W. Va. Code R. § 85-1-3

Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-1-3 - Claimant's Report of Injury and Application for Compensation
3.1. General.

Immediately after sustaining an occupational injury, a claimant should 1) seek necessary medical care; 2) immediately on the occurrence of the injury or as soon as practicable thereafter give or cause to be given to the employer or any of the employer's agents a written notice of the occurrence of the injury; and 3) file a workers' compensation claim or request that one be filed on his or her behalf. Failure to immediately give notice to the employer of the injury weighs against a finding of compensability in the weighing of the evidence mandated by W. Va. Code § 23-4-Ig and dilutes the credibility and reliability of the claim. Notice provided to the employer within two (2) working days of the injury shall be deemed immediate notice: Provided, That under no circumstances shall the fact that notice of an occupational injury was provided by the claimant later than two (2) working days from the time of the injury be the sole basis for denial of a claim. Enforcement of an employer's personnel policy requiring that a claimant report an injury immediately is not a discriminatory practice imder chapter twenty-three of the West Virginia Code.

3.2. Benefit rate calculation; wage information.

It is the joint responsibility of the claimant and the employer to ensure that the correct wage information is provided to the Insurance Commissioner or private carrier so that the correct benefit rate can be paid the claimant. If the responsible party receives inaccurate wage information, the responsible party will, upon receipt of accurate wage information, adjust prospectively the benefit rate. The submission of inaccurate wage information by the employer or the receipt of benefits based on inaccurate wage information by the claimant may serve as evidence of abuse or fraud under the applicable provisions of the West Virginia Code.

W. Va. Code R. § 85-1-3