West Virginia Workers Compensation: An Overview
Workers’ compensation is a state mandated program that provides benefits to employees who get injured or become ill while doing their job. In West Virginia, the workers’ compensation system is overseen by the West Virginia Offices of the Insurance Commissioner and The Workers’ Compensation Fund Board. The program is designed to help protect both employees and employers by providing financial support to workers who are injured on the job, while limiting the employer’s liability and ensuring that medical costs are covered.
Eligibility for West Virginia Workers’ Compensation Benefits
In West Virginia, nearly all employers are required to provide workers’ compensation benefits to their employees. The only exception is for sole proprietors with no employees, and employers of three or fewer employees in certain industries. However, many employers choose to provide workers’ compensation benefits to employees even if they are not required to do so by law.
To be eligible for workers’ compensation benefits in West Virginia, employees must meet the following criteria:
• The injury or illness must have been work related.
• The employee must have been acting within the scope of their employment at the time of the injury.
• The employee must have given notice of the injury or illness to their employer within 30 days.
• The employee must have filed a claim for workers’ compensation benefits within two years of the injury or illness.
Types of Workers’ Compensation Benefits
In West Virginia, workers’ compensation benefits are designed to cover a variety of expenses related to work-related injuries or illnesses. These benefits include:
• Medical benefits: Covers the cost of medical care related to the injury, as well as auxiliary expenses such as transportation and lodging.
• Temporary Total Disability Benefits (TTD): Weekly payments for employees who are unable to work while recovering from a work-related injury.
• Permanent Partial Disability Benefits (PPD): Payments for employees who suffer permanent disabilities as a result of a work-related injury.
• Permanent Total Disability Benefits (PTD): Payments for employees who are permanently unable to work due to a work-related injury.
• Survivors’ Benefits: Payments to surviving dependents if an employee dies as a result of a work-related injury or illness.
Workers’ Compensation in West Virginia: Statistics and Trends
According to the West Virginia Offices of the Insurance Commissioner, there were 23,050 workers’ compensation claims filed in the state in 2020. Of these claims, 80% were for injuries and 20% were for occupational illnesses. Sprains and strains were the most common type of injury reported, accounting for 32% of all claims. The construction and manufacturing industries had the highest number of claims, at 20% and 18% respectively.
In recent years, West Virginia has seen a decline in the number of workers’ compensation claims filed. In 2016, there were 26,709 claims filed, compared to 23,050 in 2020. This decline in claims is likely due to efforts to improve workplace safety and prevent work-related injuries and illnesses.
In addition to efforts to prevent workplace injuries, West Virginia has also made changes to its workers’ compensation system in recent years. In 2019, the state passed Senate Bill 118, which made several changes to the workers’ compensation system. The bill established new medical management criteria and procedures, expanded the use of telemedicine in workers’ compensation claims, and limited opioid prescriptions for injured workers.
Challenges in the West Virginia Workers’ Compensation System
While the West Virginia workers’ compensation system is designed to provide support and assistance to employees who are injured or become ill on the job, there are several challenges faced by the system. These challenges include:
• Fraudulent Claims: Like any insurance program, workers’ compensation can be subject to fraudulent claims. This can include claims for injuries that did not occur on the job, or exaggerating the severity of an injury to receive greater benefits.
• Administrative Complexity: The workers’ compensation system can be complex and confusing, especially for employees who are not familiar with the process. Navigating the system can be difficult, and even minor errors in the claims process can delay or deny benefits.
• Cost Containment: The cost of workers’ compensation benefits can be high, and employers and insurance providers are constantly looking for ways to control these costs. This can lead to reduced benefits or increased scrutiny of claims.
• Ongoing Medical Needs: Some work-related injuries or illnesses require ongoing medical care, which can be expensive and time-consuming. This can lead to disputes over the need for ongoing care, as well as disagreements over who should be responsible for paying for these expenses.
Conclusion
The West Virginia workers’ compensation system is a valuable program that provides important benefits to employees who are injured or become ill on the job. By helping to cover the costs of medical care and lost wages, the program can help alleviate the financial burden that can come with a work-related injury.
While there are certainly challenges faced by the workers’ compensation system, ongoing efforts to improve safety and prevent work-related injuries can help reduce the number of claims filed. Additionally, recent changes to the system, such as the use of telemedicine and new medical management criteria, can provide more effective, efficient, and cost-effective care to injured workers.
Overall, the West Virginia workers’ compensation system plays an important role in protecting employees and employers alike, and ensuring that workers who are injured on the job have access to the support and care they need to recover and return to work.
• The employee must have been acting within the scope of their employment at the time of the injury.
• The employee must have given notice of the injury or illness to their employer within 30 days.
• The employee must have filed a claim for workers’ compensation benefits within two years of the injury or illness.
• Temporary Total Disability Benefits (TTD): Weekly payments for employees who are unable to work while recovering from a work-related injury.
• Permanent Partial Disability Benefits (PPD): Payments for employees who suffer permanent disabilities as a result of a work-related injury.
• Permanent Total Disability Benefits (PTD): Payments for employees who are permanently unable to work due to a work-related injury.
• Survivors’ Benefits: Payments to surviving dependents if an employee dies as a result of a work-related injury or illness.
• Administrative Complexity: The workers’ compensation system can be complex and confusing, especially for employees who are not familiar with the process. Navigating the system can be difficult, and even minor errors in the claims process can delay or deny benefits.
• Cost Containment: The cost of workers’ compensation benefits can be high, and employers and insurance providers are constantly looking for ways to control these costs. This can lead to reduced benefits or increased scrutiny of claims.
• Ongoing Medical Needs: Some work-related injuries or illnesses require ongoing medical care, which can be expensive and time-consuming. This can lead to disputes over the need for ongoing care, as well as disagreements over who should be responsible for paying for these expenses.
Quick Guide West Virginia Workers’ Compensation LawsÂ
West Virginia Workers’ Compensation Laws
Multiple West Virginia workers’ compensation laws are located under the state’s revised code.  The laws on worker’s compensation insurance in West Virginia are located specifically within Chapter 24.  Some information within this article about workers’ compensation insurance in West Virginia is referenced from the following website for the WV Insurance Commissioner:
Workers’ Compensation Insurance in West Virginia and Exemptions
The following link for the Insurance Commissioner listed all of the carriers for workers’ compensation insurance in West Virginia.  The list is current as of January 24, 2012:
§23-2-1 lists all employers who may be exempt from certain West Virginia workers’ compensation laws.  Under this law, workers’ compensation insurance in West Virginia may not necessarily be carried by employers of:
• employees in domestic services
• five or fewer full-time employees in agricultural service
• employees of the state in temporary employment
• casual employees (less than three employees in temporary jobs that do not last more than 10 calendar days in a calendar quarter
• employees of the church
• employees in professional sports activities, including trainers and jockeys in horse racing
• any volunteer employee in a rescue squad
• certain employees under the Longshore and Harbor Workers’ Compensation Act
How do I file a report for my injury under West Virginia Workers’ Compensation Laws?
You need to report the accident to your employee right away, and there are certain forms you and your employer may have to submit for workers’ compensation insurance in West Virginia.  Forms are located at the following link.
What Benefits are available in Workers’ Compensation Insurance: West Virginia
An injured worker is entitled to several different kinds of benefits under workers’ compensation insurance in West Virginia: mainly medical benefits and wage loss benefits.  These types of benefits under West Virginia workers’ compensation laws are explained below:
1. Medical Benefits- the worker is fully covered for ALL medical expenses related to the work injury under workers’ compensation insurance in West Virginia.  These benefits are not limited to the compensation for services listed below:
• doctor and hospital services
• nursing services
• medication
• physical therapy
• medical equipment
• travel mileage to and from medical facilities
If the accident was severe, workers’ compensation insurance in West Virginia will also cover burial costs.
2. Wage Benefits- According to West Virginia workers’ compensation laws, a worker is entitled up to two-thirds of their weekly wages for the amount of time they are covered.  There are limits to the payments under West Virginia workers’ compensation laws though.
In 2013, the limit according to West Virginia workers’ compensation laws will be $155.74 a day, $778.70 per month, and $40,603.64 per year.
If a doctor determines the worker has a permanent disability that will impact their level of work in the future, the degree or the permanent disability will compensate for the difference in future wages.
