Claims / Workers’ Compensation
The Risk Management Division handles all auto, general liability, and property claims for the County of Henrico and Henrico County Public Schools. Risk Management can be reached by phone at 804-501-5661 or by email at [email protected]
PMA Companies is the third-party administrator for workers’ compensation for the County of Henrico and Henrico County Public Schools. PMA Companies can be reached by phone at 888-476-2669 or by email at [email protected].
For additional assistance, contact Risk Management by phone at 804-501-5661 or by email at [email protected].
Forms
Privacy Notice: Information requested on these forms is necessary to process claims, to meet reporting requirements for state and federal laws, for insurance purposes, and/or for statistical reports. To the extent permitted by law, this information will be kept confidential by the County and its vendors.
Incident and Vehicle Accident Forms
- Incident and Vehicle Accident Reporting Flowchart
- Incident & Vehicle Accident Report
- Incident & Vehicle Accident Report Supplemental Form to Add Additional Equipment/Property
- Incident and Vehicle Accident Report Supplement Form to Add Additional Vehicles
Workers’ Compensation Forms & Resources
- Workers’ Compensation Reporting Flowchart
- PMA Care 24 Telephonic Reporting Poster
- Panel of Physicians Form for Workers’ Compensation
- Employee’s Report of Injury form for Workers’ Compensation
- Supervisor’s Investigation Report for Workers’ Compensation
- Workers’ Compensation Temporary Prescription ID Card (English)
- Workers’ Compensation Temporary Prescription ID Card (Spanish)
- FMLA Eligibility Determination Request
Physical Capabilities Forms
- Physical Capabilities Form
- Police Fitness for Duty Verification Form (Police Only)
- Fire Physical Capabilities Form (Fire Only)
- Fire MTT (Medical Transport Tech) Physical Capabilities Form ( Fire Only)
- Sheriff Physical Capabilities Form
Fatality, Hospitalization & Injury Reporting Requirements
The County is required to report an employee fatality, inpatient hospitalization, amputation, or the loss of an eye to the Department of Labor & Industry within a specified time frame. Please notify Emergency Management and Workplace Safety (EMWS) and Risk Management staff immediately upon knowledge of such an incident.
| Contact | Contact Person & Title | Phone |
|---|---|---|
| EMWS Primary | Rob Rowley, Chief of EMWS | 804-316-3563 |
| Risk Management Primary | Jeanetta Lee, Director of Risk Management | 804-382-4885 |
| EMWS Alternate | Craig Collins, Environmental Health & Safety Coordinator | 804-370-8362 |
| Risk Management Alternate | Jo Ann Adkins, Liability Claims Manager | 804-317-0452 |
Workers’ Compensation Claim & CARE24 Claim Reporting Feedback
The health and safety of our employees is a top priority. A key part of maintaining a safe workplace is ensuring that all injuries, no matter how minor, are reported promptly and accurately. To strengthen our processes, we are seeking feedback from both employees and supervisors on their experiences with injury reporting and overall claims processing.
Your input will help us:
- Identify any challenges or barriers to timely reporting.
- Improve communication and training related to injury procedures.
- Ensure that our reporting system is clear, effective and supportive of everyone.
This survey should take only a few minutes to complete. Responses will remain confidential and will be used solely to guide improvements in our program as well as address issues.
Thank you for your participation and commitment to safety and injury reporting.
Additional Information from the Virginia Workers’ Compensation Commission (VWC)
- VWC Information Brochure A brief guide to Workers’ Compensation for Injured Workers from the Virginia Workers’ Compensation Commission (VWC).
- VWC Ombudsman Brochure. Ombuds Department at the Virginia Workers’ Compensation Commission (VWC) is a free, confidential resource for information and assistance to unrepresented parties to a workers’ compensation claim
- VWC Workers’ Compensation Information for Firefighters, LEOS, and Corrections. Presentation by the Ombudsman at the VWC from 2023.
- For additional help with your Workers’ Compensation questions, you and your employees can also visit the Workers’ Compensation Commission website.