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Virginia

When an employee is injured on the job, proceed with the following:

  1. Complete VWC Form 3 – First Report of Injury providing detailed information about the accident and injury.
  2. Complete VWC Form 7A – Wage Chart providing payroll information for 52 weeks immediately proceeding the date of accident.
  3. If you are a drug free work place, post-accident drug testing must be requested according to your policy requirements.
  4. Should the injured worker request medical care, present them with a list of three Urgent Care/ Walk-In Clinics located in your area for them to select treatment provider. Once the injured worker has selected their physician, circled said physician and signed the document selecting the physician, you will need to contact the selected physician by telephone prior to sending the injured worker for medical care. This document will need to be provided to Benchmark Administrators at the time the claim is reported.
  5. Inform the medical provider that you have an injured worker coming and that Benchmark Administrators is the claims administrator.
  6. Advise the injured worker they must return to your office or job site after receiving medical care and provide the doctor’s signed return to work slip or documentation of medical disability.
  7. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.
  8. If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor go with the injured worker to assist the injured worker with any insurance related information that the medical provider may require.
  9. If there is a serious injury, notify Benchmark Administrators immediately by telephone, Injured Workers’ Hotline 1-800- 289-4502.

Required State Forms

Virginia - First Report of Injury

Additional Forms

Medical Providers

MedExpress Urgent Care

Next Care Urgent Care

NextCare Urgent Care

Urgent Care

Walk-In Medical Care

Correspondence and Medical Billing:

Benchmark Administrators
P.O. Box 940097
Maitland, FL 32794
Telephone: (321) 594-7222
Toll Free: (800) 362-5198
Fax: (352) 240-1203

24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891
Customer Service Representatives are on staff 24 hours per day to assist you with reporting a claim. Please have the injured worker’s information available as well as the accident description.