Form 46 - Termination Of Wage Loss Award Page 2
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2Termination of Wage Loss Award
VWC Form #46
Filing Instructions
Claim Administrator or Authorized Representative:
1.
This form is to be completed when the Injured Worker returns to work at the pre-injury wage or is able to return to pre-
injury work. Submit the completed for to the Virginia Workers’ Compensation Commission, 1000 DMV Drive, Richmond,
VA 23220.
2.
Check the appropriate reason for the termination of the Award and provide the return to work date and wage
information, if applicable.
3.
If the basis for terminating benefits is for reasons other than what is contained on this form, you may need to file an
Employer’s Application for Hearing (VWC Form No. 5A) to terminate the outstanding Award. This form may not be
modified to meet a specific case, or the form will be rejected.
Injured Worker:
Signing this document is NOT a requirement for payment. If you do not agree with the information contained and make
modifications, it will be rejected. If you have any additional disability from work in the future, your claim can be reopened
with the following limitations:
* For questions or assistance with completing this form, please contact Customer Assistance at the Commission’s toll-free
number 877-664-2566.
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