The injured worker must file a claim with the Virginia Workers' Compensation Commission in order to protect their right to benefits under Virginia law. Please attach documents which support the allegations of the claim. 20.Standard Form 95 is used to present claims against the United States under the Federal Tort Claims Act (FTCA) for property damage, personal injury, or death. You must fill out the Claim Form and turn it into the Virginia Workers' Compensation Commission. The law requires you to complete the form within two years. Upon filing a claim, several steps are involved in the workers' compensation process. How do I file a claim? ✓ Tort Claim form is typed or printed clearly in ink. ✓ Tort Claim form is filled out completely. If the condition has lasting consequences after the worker heals, permanent disability benefits may be paid.
