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At Workers' Compensation Shop.com we provide free access to most of the forms you need relating to West Virginia Workers' Compensation Insurance. We strive to keep these forms up to date and accurate.
As with all information we provide please verify the accuracy of this information with the West Virginia Office of the Insurance Commissioner.
If you have any questions about any of these forms feel free to contact us at 888-611-7467. If you are ready you can start a quote online today.
West Virginia Acord 130 Workers' Compensation Application.
The standard Acord 130 application form for workers' comp coverage in West Virginia.
West-Virginia First Report of Injury Form
First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.
First Report of Injury Form. Employees should complete this form and send to their insurance company each time an injury occurs.
Application for Exemption from Certificate of Authority
Complete this for to apply for exemption from the Certificate of Authority.
West-Virginia Application for Exclusion of Officers and Stockholders
Owners and Officers of corporations should complete this form to exclude themselves from a workers' compensation policy.
West-Virginia Application for Exemption for Workers' Compensation Insurance
Complete this form if you are a sole-proprietor, partnership with no employees or a sole officer of a corporation and would like to be exempt from coverage.
Complete this form if you are a sole-proprietor, partner, or officer of a corporation and would like to be exempt from coverage.
Workers' Compensation Policies, Coverage Issues and Related Topics
Legal information regarding workers' compensation laws in West Virginia.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
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State Resources for West Virginia
WV Insurance Commissioner
PO Box 505401124 Smith St.Charleston, WV 25305-0540304-558-3386 http://www.wvinsurance.gov/
West Virginia State Fund
National Council on Compensation Insurance (NCCI)901 Peninsula Corporate CircleBoca Raton, FL 33487-1362800-622-4123 https://www.ncci.com/
Workers' compensation insurance is required by law for West Virginia employers.
West Virginia forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for West Virginia.
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