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Workers compensation in va wage chart form

Va workers comp wage chart 2026

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The document is a Wage Chart form used by the Virginia Workers’ Compensation Commission to record an employee's wage earnings, including gross pay and perquisites, for the 52 weeks prior to an accident. It includes sections for employer and insurer information, detailed weekly earnings, and instructions on how to complete the form accurately.

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Click ‘Get Form’ to open the VA Workers Comp Wage Chart in the editor.
Begin by filling in the top section with the insurer's information, including the Insurer Code and Claim Number. This is crucial for proper identification.
Next, provide the Employee’s details such as Name, Social Security Number, and Date of Accident. Ensure accuracy as this information is vital for processing claims.
In the weekly sections, enter the Week Number, Ending Date, Days Worked, and Gross Amount Paid for each week leading up to the accident. Remember to include overtime and any tips.
At the bottom of the chart, summarize total gross earnings and perquisites. This will help in calculating average weekly wages accurately.
Finally, ensure that all fields are filled out clearly before saving your document. Illegible forms may be returned.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long can you get workers comp in VA?

Normally, the maximum period to receive workers compensation wage-loss benefits in Virginia is 500 weeks. However, certain exceptional cases such as brain and spinal cord injuries, loss of multiple limbs, and other severe injuries have different rules that go beyond this time limit.

What is the rule 4.2 in Virginia workers comp?

Rule 4.2: Each party shall promptly provide the other parties with copies of any medical records they receive as they receive them.

What are the rules for workers comp 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.

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 does Workmans Comp work in VA?

Virginia workers compensation benefits include lifetime medical care, payment for lost wages, payment for permanent loss of use to a body part, payment for out-of-pocket medical expenses and travel reimbursement for medical appointments, all resulting from your work accident.