Some state worker's compensation acts also provide that a formal claim for compensation be made, either to the employer, the compensation board, or to the state commission board with notice to the employer that the claim is being made. This claim or notice of claim is different from the notice of injury and is governed by a different, and sometimes longer, statute of limitations. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.
West Virginia Notice of Work-Related Injury and Claim for Worker's Compensation
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US-01495BG
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How to fill out Notice Of Work-Related Injury And Claim For Worker's Compensation?
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FAQ
In these states, employers must buy workers comp insurance from an insurance fund operated by the state. Nevada and West Virginia were monopolistic states in the past but now have a competitive market system.
The average cost of workers' compensation in West Virginia is $57 per month. Your workers' comp premium is calculated based on a few factors, including: Payroll.
To make up for missed wages, an employee with a work-related injury or illness is eligible to receive up to two-thirds of their pre-injury average weekly earnings. Temporary total disability benefits begin after they can't work for more than three consecutive calendar days.
Workers' comp cases with head injuries settle for the most money compared to settlements for all other body parts.
An injured worker's wage paid is 66 2/3%. The weekly payment minimum is $175.33, 33 1/3% of the West Virginia state average weekly wage and may not exceed the Federal minimum hourly wage. The weekly maximum is $526, 100% of the West Virginia state average weekly wage. Maximum period of payments is 104 weeks.
All West Virginia employers are statutorily required to maintain workers' compensation insurance coverage.
Claims Must Be Filed Within Six Months West Virginia requires injured workers to file an application for benefits within six months of the date of injury. Do not allow yourself or your loved one to miss out on valuable financial help to replace lost wages, cover medical expenses, and more.