Change In Condition Claims Response Form

 
This form may be used by employers, insurers, or claims administrators to notify the ADR Department whether an injured worker’s Change in Condition Claim.

  • is accepted, accepted in part and denied in part, or denied;
  • the reasons for acceptance or denial, and, if denied in whole or in part;
  • whether the employer, insurer, or claims administrator consents to issue mediation with the injured worker to try and resolve the claim together, with the help of a mediator, without the need for a hearing.

This form may be filed with the Commission in the following ways:

  • ONLINE: WebFile users may upload this form through their account. Click here to learn more about WebFile.
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  • FAX: Fax the complete form to 804-823-6904
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  • MAIL: Mail the completed form to 333 E. Franklin St., Richmond, VA 23219
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  • IN PERSON: Bring the completed form to any of our VWC Office Locations.

For questions please contact the Commission toll-free at 1-877-664-2566 or by email at Questions@workcomp.virginia.gov.