Claimants

Welcome to the admitted claimants and their families page of the Birth-Injury Program. You will find below:

1. Program Portal – New! –> Get Started
2. Program Forms (Download or complete online forms)
3. Family Caregivers and Independent Caregivers
4. Caregiver Forms (Download or complete online forms)
5. Wage Benefit (See the paperwork below)
6. Program Handbook (Learn benefits and claim submission processes)
7. Program Policies (Gather more insight)
8. Documents and Letters to Families (Read communication shared)

Program Portal

• Access the Program Portal (Inquiries, claim submissions, etc.)
• Program Portal Frequently Asked Questions (FAQs)
• Program Portal Tutorials

Program Forms

• Claimant Information Form (PDF download)
• Claimant Information Form (PDF Online Form) – New!
• Family Contact Listing Form (for new claimant families)
• 2025 Claim Reimbursement Form – New!
• 2025 Claim Reimbursement Form (PDF Online Form) – New!
• 2024 Claim Reimbursement Form (PDF download)
• 2024 Claim Reimbursement Form (PDF Online Form) – New!
• Funeral/Grief Reimbursement Form (PDF online form) – New!

Family Caregivers and (non-family)
Independent Caregivers

• Start here –>  Caregiver Setup Instructions
• Caregiver Timesheet (Family or Independent Caregiver) (PDF download)
• Caregiver Timesheet (Family or Independent Caregiver) (PDF online form) – New!
• Timesheet Monthly Date Ranges (2025) – New!
• Frequently Asked Questions and Answers
• Direct Deposit Form (PDF download)
• Direct Deposit Form (PDF online form) – New!

Caregiver Forms

• Monthly Care Summary (PDF download)
• Monthly Care Summary (PDF Online Form) – New!
• Competency Certification – PDF Online Update Soon!
• Liability Form – Caregiver – PDF Online Update Soon!
• Liability Form – Parent of Claimant – PDF Online Update Soon!
• Background Certification for Parent/Guardian Caregiver
• Background Certification for Single Parent/Guardian Caregiver
• Background Certification for Independent Caregiver

Wage Benefit

• Wage Benefit Inquiry Form
• Wage Benefit Important Information
• Wage Benefit Agreement

Program Handbook & Documentation

• Program Handbook
• Program Regulations (Virginia Administrative Code)
• Administrative Guidance On Processing Claims
• Previous Guidelines (Superseded by Regulations above)
• Medical Assistance Dog Administrative Guidance

Program Policies

• Van Policy (61 K)
• Program Investment Policy (2.7MB)
• Generator Policy Statement

Documents & Letters to Families

2024

• First Letter – November, 2024

2017

• First Letter – July 11, 2017
• Second Letter – August 4, 2017
• Letter to Insurance Brokers 
• Administrative Guidance Regarding changes in the Program’s Manner of Processing Claims