The Wage Chart should be used to determine the injured worker’s pre-injury average weekly wage based on the applicable 52 weeks immediately preceding the date of accident. Note that these earnings are GROSS earnings and include overtime and tips, before any deductions aremade for taxes or Social Security. If there were any perquisites, please list the TOTAL value separately at the bottom of the chart. If the injured worker has worked less than 12 months, the earnings for the time worked should be used. The earnings for a similar employee may be used if the injured worker has worked for less than 60 days. The forms should be clear and legible or they may be returned to the insurer.
This form should be completed by the employer/insurer and should list weekly gross wages for the applicable weeks available. If an injured worker lost more than seven consecutive calendar days, although not in the same week, these periods should be noted on the Wage Chart (VWC Form No. 7-A) using an asterisk in the Week No. column and are not to be counted in the calculations. Virginia Code § 65.2-101. Samples of properly completed wage chart(s) are available through the Commission’s Website at www.workcomp.virginia.gov under the Forms menu.
This form may be filed electronically through the Commission’s WebFile system at http://webfile.workcomp.virginia.gov. To file electronically, the user must have a valid and active WebFile account. This form may be filed by mail or in-person at 1000 DMV Drive, Richmond, Virginia 23220. This form may also be filed by fax 804-823-6956.
For questions or assistance with completing this form, please contact the Virginia Workers’ Compensation Commission toll free at 1-877-664-2566 or by email at Questions@workcomp.virginia.gov.