A document that the parties must complete, preferably jointly, and file at least 7 days before a scheduled hearing on an employer’s application for hearing that provide specifics about the application, the relief sought, the defenses to the application and the facts upon which the parties agree.
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.
- FAX: Fax the complete form to 804-823-6957.
- MAIL: Mail the completed form to 333 E. Franklin St., Richmond, VA 23219
- 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.