Virginia

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  Agreement to Pay Benefits

  VAWC-4 $89.00
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  Employer’s Accident Report

  VAWC-3 $89.00
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  Employer’s Application for Hearing

  VAWC-5A $89.00
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  Initial Claim for Workers’ Compensation Benefits

  VAWC-5 $89.00
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  Report of Medical Costs

  VAWC_45G $89.00
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  Report of Minor Injuries

  VAWC_45A $89.00
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  Supplemental Agreement to Pay Benefits

  VAWC-4A $89.00
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  Supplementary Report

  VAWC-3A $89.00
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  Termination of Wage Loss Award

  VAWC-46 $89.00
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  VA WC Legal Forms Set

  VAWC_FORMS $175.00
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  Wage Chart

  VAWC-7A $89.00