For guidance to commonly reported issues, please click here.

We recognize that our users may have various Internet Browsers and Operating Systems or devices. We like our visitors to have the best possible experience when using our Web applications. The Virginia Workers' Compensation Commission recommends Google Chrome for best results or any other modern web browsers with HTML5 and CSS3 compatibility. For example Internet Explorer 9 (IE9) NOT in compatibility mode (see note and link below), Microsoft Edge (IE10 +) or Firefox (Win Version 12 +).

NOTE: If you are using Microsoft Internet Explorer and still encounter problems, please verify that your browser is not operating in Compatibility Mode. For instructions on how to disable Compatibility Mode, Click Here.

The Revocation of Prior Rejection of Coverage Form (Form 17A) should be filed when an officer wishes to revoke the officer's prior rejection of coverage under the Workers' Compensation Act (Act) filed with the Commission. The executive officer that elects to revoke a prior rejection of coverage should understand that they are now electing to accept coverage under the provisions of the Act.

Dear Customer:

Please have the following information available in order to complete this form:

• An active approved Rejection of Coverage form (Form 16A) must be on file with the Commission and have been processed on or after February 1, 2009 in order to submit a Revocation of Prior Rejection of Coverage form (Form 17A) electronically. If the 16A was filed prior to February 1, 2009, a paper submission should be filed with the Commission.
• Name and Address of Corporation or LLC
• Business FEIN (Federal Identification Number or Entity Identification Number)
• SCC Entity ID # of business (Can be located by contacting the SCC at 1-866-722-2551 or on the web at www.scc.virginia.gov)
• Officer/Manager information, including last four digits of SSN
• Email address of Employer and Officer for E-signature