Form Focus: Va. Supplemental Agreement — Varying Wage Benefits

Richmond, VA (WorkersCompensation.com) -- Virginia has a form to use when there is a supplemental agreement to pay varying wage benefits.

The form must be completed whenever a claim has been accepted as compensable and the claimant is entitled to an award. The award agreement provides the basis for the award of compensation and contains sufficient information to establish the essential elements of a compensable claim.

The completed form must be submitted the completed to the Virginia Workers’ Compensation Commission, 333 E. Franklin St., Richmond, Virginia 23219.

As a reminder, the benefits that are covered under Virginia workers' compensation law include:

Temporary Total (TT) disability – Claimant is totally disabled from work and is entitled to receive compensation for a period of total wage loss based upon 66 2/3% (.66667) of the pre-injury average weekly wage.

Temporary Partial (TP) disability – Claimant is partially disabled from work but is entitled to receive compensation for a period of partial wage loss based upon 66 2/3% of the difference between the pre-injury average weekly wage and the post-injury average weekly wage. All wage information and compensation rate(s) should be calculated pursuant to Virginia Code § 65.2-502. Forms received
without specific dollar amounts or those that reflect the word “various” will be rejected.

Permanent Partial (PP) disability – Claimant is entitled to receive compensation based upon the loss of use or the loss of a ratable body part, based upon 66 2/3% (.66667) of the pre-injury average weekly wage for a specified number of weeks, pursuant to Virginia Code § 65.2-503. Please attach a copy of the medical report or the amputation chart that supports the permanency rating to the agreement form. If Permanent Partial is for disfigurement, the Commission must set the rating based on submitted photographs.

Permanent Total – Claimant is permanently and totally disabled from work and is entitled to receive compensation for the remainder of his/her life based upon 66 2/3% (.66667) of the pre-injury average weekly wage.

Average Weekly Wage (AWW) – Amount the claimant earned in employment at the time of the injury during the period of 52 weeks prior to the date of accident, divided by 52. See Virginia Code § 65.2-101 for full definition.

Medical Only – The parties agree that the Claimant sustained a compensable injury for which the employer and insurer will accept responsibility only for the medical expenses incurred as a result of a work-related injury or occupational disease.

The compensation rate is subject to yearly maximum and minimum allowances.

Those who have questions should call the Ombuds at 833-448-1681, or email ombuds@workcomp.virginia.gov

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