Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Notice to Employees – Workers Compensation Coverage (Versión en Español)
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
OIC-WC-2 – Employers’ Report of Occupational Injury or Disease
Incident Investigation Report Form (Versión en Español)
Supervisor’s Report of Employee Incident (Versión en Español)
Witness Statement of Employee Incident (Versión en Español)
Instructions for Injured Worker Handouts
OIC-WC-1 – Employees’ and Physicians’ Report of Occupational Injury or Disease
Injured Workers First Fill Prescription Form (Versión en Español)
Consent & Authorization for Release of Information (Versión en Español)
Request for Medical History (Versión en Español)
Direct Deposit Authorization Form (Versión en Español)
Understanding the West Virginia Workers’ Compensation Claims Process: Information an Injured Worker Needs to Know
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 – Confidential Request for Ownership Information
Company Contacts Verification
Instructions for State-Specific Forms & Documents
WVWC-RF01 – Notice of Election or Rejection of Workers’ Compensation Coverage
