West Virginia Workers Compensation: Eligibility, Filing and Appeals

As of January 1, 2006 West Virginia no longer operates a state organized and managed Workers Compensation Program fund. Instead a private insurer, BrickStreet Mutual Insurance Company now provides coverage to all employers in the state. BrickSteet Mutual Insurance Company will continue to be the sole provider for Workers Compensation Insurance in the state until 2012, at which time other private insurers will be allowed to provide insurance within the state based on the individual employer's wishes to change carriers. Workers compensation is compulsory for businesses in the state that employ more than 3 workers except agriculture which is exempt up to 5 employees.

Common Covered Work Related Injuries

Workers compensation is designed to cover medical bills, lost wages and expenses that occur due to a work related injury or accident. Injuries that occur within the scope of the duties and responsibility of the job are covered, as are accidents that occur while in the workplace. Some disease and conditions may also be included under the benefits. There is a three day wait before a claim can be filed, and retroactive compensation may be available if the employee is off work more than 7 days due to the injury.

How to File a West Virginia Workers Compensation Claim

The employee needs to report any accidents that occur in the workplace directly to their employer. The employer is then required to report the incident to BrickStreet within 24 hours whenever possible. Forms for reporting injury can also be obtained online or completed via the internet to save time and increase the speed at which the claim is evaluated and processed. Information on wages, doctors reports and other information will be requested and needs to be provided by the employee as requested. A claims adjuster will then propose a settlement based on the information provided.

Workers Compensation Claim Denials

Claims are typically denied by the insurance adjuster for one of several reasons. Lack of documentation that has been requested, incorrect or inaccurate completion of forms, medical evidence that does not support the employees claim, or a discrepancy between reporting parties are all possible issues that can lead to a claim being denied.

Appealing a West Virginia Workers Compensation Denial

Since all insurance in West Virginia is either through BrickStreet or, in rare situations, through self-insurers, appeals for claims are heard by the Workers’ Compensation Office of Judges, which works in association with the Office of the Insurance Commissioner of West Virginia and the Workers’ Compensation Board of Review. The decision of the Administrative Law Judge can be appealed to the Worker's Compensation Board of Review or even to the West Virginia Supreme Court of Appeals, however the court only hears cases they agree to hear based on the individual facts of the case.

Collecting West Virginia Workers Compensation Benefits

West Virginia Workers Compensation benefits are paid on a percentage of the workers weekly salary with a minimum and maximum amount allowable for a maximum time of 208 weeks for temporary total disability. Scheduled awards can also be paid over and above any temporary total disability payments. Full medical benefits are also included in the benefits and there are no monetary or time limits on medical benefits.

Working with an experienced West Virginia Workers Compensation lawyer will help you present your case and manage any and all appeals. Since this can be a complex process, expert legal advice is recommended.