Virginia Workers' Compensation Commission Employer Application for Hearing (Form 5A). Virginia Workers' Compensation Commission Employer Application for Hearing (Form 5A) 2026

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Virginia Workers' Compensation Commission Employer Application for Hearing (Form 5A). Virginia Workers' Compensation Commission Employer Application for Hearing (Form 5A) Preview on Page 1
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The document is an Employer's Application for Hearing form from the Virginia Workers’ Compensation Commission, used to request the suspension of an employee's compensation benefits. It outlines reasons for the request, such as the employee returning to work or failing to cooperate with medical examinations. The form includes instructions for both employers and employees regarding the application process and potential outcomes.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the employee's name, address, city/state/zip, and JCN (Job Claim Number) at the top of the form.
  3. Fill in the date of the accident and provide reasons for requesting suspension of benefits. Be sure to attach any supporting documentation.
  4. Complete sections regarding the employee's return to work status, including dates and details from medical reports.
  5. Indicate if compensation was paid and at what rate, ensuring all fields are accurately filled out.
  6. Sign the application under penalty of perjury, ensuring that a copy is sent to both the employee and their attorney, if applicable.

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If supporting evidence is not filed within 90 days after an employees claim is filed, it may be dismissed upon motion of the employer after notice by the Commission to the parties.
Virginia Workers Compensation Benefits Limits. For most workers compensation cases, there is an overall limit of 500 weeks on how long you can receive benefits. There are exceptions to this limit in the case of some especially severe injuries such as spinal cord injuries, brain injuries, or the loss of multiple limbs
2021 Rates: Effective July 1, 2021, the maximum compensation rate will be $1,195. Effective July 1, 2021, the minimum compensation rate will be $298.75. Effective October 1, 2021, the cost of living (COLA) rate will be 1.4%.

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People also ask

If your claim progresses relatively smoothly and your employer promptly approves it, you may start receiving benefits within a few weeks. You have two years from the injury date to file your workers compensation claim.
Your employer should file a report of the accident or disease with the Commission within ten days Failure to report your injury or illness to your employer within thirty (30) days could result in your claim being denied. See Va. Code 65.2-600 for more information.
Yes, individuals who have the ability to work are allowed to work at a second place of employment while receiving workers compensation for an injury that occurred at the primary place of employment.
You have two years from the date you were last paid wage loss benefits to file a claim for compensable consequence.
If you have suffered a compensable injury and your employer is unable or unwilling to accommodate your light duty work restrictions, you have the right to ask for vocational rehabilitation services, which include job coaching and retraining, at the employers expense.

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