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Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form

Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form 2025

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The document is a Pneumoconiosis Claim Form from the Virginia Workers’ Compensation Commission, designed for individuals suffering from Coal Workers’ Pneumoconiosis or Black Lung Disease to file claims for benefits. It includes sections for personal and employer information, details about the disease diagnosis, and requests for various types of benefits. The form outlines the process for filing claims, including deadlines and requirements for supporting medical documentation, as well as options for dispute resolution through mediation or hearings.

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How to use or fill out Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Injured Worker Information section. Enter your name, primary and alternate phone numbers, and address details including city, state, and zip code.
Proceed to Part A for Employer Information. Input the name of your employer, county of work location, and their address. Make sure to include the date of communication and last date worked.
Indicate whether you worked after the date of communication by selecting 'Yes' or 'No'. If 'Yes', provide the name of your subsequent employer.
Sign and print your name in the designated area to confirm your claim submission. Ensure you also include the date.
If applicable, complete Part B for requesting specific benefits. Attach any necessary medical records or documentation as required.

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What are the workers compensation laws 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.

How do I contact the Virginia Workers Compensation Commission?

Contact Us by Phone For general questions, please contact the Customer Contact Center toll free at 1-877-664-2566 from 8:30 a.m. - 4:45 p.m., Monday - Friday. Language translation available, TTY users dial 7-1-1.

How do you win black lung benefits?

To win benefits, a miner must prove that he has Black Lung and that he is totally disabled due to a breathing impairment caused at least in part by Black Lung. A widow of a miner whose death was due to Black Lung is entitled to benefits.

What is included in pneumoconiosis?

The pneumoconioses are a group of lung diseases caused by the lungs reaction inhaling certain dusts. The main cause of the pneumoconioses is work-place exposure. Environmental exposures have rarely been related to these diseases.

What is the most common pneumoconiosis?

Types of pneumoconiosis One of the most common forms is black lung disease, also known as miners lung. Its caused by breathing in coal dust. Another is brown lung, which comes from working around dust from cotton or other fibers. Other types of dusts that can cause pneumoconiosis include silica and asbestos.

What are claims for pneumoconiosis?

Pneumoconiosis claims are made under the Workers Compensation Act of 1979 for dust-related diseases. The person making a claim must be able to prove inability to take civil action against employees due to ceased business.

What is a black lung claim?

The Black Lung Benefits Act provides monthly payments and medical benefits to coal miners totally disabled from pneumoconiosis (black lung disease) arising from their employment in or around the nations coal mines. The Act also provides monthly benefits to a miners dependent survivors.

How long can you receive workers compensation benefits in Virginia?

Generally, the maximum time that you can receive workers compensation benefits in Virginia is 500 weeks. There are exceptions to this limit, such as if you suffered a severe injury such as a spinal cord injury, brain injury, or amputation of multiple limbs.

Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form 2025

Here's how it works

How to use or fill out Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form

Complete this form in 5 minutes or less

Got questions?

How do I sign my Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form on iOS?

How do you edit Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form on Android?

What are the workers compensation laws in Virginia?

How do I contact the Virginia Workers Compensation Commission?

How do you win black lung benefits?

People also ask

What is included in pneumoconiosis?

What is the most common pneumoconiosis?

What are claims for pneumoconiosis?

What is a black lung claim?

How long can you receive workers compensation benefits in Virginia?

Related links

Try more PDF tools

Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form 2025

Here's how it works

How to use or fill out Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form

Complete this form in 5 minutes or less

Got questions?

How do I sign my Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form on iOS?

How do you edit Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form. Virginia Workers' Compensation Commission Coal Workers Pneumoconiosis Claim Form on Android?

What are the workers compensation laws in Virginia?

How do I contact the Virginia Workers Compensation Commission?

How do you win black lung benefits?

Related Searches

People also ask

What is included in pneumoconiosis?

What is the most common pneumoconiosis?

What are claims for pneumoconiosis?

What is a black lung claim?

How long can you receive workers compensation benefits in Virginia?

Related links

Try more PDF tools