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Available Programs:

 Carrier Risk Tolerance:

Pay As You Go Workers' Compensation

All risks acceptable:  low, medium, and high.

Includes risks such as contractors, trucking, roofing, and temporary staffing.

Direct Bill Work Comp

All risks acceptable:  low, medium, and high.

Pay As You Go General Liability

Contractor and service risks acceptable:  low, medium, and high.

Commercial Packages- 12 Equal Installs

Non-construction risks only.

Workers Compensation Information:

 Owners Wages for Workers' Compensation

Individuals and Partners

Pending info:  State moved from monopolistic to open market- NCCI.

LLC Members

Pending info:  State moved from monopolistic to open market- NCCI.

Corporate Officers: Corporations

Pending info:  State moved from monopolistic to open market- NCCI.

 General Liability Information:

 Owners Wages for General Liability:

Individuals and Partners

$31,800- flat annual (effective 07.01.84).

Corporate Officers & LLC Members

$31,800- flat annual (effective 07.01.84).

WV Resources & Links:

 WV Workers Compensation Forms:

West Virginia

http://www.wv.gov/

Insurance Commission

http://www.wvinsurance.gov/

BrickStreet Mutual Insurance Company

http://www.brickstreet.com/

(formerly West Virginia Workers’ Compensation Commission)
 

Mailing Address:
Post Office Box 3824
Charleston, West Virginia 25338-3824
 

Street Address:
400 Quarrier Street
Charleston, West Virginia 25301
Administrative Services: (888) 4-WV-COMP and (304) 926-3400 Fax: (304) 926-5372

Claims: ClaimsInquiries@brickstreet.com

Fraud: reportfraud@brickstreet.com

Insurance: (866) 45BRICK (452-7425) and (304) 941-1000

Fax: (304) 304-941-1151

Providers: ProviderInquiries@brickstreet.com

Safety Services: SafetyServicesInquiries@brickstreet.com

Workers’ Compensation Office of Judges

http://www.wvinsurance.gov/ooj/

Mailing Address:
Post Office Box 2233
Charleston West Virginia 25328-2233
 

Street Address:
One Players Club Drive
Charleston West Virginia 25311-1638
(304) 558-1686, Fax: (304) 558-1021

Workers’ Compensation Board of Review

Mailing Address:
Post Office Box 2628
Charleston, West Virginia 25329-2628
 

Street Address:
104 Dee Drive
Charleston, West Virginia 25301
(304) 558-5230, Fax: (304) 558-1322

Workers’ Compensation Industrial Council

Acord 130 Form

Certificate Request Form

ERM-14 Form

Order Loss Runs (Example)

NCCI Mod Authorization

* Information contained herein is based on the most accurate data as of the time of posting.  Please check with you states Division of Workers' Compensation Insurance for the most up to date information and to verify accuracy.