Get Declination To File Wv Workers Compensation Claim

This guide will assist you in completing the Declination To File WV Workers Compensation Claim form online. Following these detailed instructions will ensure that you accurately fill out and submit the necessary information regarding your decision not to file a workers’ compensation claim at this time.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, enter the date of your work-related injury where indicated. This date is crucial as it establishes the timeline for any future claims.
3. Next, acknowledge your decision not to file for workers’ compensation benefits by reviewing the statement present in the form. This part confirms your understanding that you may file a claim later.
4. Read the information regarding the six-month filing deadline carefully. Ensure you acknowledge this requirement by understanding that any claim must be filed within this timeframe for it to be eligible for consideration.
5. Fill in your name as the employee in the specified field. Make sure to print your name clearly.
6. Sign the form in the designated area to indicate your consent and understanding of the contents.
7. Select the date on which you are signing the document. This confirms when you made this declination.
8. If applicable, have the WVDOT representative sign the form where indicated and date their signature.
9. Once completed, you can digitally save the changes made, and then choose to download, print, or share the document as needed.

Begin the process by completing your forms online today.