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West Virginia Employees' and Physicians' Report of Occupational Injury or Disease

State:
West Virginia
Control #:
WV-SKU-0508
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Description

Employees And Physicians Report of Injury

The West Virginia Employees' and Physicians' Report of Occupational Injury or Disease is the form used by employers and physicians in West Virginia to report work-related injury or illness. The form is used to record the details of the employee’s injury or illness, such as the date and time of the incident, the location of the incident, and the type and severity of the injury or illness. The form also records the physician’s diagnosis, treatment, and the employee’s work status, such as whether the employee was able to return to work or is still off of work. There are two types of West Virginia Employees' and Physicians' Report of Occupational Injury or Disease: the WV-1 form, which is used to report any occupational injury or illness, and the WV-2 form, which is used to report any occupational injury or illness involving lost time from work or medical treatment.

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FAQ

After an injury or illness occurs, your employer must: Provide a workers' compensation claim form to you within one working day a work-related injury or illness is reported. Return a completed copy of the claim form to you within one working day of receipt.

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

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.

Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care.

To be covered under a workers compensation statute, an injury or a disease must (in most states) arise out of and in the course of employment. That is, the injury or disease must be casually related to the employment and occur while the employee is engaged in work-related activities.

The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid.

When an incident is reported quickly it allows the injured worker the opportunity to receive quick and proper treatment that may be needed. Sometimes an employee may believe they have a ?minor? injury and decide not to report it or get the injury evaluated which may cause it to become worse.

If it's an emergency, you should call 911 right away. After the injury, your employee can file a claim with your workers' compensation insurance, also known as workers' comp, to help get important benefits, like medical treatment coverage. There are different state laws for this coverage depending on where you live.

More info

An Employee's Guide on Reporting A WorkRelated Injury Or Disease ; What Type Of Condition Do I Have? ; Traumatic Injury ; Occupational Disease.Tell what happened and how it happened. CA-1, the employee should detach Form CA-20 and complete items 1-3 on the front. Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. The principal purpose for requesting information from injured workers, dependents, lien claimants, physician, employers or their representatives is to. Employees' and Physicians' Report of Injury. Prior To Completing This Form You Must. Every physician as defined in Section 3209. Read Section 6409 - Physician's report of occupational injury or illness, Cal. Lab.

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West Virginia Employees' and Physicians' Report of Occupational Injury or Disease