In West Virginia, all employers are required to have workers’ compensation coverage. Employers usually meet this obligation by purchasing a policy from a private insurance company. The insurance company is responsible for reviewing claims and deciding whether to pay benefits. The West Virginia Offices of the Insurance Commissioner oversees the administration of workers’ compensation in the state.
Workers’ compensation covers injuries that happen in the course and scope of employment. For example, if you work at a computer all day and develop carpal tunnel, your injury will likely be covered by workers’ comp. Similarly, if you aggravate an old back injury while carrying heavy boxes for work, you will likely be covered. On the other hand, if you are injured during an off-site lunch break or during your commute to or from work, you will probably not be covered. (For more information, see Workers’ Compensation: Is Your Injury or Illness Work-Related?)
To be eligible for workers’ comp benefits, you must immediately notify your employer of your injury. You must do so in writing and include the following information:
You and your doctor will also need to complete an Employees’ and Physicians’ Report of Occupational Injury or Disease. Your doctor should be able to provide you with the form and submit it to the Offices of the Insurance Commissioner on your behalf. However, it is your responsibility to make sure the claim form is filed within six months of your injury. Otherwise, your claim will be barred.
Once you give notice of your injury, your employer should notify its insurance company. The insurance company will then evaluate your claim and decide whether to accept or deny it. Its investigation may include talking to you, your employer, and your doctor. You should typically receive a decision within 14 days of giving notice.
Workers’ compensation should pay for all reasonable and necessary medical treatment related to your work injury. This includes the cost of doctors’ visits, hospital stays, prescriptions, and medical equipment. If you need emergency treatment, you should go to the nearest emergency room or urgent care. For all other treatment, you may select your own treating doctor. However, your doctor must be willing to accept state-regulated fees for workers’ comp claims.
You can also receive temporary disability benefits if you need time off work while you are being treated for your injury. These are weekly payments that are based on a percentage of your average weekly wages before your injury. If your doctor finds that you are permanently disabled as a result of your injury, you can also receive permanent disability benefits. For more information on how these benefits are calculated, see our Workers' Compensation Benefits page.
If the insurance company denies your claim, you can challenge its decision. To do so, you must file a written protest with the Office of Judges within 60 days of the denial. Include a copy of the denial letter and the reason why you are appealing the decision. Send a copy to your employer’s insurance carrier and the Insurance Commissioner. Unlike in many other states, a hearing is not automatically scheduled once you file your appeal. Instead, you must submit a written request for a hearing. Otherwise, the Office of Judges will make a decision based purely on the written documents in your case.
Many workers can handle the initial workers’ comp claim process on their own. However, if your claim is denied or there is a dispute about your benefits, you should consider hiring a lawyer. This is especially true if you need to attend a workers’ comp hearing, which follow complex procedural rules. For more information, see Should I Hire a Workers’ Comp Attorney or Can I Handle My Own Case?