The Virginia Workers’ Compensation Commission provides a Claim for Benefits form. The form has two sections: Part A and Part B. Part A asks for the information discussed above. Part B asks you to specify which benefits you are seeking.
Even if you are not seeking benefits at this time, we recommend completing Part A of the Claim for Benefits. Why? Because you protect your legal rights to benefits when you complete and file Part A of the Virginia workers comp claim form within the applicable statute of limitations. This is what’s known as an Assertion of Rights.
You do not have to use the commission’s Claim for Benefits form. If you write, sign, and file with the commission a letter that contains the details discussed above, the commission will consider that a valid workers’ comp claim.