West Virginia's workers' compensation claim application pairs the employee's account of an injury with the initial health care provider's report on one form. A clinician meets it at the first treatment for a work injury or occupational disease, since Section II must be completed by the initial provider. The form is filed with the employer's carrier, self-insured employer or TPA, which reviews it and issues a decision approving or denying the claim.
The employee completes Section I (injury date and time, employer and supervisor, body parts, how the injury happened, witnesses) and signs a medical release. The initial treating physician or hospital completes all of Section II and signs the provider certification.
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Employees' and Physicians' Report of Occupational Injury or Disease
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Yes. Section II states that all information must be completed by the initial healthcare provider. The first physician or hospital to treat the injury enters the initial treatment date, return-to-work date, time off or duty restrictions, cause, body parts, diagnosis codes, any referral and hospitalization, then signs the certification.
According to the OIC's injured-worker brochure, the claim gets a claim number and a claims adjuster. After review, the worker receives a decision saying whether the claim is approved or denied and which medical conditions are covered. A worker who disagrees can file a written protest with the Workers' Compensation Board of Review within 60 days.
The OIC brochure explains that by filing a claim, the worker irrevocably agrees that any physician may discuss their medical history and treatment with the employer and the insurer, including prior conditions of the same body part. The WC-1 provider certification also commits you to release office notes and test results immediately to the employer or its representative.