Claims Kit

Penalties for Late Reporting   85-2-6

Failure of an insurer or self-insured employer to timely report data to the Commissioner as required may subject the private carrier or self-insured employer to a fine not to exceed $500 per occurrence of untimely reporting.

Physician Selection  85-20-6

 Each injured worker selects a treating physician of record who will treat the injured worker and be responsible for coordinating all subsequent health care. The treating physician of record may be a medical doctor, osteopath, podiatrist, or chiropractor.

 The injured worker should not seek care from more than one provider without contacting the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, requesting the designation of a different attending physician, and having that request approved. Injured workers whose employer's or the employer's private carrier's managed care plans have been approved by the Commission or Insurance Commissioner, whichever is applicable, or who are covered by a managed care plan adopted by the Commission will chose a treating physician offered under the applicable plan.

On January 19, 2021, the West Virginia Insurance Commissioner issued BULLETIN No. 21 – 01 Workers’ Compensation Claims for COVID-19 providing guidance for employers, workers’ compensation insurers, and self-insured employers regarding COVID-19 workers’ compensation claims.

Posting Requirements 23-2C-15(b)

West Virginia Code requires, in part, that:

"Every employer will post a notice upon its premises in a conspicuous place identifying its workers' compensation insurer. The notice must include the name, business address and telephone number of the insurer and of the person to contact with questions about a claim. The employer will at all times maintain the notice provided for the information of his or her employees."

Reporting of Claim by Employer  23-4-1b

The employer must report every injury sustained by their employee to the commission,  The report must be on forms recommended  by the commission or the Insurance Commissioner, whichever is applicable, and shall be made within five days of the employer's receipt of the employee's notice of injury, or within 5 days after the employer has been notified by the commission or the Insurance Commissioner, that a claim for benefits has been filed. The 5 day period may not be extended by the commission the successor to the commission, or another private carrier, but the employer has the right to file a supplemental report at a later date.