Employers Application For Hearing {5A}

Form 5A - EMPLOYER’S APPLICATION FOR HEARING. This form is used by employers or insurance carriers in Virginia to formally request a hearing before the Virginia Workers’ Compensation Commission in order to suspend, modify, or terminate an employee’s workers’ compensation benefits. The form outlines the reasons for the request, such as the employee returning to pre-injury or light-duty work, failure to attend medical appointments or cooperate with vocational rehabilitation, or medical documentation indicating the disability is unrelated to the workplace injury. Employers must submit this form under penalty of perjury, provide supporting documentation, and send copies to the employee, the employee’s attorney (if known), and the Commission. Once filed, the Commission will review the request and notify the parties if benefits are to be suspended or continued pending a hearing. Employees who wish to contest the suspension must submit a written statement with evidence within 15 days. www.FormsWorkflow.com