Vwc Form 7A PDF Details

The Virginia Workers' Compensation Commission (VWC) uses the VWC Form No. 7A, commonly referred to as the Wage Chart, as a vital tool in its administrative proceedings. Designed to meticulously detail an employee's wage earnings in the fifty-two weeks leading up to a work-related accident, this document is integral for determining compensation benefits. To ensure accuracy and fairness in compensation, the form requires comprehensive information including gross weekly earnings, details of perquisites (additional benefits in kind), and the inclusion of overtime and tips. Moreover, it critically accounts for periods of non-work exceeding seven days due to injury through specific notations. The backing methodology for the form embraces both full yearly earnings and shortened work periods, catering to employees with less than a full year of work prior to the accident. In instances of incomplete yearly data, the form advises on proportional calculations to ascertain the employee's average weekly wage. Additionally, it features guidance for those paid on a bi-weekly basis, ensuring that all forms of wage payment schedules are accommodated. With instructions that are sensitive to potential variances in individual employment scenarios, including provisions for similar employee comparisons when direct earnings data is insufficient, the VWC 7A form is a comprehensive apparatus designed to facilitate precise workers' compensation claims processing. The documentation is a critical link between injured workers and their rightful claims, painstakingly ensuring that every relevant detail pertaining to an individual's employment and earnings before an accident is captured and accurately reflected in compensation decisions.

QuestionAnswer
Form NameVwc Form 7A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvwc form 3, va workers compensation wage statement, vwc form no 7a rev 07 01 06, how to vwc form 7a

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Wage Chart

 

 

to the right

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The boxes

Reserved

 

 

VWC File Number

 

 

Employer’s Statement of Wage Earnings

 

 

are for the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

use of the

Insurer Code

 

 

Insurer Location

 

 

Virginia Workers’ Compensation Commission

 

insurer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1000 DMV Drive Richmond VA 23220

 

 

 

Insurer Claim Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Name of Employee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Accident

 

Date of Hire

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer

 

 

 

 

 

 

 

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Name of Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employee’s Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE REFER TO THE FILING INSTRUCTIONS PRINTED ON THE BACK OF THIS FORM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Week

 

Week

 

 

 

 

Days

Gross amount

 

 

Week

Week Ending

Days

Gross amount

Week

 

Week Ending

 

 

Days

 

Gross amount

No.

 

Ending

 

 

 

 

Worked

paid, including

 

 

No.

 

Date

Worked

paid, including

No.

 

Date

 

 

Worked

 

paid, including

 

 

Date

 

 

 

 

 

 

overtime

 

 

 

 

 

 

 

 

overtime

 

 

 

 

 

 

 

 

 

overtime

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Value of perquisites for entire year:

 

 

 

 

 

 

Total gross earning $ ____________

Total weeks worked _______

 

 

Bonuses

$

 

 

 

 

Electricity

$ _______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Meals/Lodging $

 

Water $

 

 

Total value of perquisites $_____________

 

 

 

 

 

 

 

 

 

 

 

VWC use only:

 

Meals Only $

 

 

Telephone $ _______

 

 

 

 

 

 

 

 

 

 

Temporary Lodging $

 

Uniforms $ _______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

House Rent $

 

 

Laundry $

 

 

 

Total earnings & perquisites $ _____________

 

 

AWW: ________

 

 

 

 

 

 

 

Tip Income $ ________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CR: ________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURER OR EMPLOYER (include name & signature)

Date

Telephone number

Wage Chart

VWC FORM NO. 7A (REV. 07-01-06)

FILING INSTRUCTIONS

(Instructions Updated 09/01/07)

Wage Chart

VWC Form No. 7A

The information at the top right of the form should be provided by the insurer. Please note that the insurer code refers to the five-digit numeric code assigned by The National Counsel on Compensation Insurance (NCCI). Self-insured employers are assigned a similar five-digit code number by the Virginia Workers’ Compensation Commission.

Illegible forms will be returned to the insurer.

How to complete the Wage Chart:

•Indicate gross weekly earnings for the 52 weekly periods immediately preceding the date of accident.

•Note that these earnings are GROSS earnings and include overtime and tips, before any deductions are made for taxes or Social Security. If there were any perquisites, please list the TOTAL value separately at the bottom of the chart.

•If an injured employee lost more than seven consecutive calendar days, although not in the same week, these periods should be noted on the Wage Chart (VWC Form No. 7-A) using an asterisk in the Week No. column and are not to be counted in the calculations. Va. Code § 65.2-101.

•If injured employee has worked less than 12 months, the earnings for the time worked should be used. The earnings for a similar employee may be used if the employee has worked less than 60 days.

How to calculate the Wage Chart:

•If a full year’s wage information has been provided covering the 52 week period prior to the date of accident:

-determine the total wages earned, including yearly perquisites;

-divide the total wages earned for this period by 52;

-the sum will be the average weekly wage.

•If a full year’s wage information has not been provided covering the 52 week period prior to the date of accident:

-determine the total wages earned, including yearly perquisites;

-divide the total wages earned by the number of weeks wages were earned (Note: if warranted, the weeks can be converted into days and calculated on that basis);

-the sum will be the average weekly wage.

•If the form is completed on a bi-weekly basis:

-determine the total wages earned, including yearly perquisites;

-divide the total wages earned by the number of weeks worked (employee

paid 26 times a year represents 52 weeks of wages);

-the sum will be the average weekly wage.

•Samples of properly completed wage chart(s) are available through the Commission’s Website at www.vwc.state.va.us under the forms menu.

•For questions or assistance with completing this form, please contact the Awards Unit using the Commission’s Toll-Free number at (1-877) 664-2566.

How to Edit Vwc Form 7A Online for Free

When working in the online PDF editor by FormsPal, you may complete or change va workers compensation wage statement here. Our professional team is ceaselessly endeavoring to improve the tool and help it become much better for users with its many functions. Bring your experience to another level with continually improving and exceptional opportunities available today! To get the process started, go through these basic steps:

Step 1: Click the "Get Form" button in the top section of this page to get into our PDF editor.

Step 2: As you launch the online editor, you'll notice the form all set to be filled in. In addition to filling out different blanks, you can also perform various other actions with the file, namely writing your own text, changing the initial text, adding illustrations or photos, placing your signature to the PDF, and a lot more.

It is actually simple to finish the form using out practical guide! This is what you have to do:

1. To begin with, when filling out the va workers compensation wage statement, begin with the form section that contains the following fields:

Learn how to fill in vwc form no 7a portion 1

2. Once your current task is complete, take the next step – fill out all of these fields - Totals, Value of perquisites for entire, and Bonuses Electricity with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

How to fill in vwc form no 7a step 2

Always be extremely attentive while completing Bonuses Electricity and Totals, since this is the part in which a lot of people make some mistakes.

3. Completing Bonuses Electricity, Meals Only Telephone, Temporary Lodging Uniforms, House Rent Laundry Total, VWC use only AWW CR, INSURER OR EMPLOYER include name, Date Telephone number, VWC Form No A rev, and Wage Chart is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

vwc form no 7a completion process shown (stage 3)

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