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Claims Services Division

                             

New claim applications are received by the Claims Services Division that is specifically determined to fall under the Old Fund and the Coal Workers Pneumoconiosis Fund (CWPF).

Claims that fall under the Old Fund include applications for occupational disease claims such as hearing loss or toxic exposure, with dates of last exposure prior to July 1, 2005; applications for occupational pneumoconiosis claims with dates of last exposure prior to July 1, 2005; applications for Fatal Dependents Benefits for claims with dates of last exposure prior to July 1, 2005. Claims that fall under the CWPF include Federal Black Lung Notice of Claim with dates of last exposure prior to January 1, 2006, and Federal Black Lung Survivor claims with dates of last exposure prior to January 1, 2006.

All claims are reviewed for applicable dates of last exposure and the responsible employer. Upon determination that a claim belongs to the Old Fund or CWPF, it is processed to obtain a Jurisdictional Claim Number (JCN), and assigned to a TPA for administration. Claims filed after the specified dates must be filed with new carriers.

  Employee’s and Physicians Report of Occupational Injury or Disease [OIC-WC-1] 
  Employer’s Report of Occupational Injury or Disease [OIC –WC-2]
  Employee’s and Physicians’ Report of Occupational Hearing Loss [OIC-WC-1HL]
  Application for Fatal Dependents’ Benefits {OIC-WC-201]
  Employees’ Report of Occupational Pneumoconiosis [OIC-WC-1OP]
  Employers’ Report of Occupational Pneumoconiosis [OIC-WC-2OP]
  Physician’s Report of Occupational Pneumoconiosis [OIC-WC-30P] – Includes ILO Form


Contact Information:

West Virginia Offices of the Insurance Commissioner
Claims Services Division
PO Box 50540
Charleston, WV  25305
Phone: (304)-558-5838
Fax: (304)-558-8948

 

   



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