West Virginia Workers' Comp Claims: Eligibility, Filing and Appeals

Employees in the State of West Virginia are entitled to collect workers' compensation benefits if they are injured while performing their job or if they develop an illness that is related to their work (an “occupational” disease). Workers' compensation covers medical care for the work-related injury as well as lost income due to being unable to work, for the short or long term.

The State of West Virginia requires most employers that have at least three employees to provide workers' compensation coverage.

Employers Who Aren’t Required to Provide Workers Compensation

Certain employers in West Virginia are not legally required to provide workers compensation benefits. These include:

  • employers with less than three employees working at temporary jobs lasting not more than ten days per quarter
  • agricultural employers with five or less employees
  • employers of domestic servants
  • churches, and
  • professional sport employers.

In addition, the following workers are not required to be covered:

  • temporary employees of the state
  • volunteer employees in emergency services, and
  • some longshore and harbor workers.

Injuries and Illnesses Covered by West Virginia Workers' Comp

A West Virginia employee can receive workers’ compensation benefits if the injury occurred as the result of a work-related accident. Employees who develop illnesses related to their type of job, called “occupational diseases,” are also entitled to workers' compensation benefits. If a job exposes an employee to toxins, for instance, and the worker gets a disease known to be caused by those toxins, that is a compensable occupational disease.

If you are filing a claim because you have an occupational disease, you must do so within three years of the last time you were exposed to the condition that made you ill or within three years of the time you knew, or reasonably should have known, that you were sick due to conditions at your workplace.

What to Do When You Are Injured or Become Ill

If you become injured or ill on the job, let your employer know about it immediately.

File a Claim

You will need to file a claim with the Offices of the Insurance Commissioner. You can fill out the claims forms online, ask your employer for a form, call (304) 558-2094 to request a form, or request an application form by mail from:

West Virginia Offices of the Insurance CommissionerAttention: Rates & Forms P.O. Box 50540, 1124 Smith Street Charleston, WV 25305-0540

Submit this form as soon as possible to avoid any delay in your benefits. Technically you have six months to file your claim, but it is to your advantage to file it right away.

Seek Medical Treatment

See a doctor as soon as you can. In West Virginia, you are allowed to choose your own physician for workers’ compensation purposes, at least for the initial visit. You will need your doctor to determine if you are unable to work, to monitor your improvement under treatment, and finally, to determine when you are ready to return to work.

Medical Benefits

Workers' compensation will provide full medical benefits for any care required to treat your occupational disease or work-related injury. These medical benefits will be provided for as long as you need them, and there is no cap on the amount of medical coverage you can receive.

Coverage includes but is not limited to doctor and hospital visits, nursing care, prescriptions, medical equipment, and travel to and from medical appointments. Physical and vocational rehabilitation benefits are also available.

Temporary Disability Payments

Eligible employees will receive up to two-thirds of their average weekly wages during the time they are eligible for benefits. The amount of weekly benefits was capped in 2013 at $155.74 per day, $778 per month, and $40,603 per year.

Workers can receive temporary total disability benefits if they are completely unable to work, and temporary partial disability payments if an injury prevents a worker from performing their job for the usual number of hours.

Temporary disability benefits can be received for up to 208 weeks (four years).

If a worker is also found to have a permanent disability that will interfere with future ability to work, the worker will also be paid an additional amount based on the assigned percentage of disability.

Permanent Disability Payments

A separate application must be submitted in order to apply for permanent total disability (PTD) payments. Call (304) 558-2094 to request a PTD application, or request an application form by mail from:

West Virginia Offices of the Insurance CommissionerAttention: Rates & Forms P.O. Box 50540, 1124 Smith Street Charleston, WV 25305-0540

Payments for permanent total disability are based on the percentage, or severity, of disability. Based on how a disability is rated, a percentage of the employee's salary is paid. Payments can last up until the employee becomes eligible for Social Security retirement benefits.

Eligibility to Apply for Permanent and Total Disability

Certain disabilities are presumed to be total and permanent:

  • loss of both eye, or loss of sight in both eyes
  • loss of both hands, or loss of use of both hands
  • loss of both feet, or loss of the use of both feet, and
  • loss of one hand and one foot, or loss of the use of both one hand and one foot.

Not all other workers compensation recipients are eligible to apply for permanent and total disability. Eligibility requires that an employee:

  • is receiving 50% or more in permanent partial disability payments
  • has an injury or illness that the Commission has found is at least a 50% medical impairment.
  • has a disability rated, by statute, at 35% or more (can be evaluated to decide if it should have been 50% or more, to see if it can be made eligible for PTD application), or
  • has a disability rated at 85% or more and has a “whole body” medical disability of 50%.

How Are Percentages of Disability Decided on?

If you have completely lost the use of a part of your body, the percentage you will be compensated is decided by statute. For example, the loss of a single toe varies from 2% to 10%, the loss of a hand will be 50%, and the loss of an arm will be 60%.

Permanent Partial Disability Benefits

Payments for permanent partial disability (PPD) are also calculated according to the severity of the disability for which an employee is paid a comparable percentage of their prior wages.

If you are not permanently disabled such that you are totally unable to work, you may still suffer a partial disability that is permanent. The amount of your permanent partial disability benefit will vary based on what type of injury you have, how severe it is, and the amount of average weekly wage.

Appealing a Workers' Comp Decision in West Virginia

After you have submitted your claim and a decision is made, you have the right to file an appeal if you disagree with the decision. You must file your appeal within 60 days of receiving the decision, and your appeal must be in writing. You have to submit a copy of the decision along with a written statement of why you disagree to:

Office of Judges P.O. Box 2233 Charleston WV 25328-2233

You must also send a copy of these documents to your employer and to the claims administrator or else your appeal won't be considered.

For more information on appealing a decision, see our article on appealing a denial of West Virginia Workers' comp benefits.

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