Get Nm Workers Comp Form Wc 1 For Wv

Filling out the Nm Workers Comp Form Wc 1 For Wv online can streamline the process of reporting workplace injuries or illnesses. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your web browser.
2. Begin by filling out Section I, 'Employee’s Claim Information.' Start with the insurer and third-party administrator details.
3. Enter the employee’s personal information, including their name, address, telephone number, date of birth, and social security number.
4. Indicate the employee’s marital status, sex, and provide details regarding the date and time of the injury or last exposure.
5. Complete the employer’s information, including their name, address, and the contact number of the supervisor.
6. Describe the job title and the specific body part(s) that were injured, followed by a detailed description of how the injury occurred.
7. Indicate whether the injury occurred on the employer’s property and list any witnesses to the injury.
8. An employee must certify their information by signing the form and providing the date.
9. Proceed to Section II, which needs completion by the healthcare provider. Here they fill in their name, social security number, and contact details.
10. The healthcare provider should complete the date of initial treatment, advise on work capability, and specify the nature of the injury.
11. Once all information is filled out, the healthcare provider must sign and date the form.
12. After completing the form, you can save your changes, download, print, or share the form as needed.

Complete your Nm Workers Comp Form Wc 1 For Wv online today to ensure timely processing of your claim.