The Virginia Workers’ Compensation Commission has many forms that help the participants expedite the claim process. There are several forms that help doctors identify amputations. This includes a foot amputation form.
The Physician completes this form to provide information to support an injured worker’s claim for an amputation of the foot, toes, or metatarsals.
Instructions:
The physician fills out this form using a straight line (not circles) drawn at the exact point of amputation. The purpose of this form is to help the Virginia Workers’ Compensation Commission determine permanent partial disability benefits.
The form can be filed electronically, by mail or in-person. It can also be faxed.
Key parts of the foot amputation form include noting:
- Which foot
- Which toe – big toe, second toe, third toe, fourth toe, and fifth (smallest toe)
- Which part of the foot – Phalanges (three for each toe), Metatarsal, or some other part of the foot
If a Body Part Had to be Amputated, Call Virginia Injured Worker’s Lawyer Joe Miller
Attorney Joe Miller helps injured workers. He has represented and continues to represent amputees. He fights for all your necessary medical bills including prosthetics costs and medication expenses. He fights to get injured workers all the benefits they deserve and to make sure their claim is properly categorized. This includes arguing, when justified, that a worker has a partial total disability or a complete total disability. Contact attorney Joe Miller at 888-694-1671 to make an appointment or complete the online form to request an appointment.
