job injuries and diseases may be eligible for benefits under the Virginia Workers Compensation Act. If injured, you should (1) report your injury to your employer immediately; and (2) file a claim with the Commission no later than two years after the accident.
Are you required to have workers compensation in Virginia?
Virginia law requires that most employers carry workers compensation insurance in order to cover their workers in the event of a work injury. Workers compensation provides a tradeoff for both employers and employees. For the employer, it provides an exclusive remedy, shielding the employer from civil suit.
fillable form 61a
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certificate of workers' compensation insurance form 61a
2024 General Assembly Session
61A forms. Child abuse and neglect; mandatory reporters; statute of limitations; penalties. HB 1542 (Mundon King) adds aggravated sexual battery of a childRead more
Certificate of Workers Compensation Insurance (Form 61A)
Pursuant to Code of Virginia 65.2-800 and 58.1-3714 signed certifications of insurance coverage are to be provided by the contractor to the localities.
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