At Workers` Compensation, we offer free access to most of the forms you need regarding West Virginia workers` compensation insurance. We strive to keep these forms up-to-date and accurate. Second, the law requires that the notice include information about the “person” to whom an injured employee may turn for questions about a claim. Our Office interprets this requirement broadly. The “person” identified in the notice may (1) be an employee of the injured employee`s employer – for example, a manager, human resources manager or benefits coordinator; (2) a claims adjuster for the insurer; or 3) the insurer`s claims manager. However, the identified “person”: (1) should be easily accessible to the injured worker to assist him or her personally in his or her claim; and (2) sufficient knowledge of the workers` compensation claim process to do so adequately. As with any information we provide, please verify the accuracy of this information with the Office of the West Virginia Insurance Commissioner. In short, the law provides that the timely submission of a WV WC-1 form is a prerequisite for the application of entitlement to workers` compensation benefits. Failure to submit the form on time prevents an applicant from applying for benefits. However, the Office of Judges found that the plaintiff`s failure to file a WC-1 was excusable and stated that the employer was reasonably informed of the claim. There is no evidence that the carrier or employer provided the applicant with an empty WC-1 or informed the applicant of the requirement of the application form. The Review Board confirmed this by stating that “the employer and the claims administrator were informed of Mr.

Barker`s violation within the legal six-month period for filing a claim.” If you have any questions about any of these forms, please do not hesitate to contact us at 888-611-7467. When you`re ready, you can get a quote online today. With respect to the physical composition of the notice, there is no requirement in the law regarding the composition or scope of the notice or the policy used in the notice, and these provisions are at the discretion of the insurer. It should be noted that the law requires that the notice be placed in a conspicuous place on the employer`s premises. In accordance with the spirit of this Directive, notices should be drafted in such a way as to provide workers with the necessary information in a readable and easily comprehensible format. In other words, the court was perfectly in agreement with an incompletely completed form; The application was simply rejected for other, more substantial reasons. West Virginia forms and applications such as owner admission or exclusion forms are sometimes updated by the state. Contact us if you need help or can`t find workers` compensation for your needs in West Virginia. The Applicant had several follow-up visits to the hospital for a range of symptoms and treatments, and on one occasion a second WC-1 form was completed, again within six months of the date of injury. Then, on May 30, 2019, the Claims Administrator dismissed the claim because he had not received a WC-1 form. The strict requirement for a signed and finished WC-1 then apparently began to erode.

In Goins v. West Virginia Division of Natural Resources, No. 16-0328 (May 5, 2017) (Memorandum Decision), the applicant never signed Form WV WC-1, and the physician`s section of the form was left blank. The courts found that the plaintiff`s failure to sign Form WC-1 did not preclude the application from the review, and the Supreme Court stated, “The fact that the medical service was not completed calls into question the compensability of the injury; However, it does not completely exclude the application for benefits. The court also commented: Fill out this form if you are a sole proprietor, a partnership without employees or a sole officer of a business and you wish to be exempted from coverage. Business owners and managers must complete this form to opt out of a workers` compensation policy. Initial injury report (screen). Employers must complete this form and send it to their insurance company each time an injury occurs. Allow any employee.. for compensation under this Chapter, with the exception of occupational pneumoconiosis or other occupational diseases, the claim for compensation shall be made on the form or forms prescribed by the insurance agent.dem, private carrier or self-insured employer within six months of the injury or death, as the case may be; And if it is not filed within the six-month period, the right to compensation under this chapter is forever time-barred, this limitation period being declared a condition of the law and therefore a place of jurisdiction.

On December 15, 2010, more than two years after the date of the breach, the Claimant dismissed the claim as it had been filed earlier because he had never received a signed WC-1 form. The claims manager also stated that all payments were overpayments. The West Virginia Workers` Compensation Review Board and the Supreme Court upheld the dismissal of the claim, citing the mandatory provisions of the law, but did not uphold the explanation for the overpayment, stating that the plaintiff had objected to relying on approvals and benefit payments. Essentially, the claims administrator was prevented from reporting payments already made as overpayments, subject to recovery under otherwise applicable overpayment procedures. If you have any questions or would like to discuss the WC-1 requirement of the WV Form or other matters relating to the defense of workers` compensation with experienced WV workers` compensation coverage, you can make an appointment with Steve or his workers` compensation advocacy team by calling (304) 523-2100 or by completing this online contact form. The standard Acord 130 application form for West Virginia employee coverage. Two years after Ward, the Supreme Court again upheld the mandatory requirement for a WC-1 form in Saiyed v. 3 S Network, Inc., No. 15-0864 (August 26, 2016) (Memorandum Decision). In saiyan, the plaintiff resided in Virginia and most of his work was in Virginia.

He was injured while working in West Virginia. The plaintiff filed a claim for workers` compensation benefits in Virginia in August or September 2012. Then, on January 14, 2013, the Claims Administrator sent the claimant a letter detailing a brochure about the West Virginia claim and describing the West Virginia claim process and a blank WV WC-1 form. Each state has its own laws and requirements regarding when and how employers can opt out of coverage as part of their workers` compensation policy. . . .