COLA-Social Security Verification Request {CA51}

COST-OF-LIVING ADJUSTMENT (COLA) REQUEST. This form is used by claimants or beneficiaries to request a COLA increase through the Virginia Workers’ Compensation Commission. This form verifies Social Security benefits to determine eligibility for a cost-of-living adjustment on workers’ compensation payments. Applicants must provide identifying information and submit supporting Social Security documentation using one of two methods: obtaining a benefits verification letter online or having a Social Security Administration representative complete the form. The information is used to calculate whether combined benefits fall below eligibility thresholds. The form must be submitted with supporting documentation to process a COLA request. www.FormsWorkflow.com