You may file a claim for benefits either by
writing a simple letter, by filling out the claim for benefits
form provided by the Virginia Workers’ Compensation
Commission, or by filing online at http://www.vwc.state.va.us
Even though I use letter form to file claim
for benefits for my clients, I recommend to injured
workers who do not have an attorney to use the claim
for benefits form. You can go to my website and download the form at
http://www.injuredworkerslawfirm.com. To fill the form out, you
need to have the employer’s name and address. The most
important part of this form is “parts of your body injured.”
You MUST list ALL the body parts injured specifically. A
shoulder is not an arm. A neck is not a shoulder. A head
injury is not a brain injury. If you do not list the body part
specifically, then they do not have to provide medical
treatment for that body part. Overkill is best. Even if the
body part doesn’t need medical treatment currently, if it
was injured during the accident, list it. You also need to
list the specific date of injury and your average weekly
wage per week. If you don’t know whether the insurance
adjuster is accepting or denying your claim at this point,
or you believe they are accepting your claim, that’s all
you fill out and then you mail the form to the Virginia
Workers’ Compensation Commission. At that point, they
will contact the insurance adjuster and require them to
fill out forms that will generate the Award order that you
need. If you know they are already denying part of your
claim, under Part B, you want to check the various items
that are in dispute and what you are seeking: medical
benefits, lost wages or partial lost wages, or permanent
partial disability benefits (when a doctor has given you
an impairment rating to a body part when you have
lost range of motion). You can also use this form if your
situation changes and you have what’s called a Change in
Condition, or to request a hearing on the various items
that are under Part B.
