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

Employees in 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.

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

Employers That 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 Commissioner
Attention: 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

Employees who miss time from work while recovering from their injuries can receive temporary total disability benefits. These benefits are two-thirds of the worker's average weekly wage, subject to a cap set by law. For injuries occurring between July 1, 2024 and June 30, 2025, weekly benefits cannot be more than $1,067.12.

Temporary disability benefits are paid until the employee is able to return to work or reaches maximum medical improvement--the point at which the condition is not likely to improve any further. However, temporary disability benefits cannot be paid for more than 104 weeks (two years).

Permanent Disability Payments

If a worker is 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 Partial Disability

Once a worker reaches maximum medical improvement, a doctor will determine whether there is a permanent disability. If the disability is partial, workers can receive two-thirds of their average weekly wage, subject to a maximum amount.

Starting July 1, 2024, the maximum is $746.98 per week. For each percentage of disability, the worker will receive four weeks of payment. Your percentage of disability depends on the nature and severity of your injury, as determined by your doctor.

Permanent and Total Disability

• 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.

However, other disabilities may qualify if the 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%.

Permanent and total disability benefits are two-thirds of your average weekly wage, subject to the same maximum as temporary total disability benefits ($1,067.12 per week starting July 1, 2024). Payments can last up until the employee becomes eligible for Social Security retirement benefits.

A separate application must be submitted in order to apply for permanent total disability (PTD) payments.

Appealing a Workers' Comp Denial 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.

The Workers' Compensation Board of Review uses e-filing for its appeals. Attorneys must file through the e-filing portal; unrepresented claimants without access to e-filing can submit their appeal to the following address:

Workers' Compensation Board of Review
PO Box 2628
Charleston, WV 25329-2628

The West Virginia Insurance Commissioner's website has all the information you need to file your appeal.