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First Benefits Insurance Mutual Claims

Claims Department Phone: 800.360.7867
Fax: 919.977.5844

Secure Medical Treatment

Virginia law requires an employer to provide medical treatment to an injured employee.  The injured employee must choose a doctor from a panel of physicians selected by the employer.  Virginia employers should have a prepared list of three panel physicians before an injury occurs. Click here to download the Panel of Physicians Form. (Enter your information once the form is downloaded.)  The form must include the name of physician, the physician’s practice, and the physician’s address and phone number.  We strongly encourage employers to have an injured worker complete this or a similar form.

If you need assistance preparing a list of three panel physicians, please contact the Claims Department at First Benefits and we will be happy to assist you.

How to File a Claim

It is important for an employer to complete a First Report of Injury or Illness and submit it to First Benefits within 24 hours of injury so that we can provide appropriate forms to an employee on your behalf. (Download the form to enter your information.)

Wage Information

If an employee misses time from work due to a compensable injury, he or she will be entitled to wage replacement benefits called temporary total disability.  In order to determine the amount of weekly compensation an injured worker is entitled to receive, we need for you to complete a Wage Chart Form (VWC Form No. 7A).  The Wage Chart Form should reflect gross wages earned by the injured worker during the 52-weeks immediately preceding the date of injury.  There are specific instructions on how to complete a Wage Chart Form on the second page of the attachment.

Questions? Contact us at or call (800) 360-7867.

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