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Get and Sign Virginia Workers' Compensation Commission Employer Application for Hearing Form 5A Virginia Workers' Compensation Commission Emp
Application and the supporting documentation must be sent to the employee and to the employee s attorney if represented. The employer must send the employee a copy of the Employee Instructions as shown below. Notice to the employee If the Virginia Workers Compensation Commission approves this application your compensation benefits will be suspended. Please refer to the additional instructions on the back of this form. VWC Form No. 5A rev. 4/01/09 FILING INSTRUCTIONS Instructions Updated...
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