VA VWC 61-A 2014 free printable template

Contractor s Certificate of Workers Compensation Insurance (Form 61-A) www.workcomp.virginia.gov INSTRUCTIONS ON REVERSE SIDE File completed form at local office where business license is obtained

How to fill out VA VWC 61-A

How to fill out VA VWC 61-A

1. Gather personal information: Collect your Social Security number, address, and contact information.
2. Fill out the claimant's section: Include your name, contact details, and the date of the injury.
3. Describe the incident: Provide a detailed account of how the injury occurred, including date, time, and location.
4. Complete the medical information: Include details of any medical treatment received and the names of healthcare providers.
5. Document wages: Input your earnings prior to the injury, including the frequency of pay.
6. Sign and date the form: Make sure to sign the form to validate your claim.
7. Submit the form: Send the completed form to the appropriate VA office or your employer as indicated.

Who needs VA VWC 61-A?

1. Employees who have sustained work-related injuries or illnesses.
2. Veterans seeking compensation for service-connected disabilities impacting their ability to work.
3. Individuals filing for benefits related to specific workplace incidents covered by VA regulations.

• Who Needs VOC Form 61-A?
• What is VOC Form 61-A for?
• Is VOC Form 61-A Accompanied by Other Forms?
• • When is VOC Form 61-A due?
  • How Do I Fill out VOC Form 61-A?
  • Where Do I Send VOC Form 61-A?

Who Needs VOC Form 61-A?

VOC Form 61-A is officially called Contractor’s Certificate of Worker’s Compensation Insurance. It is widely used by contractors and businesses that perform their work in the Virginia state. Out of state employers must have valid Virginia coverage.

What is VOC Form 61-A for?

Generally, Certificate of Insurance is issued to provide information about worker’s insurance policy coverage to the party that has requested it. As an informative document it is rather limited in ability. Its main aim is to help companies or individuals who are hiring contractors to relieve responsibility for injuries and damages that may occur during work. With Contractor’s Certificate companies make sure that they will not be liable for possible damages. This certificate doesn’t guarantee any changes to the insurance policy, neither it bestowed nor extends the rights of the policyholder.

Is VOC Form 61-A Accompanied by Other Forms?

No additional documents are required to be attached to the certificate.

When is VOC Form 61-A due?

As the certificate serves informative purpose there is no specific due date for it. It is filled out upon request.

How Do I Fill out VOC Form 61-A?

VOC Form 61-A consists of one fillable page accompanied by instructions. In total there are fifteen fillable fields. The first one must be completed by the official issuing business license. Starting from the second field and up to the end of the Form 61-A, all information is provided by the contractor. The information includes business owner’s or contractor’s name, address, phone number, mail address that is used by the business to receive mail by the U.S. Postal Service. It is also mandatory to indicate the type of trade in which business is classified and its VEIN.  

Where Do I Send VOC Form 61-A?

Completed Form 61-A is sent to the local office where business license was obtained.

Instructions and Help about VA VWC 61-A

A form 61 in a North Carolina workers compensation case is a form that is sent by the insurance company the defendants in your case and the insurance company is representing your employer they will file a Form 61 if they are denying your workers compensation claim so if you file for workers compensation, and you receive a form 61 then it means they don't agree that this should be covered under workers compensation and that they are fighting your case, and they will request a hearing to be able to say why they've denied your case, and you will not receive benefits while you're going through that hearing a lawyer going through your case so if you've received a form 61 in your workers compensation case it's extremely important that you contact a North Carolina workers compensation attorney, so they can go through the facts of your situation and determine whether your case is compensated or not because it's not uncommon especially if somebody is representing themselves if you're representing yourself what's called pro SE meaning you don't have an attorney it's not uncommon that an insurance company will file a Form 61 because they know that you as the injured worker don't necessarily know what to do with that and if you don't do the right things then your case could be kicked out, and you may not receive any compensation at all if that's the case so again if you receive a form 61 it means the insurance company who represents your employer is denying your workers compensation case, and it is my belief that you should certainly try to reach out to North Carolina workers compensation attorneys such as ourselves, and we offer free consultation, so you can learn more about your case we look forward to hearing from you and thanks so much

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How do I file a workers comp claim in Virginia?

You may file the claim: In person: Complete the Claim for Benefits Form and deliver it to any of our office locations. By mail: Complete the Claim for Benefits Form and mail it to: Virginia Workers' Compensation Commission, 333 E. By fax: Complete the Claim for Benefits Form and fax it to: 804-823-6956.

What is a Form 61A?

Certificate of Workers' Compensation Insurance (Form 61A)

What is proof of coverage in Virginia?

Proof of coverage shall include the name and address of the insured, the insured's federal employer identification number (FEIN), the policy number, dates of insurance coverage, the name and address of the insurer, and the insurer's identification number.

Who is required to have workers comp in VA?

1 Q: Am I required to obtain workers' compensation insurance? A: Virginia law requires that an employer who regularly employs more than two part-time or full-time employees carry workers' compensation.

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What is VA VWC 61-A?

VA VWC 61-A is a form used in Virginia for reporting workers' compensation claims.

Who is required to file VA VWC 61-A?

Employers who have an injured worker must file VA VWC 61-A to report the incident and any related compensation claims.

How to fill out VA VWC 61-A?

To fill out VA VWC 61-A, provide the necessary information about the injured employee, the incident details, and any relevant compensation data.

What is the purpose of VA VWC 61-A?

The purpose of VA VWC 61-A is to document and report workplace injuries to ensure compliance with workers' compensation laws.

What information must be reported on VA VWC 61-A?

Information that must be reported includes the employee's details, nature of the injury, date of the incident, and any compensation information.