To best inform employees and protect a company’s interests, West Virginia (WV) employers need to be aware of the general process for WV workplace injury claims. This process is established by state law and the West Virginia workers’ compensation rules under chapter 23 of WV Code and title 85 of the Code of State Rules (CSR). Understanding employer responsibilities, the benefits available to employees, and the process for claims and objections is essential to effective workers’ compensation management by employers.
The Process for WV Workplace Injury Claims under West Virginia Workers’ Compensation Rules
WV workers’ compensation laws have undergone significant changes in recent years, and that trend is likely to continue. The basic process for filing a claim has remained fairly consistent, while procedures governing protests, objections, and other aspects of the process for WV workplace injury claims have been substantially overhauled. The advice of experienced legal counsel, like Clarksburg workers’ compensation defense attorney James “Mac” Heslep, helps employers keep their policies and procedures aligned with current and pending legislation.
The Initial Process for WV Workplace Injury Claims
When an employee in WV sustains an injury on the job that requires medical treatment, the employee, initial treatment provider, and employer are all responsible for filing a report of injury. The Offices of the Insurance Commissioner (OIC) provides the WV workers’ compensation forms required for filing a claim.
The employee and initial healthcare provider complete the Employees’ and Physicians’ Report of Occupational Injury or Disease (OIC-WC-1) . The employer files the Employers’ Report of Occupational Injury or Disease (OIC-WC-2).
The employee completes section I of the OIC-WC-1 form, providing contact information; the employer, job title, and employment status; and details about the injury. The medical provider completes section II of the OIC-WC-1, which includes details about the injury or illness, recommendations regarding ability to work, and the provider’s opinion regarding whether the injury or illness is occupational.
The employer is responsible for filing the OIC-WC-2 within five days of receiving notice of an on-the-job injury or illness that requires medical treatment. The report includes information about the employer, employee, injury or illness, wages, and lost time. The OIC-WC-2 also provides an opportunity to state whether the employer questions the injury.
Insurance carriers and third-party administrators are permitted to modify the WV workers’ compensation forms provided by the Insurance Commission to some extent, though changes to certain fields require approval of the OIC.
West Virginia Workers’ Compensation Rules for Claims Administration
After receiving a report of occupational injury, the claims administrator must act upon a claim within 15 working days. The claim may be approved conditionally if more information is needed to make a decision. An order including the decision on the compensability of the claim must be sent to the claimant, employer, and any counsel of record.
The initial order must notify the claimant of his or her right to protest the decision of the insurance carrier or administrator. If approved, the claimant may be eligible for various benefits under the employer’s workers’ compensation insurance coverage, including TTD, permanent partial disability (PPD), or permanent total disability (PTD) benefits, among others.
West Virginia workers’ compensation rules require all decisions regarding benefits to be issued in writing and sent to all parties to the claim with notice of the right to protest. Unless a protest is filed within 60 days of notice, these decisions are final.
Protests and Objections under West Virginia Workers’ Compensation Rules
As of July 1, 2022, initial objections of claim decisions are heard by the WV Workers’ Compensation Board of Review. The claimant, employer, the Insurance Commissioner, or the private insurer may protest decisions issued by the Board of Review. These protests must be made within 30 days of notice of the decision or within 60 days of the decision, regardless of notice. Protests of decisions by the Board of Review are now heard by the WV Intermediate Court of Appeals.
Contact a Clarksburg Workers’ Compensation Defense Attorney
Missteps by employers and insurance carriers in the process for WV workplace injury claims and litigation can be costly, and keeping up with changes to the West Virginia workers’ compensation rules requires diligence. Clarksburg workers’ compensation defense attorney James “Mac” Heslep and the workers’ compensation defense team at Jenkins Fenstermaker, PLLC constantly track these changes and advise clients on best practices. For help managing your company’s workers’ compensation procedures, claims, and litigation, contact Mac by calling (304) 521-6120 or completing the firm’s online contact form.