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