The Virginia VWC First Report of Injury (VWC Form #3, Rev. 10/08) is the form a Virginia employer uses to report a work-related injury, illness, or death to its workers’ compensation insurer or claim administrator, who then sends that data to the Virginia Workers’ Compensation Commission. Every employer with three or more employees must report a workplace injury, and for accidents on or after October 1, 2008, this paper form flows to the carrier first, who files it electronically with the Commission through EDI.
Getting this form right matters because the report starts the official record of an injury, protects the worker’s right to benefits, and keeps the employer in step with Va. Code § 65.2-900. A late or sloppy report can stall a claim, trigger Commission scrutiny, and leave a worker without timely medical care. Virginia processes tens of thousands of these reports each year, and a single wrong code or missing date can bounce a filing back for correction.
This guide walks you through the form line by line in plain language.
- 📋 What each box on VWC Form #3 asks and how to answer it correctly
- ⏱️ The exact 10-day, 24-hour, and 30-day deadlines that govern your filing
- ✍️ Three full filled-out examples using real workplace scenarios
- 🚫 The most common mistakes that get reports rejected and how to dodge them
- ❓ Clear answers to the field-level questions employers ask most
What the Form Is and Who Must File It
The First Report of Injury, known as the FROI or VWC Form #3, is the official notice that a work-related injury happened. The employer fills it out, not the injured worker. The form tells the insurance carrier and the Virginia Workers’ Compensation Commission the who, what, when, and where of a workplace accident so the claim can be tracked and a Jurisdiction Claim Number can be assigned.
Any employer that regularly employs three or more workers in Virginia must carry workers’ compensation insurance and must report injuries. When a worker gets hurt, the employer completes this form and sends it to the claim administrator for the insurer that covered the business on the date of the accident. The claim administrator then reports the data to the Commission through Electronic Data Interchange (EDI).
The form serves a clear purpose. It opens the file, links the worker to the right insurance policy, and gives the Commission the facts it needs to oversee the claim. The agency that receives the data is the Commission. The statute that requires the report is Va. Code § 65.2-900. The deadline that governs it is ten days from the employer’s knowledge of the injury. The penalty for ignoring it can include fines and a damaged claim record.
One point trips up many employers. Filing this report is not the same as the worker filing a claim. The injured worker must file their own VWC Form 5, Claim for Benefits, to protect their rights, and that claim carries a separate two-year statute of limitations. The employer’s report and the worker’s claim are two different actions, and one does not replace the other.
Before You Start: Documents and Information You Need
Filling out the form goes faster when you gather your facts first. A missing FEIN or policy number is the top reason a report stalls at the carrier. Pull these items together before you open the form.
- Your Federal Employer Identification Number (FEIN). The Commission and carrier match the claim to your account using this number, and a wrong digit links the injury to the wrong employer.
- Your workers’ compensation policy number. Without it, the carrier cannot tie the claim to the correct coverage, and the report may sit unprocessed.
- The name and address of your insurer or claim administrator. You send the form here, so the wrong contact means the report never reaches the Commission.
- The injured worker’s full legal name, address, and phone number. The Commission mails notices to the worker, and a bad address delays benefits.
- The worker’s Social Security Number or other ID. This is the key field the Commission uses to identify the person across the claim’s life.
- The worker’s date of birth, sex, and occupation. These confirm identity and help set the wage and benefit calculations later.
- The exact date, hour, and location of the accident. These anchor the legal timeline and decide whether the claim is even within the statute.
- A clear description of how the injury happened and the body parts affected. Vague facts here cause the carrier to question or deny the claim.
- The reporting date and, if the accident was fatal, the date of death, marital status, and number of dependent children. Death claims need this for dependency benefits.
- The name, title, phone, and address of the person preparing the form. The Commission contacts this submitter with questions.
Gather these items in one place. If any piece is missing when you file, the carrier may return the form, and each round trip eats into your ten-day clock.
Where to Get the Form and How to Access It
You download the current form straight from the Commission’s website. The official PDF lives on the First Report of Injury page of the VWC site, marked Rev. 10/08 in the corner. Confirm that revision date so you know you have the current version and not an old VWC Form No. 3 (rev. 03/22/02) floating around online.
The form is a fillable PDF. You can type your answers on screen or print it and write them by hand. The Commission asks that the form be typed or legibly printed, signed, and dated by the preparer. A handwritten form that no one can read is as good as no report at all.
For accidents on or after October 1, 2008, you do not mail this form to the Commission. You send it to your insurance carrier or claim administrator, and they file the data electronically through EDI. The paper form is your way to hand clean information to the carrier. For accidents before October 1, 2008, that were never reported, you complete the paper form and send it to the Commission to obtain a Jurisdiction Claim Number.
Uninsured employers are the exception. If your business has no workers’ comp coverage, you use this form regardless of the accident date and deal directly with the Commission. If you cannot find or open the PDF, call the Commission toll-free at 877-664-2566 for help.
Step-by-Step: How to Fill Out VWC Form #3 Line by Line
The form is one page split into clear blocks: a top filing section, Employer, Time and Place of Accident, Injured Worker, Nature and Cause of Accident, and Signatures. Work top to bottom. Below, each field gets its own walkthrough.
Reason for Filing
This box at the very top asks for a single numerical code, 1 through 7, that tells the Commission why you are filing.
To answer it, match your accident to one of the seven criteria and write the matching number. The codes are: (1) lost time exceeds seven days; (2) medical expenses exceed $1,000.00; (3) compensability is denied; (4) issues are disputed; (5) accident resulted in death; (6) permanent disability or disfigurement may be involved; and (7) a specific request is made by the Commission.
For example, Marcus, a warehouse manager, reports a back injury that kept his worker out for two weeks, so he writes 1 in the reason-for-filing box.
A common edge case: if none of the seven criteria apply, you still must report the accident, but you leave this box blank and may use either Form 45A or this form to do so. The report is required even when no code fits.
The most common mistake here is forcing a code onto a minor injury that meets none of the criteria, which mislabels the claim and can trigger needless review. People wrongly believe this box is optional for serious injuries, but skipping a valid code on a reportable accident can make the filing incomplete.
VWC Jurisdiction Claim Number
This field asks for the Jurisdiction Claim Number the Commission assigns to the claim, if one already exists.
To answer it, enter the number only if it has already been assigned; otherwise leave it blank. New injuries on or after October 1, 2008, usually do not have a number yet because the carrier’s EDI filing generates it.
For example, Aisha in HR is reporting a brand-new injury with no prior filing, so she leaves the Jurisdiction Claim Number blank.
The edge case appears with pre-October 2008 accidents being reported late, where you file the paper form precisely to get this number assigned. In that case the box stays blank until the Commission issues it.
The common mistake is inventing or guessing a number, which creates a mismatch in the Commission’s system. Many filers think every claim has a number from day one, but the number comes after the report, not before it.
Claim Administrator File Number
This field asks for the internal file number your insurance carrier or third-party administrator uses to track the claim.
To answer it, enter the number if your carrier has already opened a file and given you one; if not, leave it blank and the carrier will add it.
For example, Janet, a small-shop owner, called her carrier first and was given file VA-2026-00821, which she writes here.
The edge case is when you report before contacting the carrier, which is common with fast filings. Then this box stays empty, and the administrator fills it on their end.
The common mistake is confusing this with the Jurisdiction Claim Number and swapping the two, which scrambles the claim’s identity. People assume these numbers are the same, but one belongs to the carrier and the other to the Commission.
Employer’s Legal Name
This field asks for the full legal name of the business that employs the injured worker.
To answer it, write the exact registered business name, not a trade name or “doing business as” nickname, because the Commission matches it to your insurance policy and FEIN.
For example, Marcus writes Blue Ridge Logistics, LLC rather than the store-front name “Blue Ridge Movers.”
The edge case is a business with multiple locations or a parent company. Use the legal entity that actually employs the worker and holds the policy.
The common mistake is entering a brand or DBA name that does not match the policy, which causes the carrier to reject the link between worker and coverage. Filers often think any recognizable name works, but only the legal name on the policy will match.
Federal Employer Identification Number (FEIN)
This field asks for your nine-digit federal tax ID number.
To answer it, enter all nine digits in the format XX-XXXXXXX, double-checking each digit against your IRS records or payroll system.
For example, Aisha enters 54-1234567 for her employer.
The edge case is a company that uses different FEINs for different divisions. Use the FEIN tied to the workers’ comp policy covering this worker.
The common mistake is a single transposed digit, which links the injury to the wrong employer account and delays everything. People assume a close-enough number is fine, but the Commission cross-checks it exactly, and one wrong digit breaks the match.
Employer’s Mailing Address
This field asks where the employer receives mail about the claim.
To answer it, write the full street or P.O. Box address, city, state, and ZIP where your business gets official mail, not the accident site.
For example, Janet enters 418 Main Street, Suite 2, Roanoke, VA 24011.
The edge case is when your mailing address differs from your physical worksite, which is common. Always use the address where you reliably receive mail, even if it is a P.O. Box.
The common mistake is listing the accident location here instead of the mailing address, which sends notices to the wrong place. Filers often confuse “where the business is” with “where the accident happened,” but this box is for mail only.
Name/FEIN of Entity on Policy
This field asks for the name and FEIN of the entity actually named on the insurance policy, which may differ from the employing entity.
To answer it, copy the named insured and FEIN exactly as they appear on your workers’ comp policy declarations page.
For example, Marcus lists Blue Ridge Holdings, Inc., 54-7654321, the parent company that holds the policy for all its subsidiaries.
The edge case is the most common reason for confusion: a staffing agency, PEO, or parent company holds the policy while a related entity employs the worker. Match the policy document, not your assumptions.
The common mistake is leaving this blank or repeating the employer name when the policyholder is different, which breaks the coverage link. People wrongly believe the employer and the policyholder are always the same entity, but they often are not.
Nature of Business
This field asks what your business does.
To answer it, give a short, clear description of your industry or main activity, such as trucking and freight or residential roofing.
For example, Aisha writes commercial janitorial services.
The edge case is a business with several activities. Name the primary one tied to the work the injured employee performs.
The common mistake is writing something vague like “services,” which gives the Commission no useful context for the risk. Filers think the box is a formality, but it helps classify the claim and confirm the policy type.
Name and Address of Insurer or Self-Insurer for This Claim
This field asks for the workers’ comp insurer, or, if you carry your own risk, the self-insurer information.
To answer it, write the full name and mailing address of the insurance company or claim administrator that covered your business on the accident date.
For example, Janet enters Cincinnati Insurance Company, P.O. Box 145496, Cincinnati, OH 45250.
The edge case is a recent policy change. Always name the carrier that was on the risk on the date of injury, not your current carrier if you switched.
The common mistake is naming your new insurer after a mid-year switch, which routes the claim to a company that never covered the loss. People assume their current carrier handles all open claims, but the carrier on the injury date owns it.
Policy Number
This field asks for your workers’ comp policy number.
To answer it, copy the full policy number from your declarations page, including any letters and dashes, exactly as shown.
For example, Marcus enters WC-VA-0098217-03.
The edge case is again a mid-term policy change, where you must use the number active on the accident date. Keep your prior declarations page handy for older claims.
The common mistake is dropping leading zeros or letters, which prevents the carrier from matching the claim to coverage. Filers think partial numbers are enough, but the system needs the complete string.
Location Where Accident Occurred
This field asks for the physical place the injury happened.
To answer it, give a specific address or location, such as a job site, a department, or a street address, not just a city.
For example, Aisha writes Loading dock, 2200 Industrial Blvd., Richmond, VA 23234.
The edge case is a mobile worker, like a driver or a home-health aide, injured away from the main office. Record the actual spot, even if it is a highway mile marker or a client’s home.
The common mistake is entering only the employer’s address when the accident was elsewhere, which misstates where the injury occurred. People assume the worksite and the accident site are the same, but for field workers they often differ.
Date of Injury
This field asks for the calendar date the accident or injury happened.
To answer it, write the date in MM/DD/YYYY format, using the exact day of the accident.
For example, Marcus enters 04/15/2026.
The edge case is a gradual condition or occupational disease with no single accident day. Use the date the worker first noticed the condition or got a diagnosis, and note that in the description.
The common mistake is guessing the date or using the reporting date instead, which can throw off the two-year statute of limitations for the worker’s claim. Filers think any nearby date works, but the injury date is a legal anchor and must be exact.
Hour of Injury
This field asks what time of day the injury happened, with a.m. or p.m. checkboxes.
To answer it, write the time and check a.m. or p.m. If you only know the approximate time, give your best estimate.
For example, Janet enters 2:30 and checks p.m.
The edge case is an injury found at shift change or a condition noticed over time. Estimate as closely as you can and avoid leaving it blank.
The common mistake is forgetting to check a.m. or p.m., which makes a 3:00 entry ambiguous. People treat the time as minor, but it can matter when an injury straddles two shifts or the worker was off the clock.
If Fatal, Give Date of Death
This field asks for the date the worker died, used only in fatal cases.
To answer it, enter the date of death in MM/DD/YYYY format; leave it blank if the injury was not fatal.
For example, in a fatality, Marcus would enter 04/18/2026 if the worker died three days after the accident.
The edge case is a death that follows the injury by days or weeks. Use the actual death date, not the accident date, since they can differ.
The common mistake is confusing the death date with the injury date, which corrupts the dependency benefit timeline. Filers assume the two dates match, but a worker can die well after the accident.
Date Injury or Illness Reported
This field asks when the worker, or someone, first told the employer about the injury.
To answer it, enter the date you or a supervisor first learned of the injury, in MM/DD/YYYY format.
For example, Aisha enters 04/16/2026, the day the worker told his supervisor.
The edge case is a delayed report, where the worker waited days to speak up. Record the true date you learned of it, since your ten-day clock starts then.
The common mistake is back-dating this to make the filing look prompt, which is both inaccurate and risky if challenged. People think this date should match the injury date, but it marks employer knowledge, which can come later.
If Fatal, Give Number of Dependent Children and Marital Status
These fields ask, in a death claim, how many dependent children the worker had and whether they were single, married, divorced, or widowed.
To answer them, enter the number of dependent children and check the matching marital-status box; leave blank for non-fatal injuries.
For example, in a fatality, Marcus enters 2 dependent children and checks Married.
The edge case is a blended family or stepchildren. Count those who legally depended on the worker and note details for the carrier.
The common mistake is leaving these blank in a fatal claim, which delays dependency benefits to the family. Filers think the Commission gathers this later, but the death benefits hinge on it from the start.
Name of Injured Worker
This field asks for the full legal name of the person who was hurt.
To answer it, write the worker’s first, middle, and last name as it appears on their Social Security card or ID.
For example, Aisha enters Carlos M. Reyes.
The edge case is a worker who goes by a nickname or recently changed their name. Use the legal name on file with payroll and the SSA.
The common mistake is using a nickname or misspelling the surname, which can mismatch SSA records and stall identity checks. People think the everyday name is fine, but the Commission needs the legal name.
Phone Number and Injured Worker’s Mailing Address
These fields ask for the worker’s phone number and mailing address.
To answer them, enter a working phone number and the full mailing address where the worker receives mail.
For example, Carlos lists (804) 555-0147 and 905 Oak Lane, Apt. 3, Richmond, VA 23223.
The edge case is a worker who has moved or is between addresses. Use the most current address and update the carrier if it changes.
The common mistake is entering an old address, which means the worker misses Commission notices and benefit checks. Filers assume payroll has the current address, but it is worth confirming with the worker.
Injured Worker ID Number and Type of ID
These fields ask for the worker’s identification number and which type of ID it is, with checkboxes for Social Security No., Green Card, Employment Visa, Passport No., and Unknown.
To answer them, enter the number and check the box that matches the document type, usually the Social Security Number.
For example, Aisha enters XXX-XX-1234 and checks Social Security No.
The edge case is a worker without an SSN, such as some visa holders. Use the available ID, like a passport or green card number, and check that box rather than leaving it blank.
The common mistake is leaving the ID blank or checking “Unknown” when an SSN exists, which hampers identity matching across the claim. People worry about privacy, but the Commission needs this to track benefits accurately.
Occupation, Date of Birth, and Sex
These fields ask for the worker’s job title at the time of injury, date of birth, and sex.
To answer them, write the occupation, enter the date of birth in MM/DD/YYYY, and check Male or Female.
For example, Carlos is listed as Warehouse Associate, born 03/14/1985, Male.
The edge case is a worker with multiple roles. Name the job they were performing when the injury occurred, since duties affect risk and wage data.
The common mistake is entering a generic title like “employee,” which hides the real exposure. Filers think the title is cosmetic, but it helps the Commission understand how the injury fits the job.
Machine, Tool, or Object Causing Injury or Illness
This field asks what physical thing caused the harm.
To answer it, name the specific item, such as a forklift, box cutter, or wet floor, that led to the injury.
For example, Carlos lists loaded pallet jack.
The edge case is an injury with no single object, like a repetitive-motion strain. Describe the activity or condition, such as “repeated lifting,” instead of forcing an object.
The common mistake is writing “none” or leaving it blank when an object was involved, which weakens the accident description. People think this is optional, but it helps establish how and why the injury happened.
Describe Fully How Injury or Illness Occurred
This field asks for a complete account of the accident.
To answer it, write a clear, factual narrative of what the worker was doing and what went wrong, in plain order.
For example, Carlos’s entry reads Worker was pushing a loaded pallet jack up a ramp when it rolled back and pinned his lower back against a steel post.
The edge case is an unwitnessed or disputed accident. Stick to the known facts and avoid speculation, since this narrative shapes how the carrier views compensability.
The common mistake is a vague entry like “hurt back at work,” which invites the carrier to question or deny the claim. Filers think brevity is safer, but a thin description raises more doubts than a clear one.
Describe Nature of Injury, Occupational Disease, or Illness, Including Body Parts Affected
This field asks what was actually injured and which body parts.
To answer it, name the medical injury and the specific body parts, such as lumbar strain, lower back or laceration, left index finger.
For example, Carlos’s entry reads Lumbar muscle strain affecting the lower back.
The edge case is multiple injuries from one accident. List each body part, because an omitted part may later be excluded from the claim.
The common mistake is naming only one body part when several were hurt, which can block treatment for the unlisted areas. People assume the claim covers the whole body, but the listed parts define what gets treated.
Submitter Name, Signature, Title, Date, Phone, and Address
This final block asks who prepared the form, with name, signature, title, date, phone number, and address.
To answer it, the preparer prints their name and title, signs, dates the form, and adds a phone number and mailing address.
For example, Aisha Johnson, HR Coordinator, signs, dates it 04/16/2026, and lists her work phone and the company address.
The edge case is an outside agent or attorney preparing the form. They sign as submitter and list their own contact details so the Commission knows whom to call.
The common mistake is leaving the form unsigned or undated, which makes it incomplete and unacceptable. Filers think a typed name counts as a signature, but the Commission expects a real signature and date.
Three Filled-Out Examples Using Real Scenarios
Below are three of the most common reporting situations, each followed by a named filer through the key sections of VWC Form #3.
Scenario 1: Lost-Time Back Injury at a Warehouse. Marcus reports a serious strain that kept his worker out for two weeks.
| Form Section | What Marcus Enters |
|---|---|
| Reason for filing | 1 (lost time exceeds seven days) |
| Employer’s Legal Name | Blue Ridge Logistics, LLC |
| FEIN | 54-1234567 |
| Policy Number | WC-VA-0098217-03 |
| Date of injury | 04/15/2026 |
| Name of Injured Worker | Carlos M. Reyes |
| Occupation | Warehouse Associate |
| How injury occurred | Pallet jack rolled back and pinned worker’s lower back against a post |
| Nature of injury | Lumbar muscle strain, lower back |
| Submitter | Marcus Hale, Operations Manager, signed and dated 04/16/2026 |
Scenario 2: Medical-Only Laceration at a Cleaning Company. Aisha reports a minor cut that needed stitches but no lost time, and whose costs may top $1,000.
| Form Section | What Aisha Enters |
|---|---|
| Reason for filing | 2 (medical expenses exceed $1,000.00) |
| Employer’s Legal Name | Capital Clean Services, Inc. |
| FEIN | 54-9876543 |
| Policy Number | WC-VA-0044120-01 |
| Date of injury | 05/02/2026 |
| Name of Injured Worker | Dawn Pittman |
| Occupation | Custodian |
| How injury occurred | Worker cut left hand on broken glass while emptying a trash bin |
| Nature of injury | Laceration, left palm requiring stitches |
| Submitter | Aisha Johnson, HR Coordinator, signed and dated 05/02/2026 |
Scenario 3: Workplace Fatality at a Construction Site. Janet reports the death of a worker after a fall, the most serious filing type.
| Form Section | What Janet Enters |
|---|---|
| Reason for filing | 5 (accident resulted in death) |
| Employer’s Legal Name | Roanoke Builders Group, LLC |
| FEIN | 54-2233445 |
| Date of injury | 05/20/2026 |
| If fatal, date of death | 05/20/2026 |
| Dependent children / marital status | 2 / Married |
| Name of Injured Worker | Thomas Greene |
| How injury occurred | Worker fell approximately 18 feet from scaffolding that collapsed |
| Nature of injury | Fatal traumatic head and chest injuries |
| Submitter | Janet Cole, Owner, signed and dated 05/20/2026 |
How to File the Completed Form
How you file depends on the accident date and your insurance status. For accidents on or after October 1, 2008, you do not send this form to the Commission. You send it to your insurance carrier or claim administrator, who files the data electronically through EDI.
- To the carrier or claim administrator (standard route). Send the signed original to your insurer’s claim contact by mail, fax, secure email, or their online portal. There is no fee. Keep a dated copy and a delivery confirmation as your proof of filing. The carrier then submits the EDI data to the Commission, usually within days.
- By mail to the Commission (pre-10/1/08 or non-EDI cases). Mail the completed form to the Virginia Workers’ Compensation Commission, 333 E. Franklin St., Richmond, VA 23219. There is no filing fee. Use certified mail so you have a return receipt as proof, and expect a Jurisdiction Claim Number back for older accidents.
- By phone for help. For questions while completing or routing the form, call the Commission toll-free at 877-664-2566. The staff cannot file it for you, but they will confirm where it should go.
Uninsured employers file directly with the Commission regardless of the date. Whatever channel you use, save a time-stamped copy, because that record is your evidence that you met the ten-day deadline if anyone ever asks.
What Happens After You File
Once your carrier receives the form, the claim administrator opens a file and submits the injury data to the Commission through EDI. The Commission then assigns a Jurisdiction Claim Number that identifies the claim from that point forward. You and the worker can use that number to track the case.
The carrier reviews the facts and decides whether to accept or deny the claim. If accepted, the insurer arranges medical care and any wage-loss benefits the worker qualifies for. If the carrier disputes the claim, the matter can head to the Commission for a hearing.
Filing the First Report does not, by itself, secure the worker’s benefits. The injured worker still must file VWC Form 5, Claim for Benefits, within two years of the accident to protect their rights. Smart employers tell the worker about this step so the worker does not lose benefits by relying on the employer’s report alone.
You may hear from the carrier or the Commission if a field is unclear or missing. Respond fast, since gaps slow the whole process and can delay care for your injured employee.
Mistakes to Avoid When Filling Out the Form
Small errors on this form cause big delays. Watch for these.
- Filing late. Missing the ten-day deadline can bring penalties and weaken your compliance record.
- Wrong FEIN. A single bad digit links the injury to the wrong employer and stalls processing.
- Wrong policy number. An incorrect number stops the carrier from matching the claim to coverage.
- Naming the wrong insurer. Listing your current carrier after a switch routes the claim to a company that never covered the loss.
- Using a DBA instead of the legal name. A trade name will not match your policy and breaks the coverage link.
- Vague accident description. A thin narrative invites the carrier to question or deny the claim.
- Listing only one body part. Omitted body parts may be excluded from covered treatment.
- Guessing the injury date. A wrong date can throw off the worker’s two-year statute of limitations.
- Leaving the time’s a.m./p.m. blank. An ambiguous time can matter when an injury straddles shifts.
- Forcing a reason-for-filing code. Coding a minor injury that meets no criteria mislabels the claim.
- Skipping the signature or date. An unsigned form is incomplete and gets bounced back.
- Confusing the Jurisdiction Claim Number with the carrier’s file number. Swapping them scrambles the claim’s identity.
Do’s and Don’ts
These quick rules keep your report clean.
Do’s
- Do gather every fact before you start, because missing data forces a return trip and burns your deadline.
- Do report within ten days of learning of the injury, since the clock starts at employer knowledge.
- Do use the exact legal business name and FEIN, so the claim matches your policy.
- Do describe the accident in clear, full detail, because the narrative shapes the compensability decision.
- Do list every injured body part, since unlisted parts can be denied treatment.
- Do keep a dated copy and proof of delivery, as your evidence the deadline was met.
Don’ts
- Don’t treat this report as the worker’s claim, because the worker must still file Form 5 within two years.
- Don’t back-date the reporting field, since an inaccurate date is risky if the timeline is challenged.
- Don’t guess the policy or claim numbers, because a wrong number breaks the match in the system.
- Don’t leave the signature or date blank, as an incomplete form will be rejected.
- Don’t name your new carrier for an old injury, since the carrier on the injury date owns the claim.
- Don’t write a vague injury description, because it raises doubts and slows the claim.
Pros and Cons of Filing on Your Own vs. With Help
Many small employers file this form themselves, while others lean on their carrier or a third-party administrator. Each path has trade-offs.
Pros of filing on your own
- It is free, since there is no fee and no cost for outside help.
- It is fast, because you control the timing and can meet the ten-day clock without waiting on others.
- You know your facts, so you can describe the accident and worker details accurately.
- It builds your knowledge, which helps the next time an injury happens.
- It keeps control in house, so you see the claim from the start.
Cons of filing on your own
- Field errors are easy, and a wrong code or number can stall the claim.
- You may miss nuances, like which entity is named on the policy.
- No expert review, so mistakes slip through unchecked.
- Time cost, since gathering data and completing the form pulls you from other work.
- Risk of late filing, if you are unsure where to send it and lose days.
A practical middle path is to complete the form yourself but call your carrier’s claim contact, or the Commission at 877-664-2566, to confirm the routing and the reason-for-filing code before you send it.
FAQs
Do I send this form to the Commission or to my insurance carrier?
No. For accidents on or after October 1, 2008, you send it to your insurance carrier or claim administrator, who then files the data with the Commission through EDI.
Do I have to file a First Report even if the injury was minor?
Yes. You must report every work-related injury, but if it meets none of the seven criteria, leave the reason-for-filing box blank and may use Form 45A or this form.
Does filing this report mean my employee has filed a claim?
No. The worker must file their own VWC Form 5, Claim for Benefits, within two years of the accident to protect their right to benefits.
Do I write a code in the “reason for filing” box for every report?
No. Enter a code from 1 to 7 only if the accident meets a listed criterion; if none apply, you leave that box blank.
Do I put a Jurisdiction Claim Number on a brand-new injury?
No. New post-2008 injuries usually have no number yet, so leave that field blank; the carrier’s EDI filing generates the number.
Do I use my current insurer if I switched policies after the accident?
No. Name the carrier that covered your business on the date of injury, because that carrier owns the claim, not your current one.
Do I list every body part that was hurt?
Yes. List each injured body part, because any part you leave out may later be excluded from covered medical treatment.
Do I use my business’s trade name in the legal name box?
No. Enter the exact registered legal name, not a DBA, so the report matches your workers’ comp policy and FEIN.
Do I have to sign the form?
Yes. The preparer must print their name and title, sign, and date the form, since an unsigned report is incomplete and will be returned.
Do I have ten days to file this report?
Yes. Va. Code § 65.2-900 requires the report within ten days of the employer’s knowledge of the injury, with stricter timing for fatalities.
Do I need the worker’s Social Security Number?
Yes. Enter it and check the SSN box, but if the worker has no SSN, use another listed ID type such as a passport or green card.
Do uninsured employers use this same form?
Yes. Uninsured employers use this form regardless of the accident date and report directly to the Commission rather than through a carrier.
Do I report a work-related illness on this form too?
Yes. Occupational diseases and illnesses are reported here; describe the condition and the body parts affected, using the date symptoms or diagnosis began.
Related reading
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