West Virginia Report of Occupational Injury or Illness

State:
Multi-State
Control #:
US-427EM
Format:
Word; 
Rich Text
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Description

This form is used to document information concerning an injury or illness suffered by an employee on company property.

How to fill out Report Of Occupational Injury Or Illness?

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FAQ

I had an accident at work. How do I file a workers compensation claim in my state? If you are injured while on the job, you should 1) seek the appropriate medical care necessary; 2) provide written notice to your employer as soon as possible, if not immediately; and 3) file a workers' compensation claim.

The State of West Virginia requires workers' compensation claims to be filed within six months from the date of the injury. It can be within three years from the date of diagnosis of an occupational disease or illness, or three years from the employee's last exposure to the hazardous condition that caused the illness.

DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers' compensation benefits and the Medical Provider Network (MPN) in California.

Form CA-7 is used by federal workers seeking to claim compensation for traumatic injuries suffered while on the job, as well as those who may have sustained an occupational disease during the performance of work-related duties. This form may be filled online, or downloaded and filled offline.

According to the Compensation of Occupational Injuries and Diseases Act (COID), employees are required by law to report all near misses and incidents to their supervisor, health and safety representative or any authority managing them.

The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

When & How to Document Workplace InjuryGet to the site as quickly as possible.Ensure the area is safe to enter.Make sure the injured/ill person is receiving first-aid or medical attention.Identify any witnesses.Record the scene with photos (ideally with date and time stamp) or sketches.Safeguard any evidence.More items...

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.

How do I file a workers compensation claim in my state? If you are injured while on the job, you should 1) seek the appropriate medical care necessary; 2) provide written notice to your employer as soon as possible, if not immediately; and 3) file a workers' compensation claim.

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.

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West Virginia Report of Occupational Injury or Illness