Workers Compensation Notice {1} | | Virginia

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Workers Compensation Notice {1} |  | Virginia

Workers Compensation Notice {1}

This is a Virginia form that can be used for Workers Compensation.

Alternate TextLast updated: 12/5/2006

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Virginia Workers Compensation Commission Page 1 of 2 Form VWC1 WORKERS COMPENSATION NOTICE The employees of this business are covered by the Virginia Workers Comp ensation Act. In case of injury by accident or notice of an occupational disease: THE EMPLOYEE SHOULD: 1. Immediately give notice to the employer, in writing, of the injury or occupational disease and the date of accident or notice of the occupatio nal disease. 2. Promptly give to the employer and to the Virginia Workers Compensation Commission notice of any claim for compensation for the period of disabi lity beyond the seventh day after the accident. In case of fatal injuries, no tice must be given by one or more dependents of the deceased or by a person i n their behalf. 3. In case of failure to reach an agreement with the employer in regard to compensation under the act, file application with the Commission for a hearing within two years of the date of accidental injury or first communication of the diagnosis of an occupational disease. 4. If medical treatment is anticipated for more than two years from the dat e of the accident and no award has been entered, the employee should file a c laim with the Commission within two years from the date of the accident. NOTE: The employers report of accident is not the filing of a claim for the employee. The voluntary payment of wages or compensation during disability, or of medical expenses, does not affect the running of the t ime limitation for filing claims. An award based on a voluntary agreement mu st be entered or a claim filed within two years; one year in death cases. THE EMPLOYER SHOULD: 1. At the time of the accident, give the employee the names of at least thr ee physicians from which the employee may select the treating physician. 2. Report the injury to the Commission through your carrier or directly to the Commission. 3. Accurately determine the employees average weekly wage, including overtime, meals, uniforms, etc. <<<<<<<<<********>>>>>>>>>>>>> 2Virginia Workers Compensation Commission Page 2 of 2 Questions may be answered by contacting the Commission. A booklet explai ning the Workers Compensation Act is available without cost from: THE VIRGINIA WORKERS COMPENSATION COMMISSION 1000 DMV Drive Richmond, Virginia 23220 804-367-8600 1-877-664-2566 Toll Free in Virginia vwc.state.va.us Every employer within the operation of the Virginia Workers Compensatio n Act MUST POST THIS NOTICE IN A CONSPICUOUS PLACE in his place of business.

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