COLA Request Form (CA51)

The injured worker must file a COLA Request Form every year in order to apply for the applicable cost of living adjustments.


To apply for a Cost-of-Living Adjustment (COLA), the injured worker or beneficiary should complete the required information (upper portion of the eligibility form) and choose either Option 1 or Option 2 and return this form to the Virginia Workers' Compensation Commission.

This form may be filed electronically through the Commission’s WebFile system at To file electronically, the user must have a valid and active WebFile account. This form may be filed by mail or in-person at 333 E. Franklin St., Richmond, VA 23219. 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