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Claims Services Division

           

The SAWC program maintains a $250,000.00 deductible policy with Zurich, which was effective October 1, 2011 through June 30, 2017.  Effective July 1, 2017, the SAWC program transitioned to BrickStreet Insurance Company. Claims with a date of injury on or before June 30, 2017 must be reported to Zurich. Claims with a date of injury on or after July 1, 2017 must be reported to BrickStreet Insurance Company.

The Claims Services Staff conducts ongoing quality assurance reviews, coordinates and participates with large loss claims staffing, and travels when applicable to conduct on-site semi-annual claims best practices reviews that ensure compliance and claims handling efficiency.

The West Virginia state agencies, boards and commissions have been combined under one workers' compensation policy covering all state employees. Specific policy information is provided below:

  Enabling Statute - WV Code §33-2-21a 
  SAWC Member Listing
  SAWC Safety Policy Statement

 

Additional Information:

     Claims Reporting - -

 Claims with DOI on or before June 30, 2017  
  - Zurich Claims Reporting
                       Claims with DOI on or after July 1, 2017  
  - BrickStreet Claims Reporting
  Employer Manual     BrickStreet Contacts and Important Information
  Employee Manual   Claim Reporting Process
  Employee Brochure     First Fill
  Customer Letter     Inquiry Kit
  HealthSmart Wallcard     Medical Records Release
  HealthSmart Employee ID     Preferred Provider Directory
  Agency and Location Site Codes   Return to Work Notice
  Zurich FAQ     TTD Wage Calculator
  Zurich - Important Information     Election of Option Form

  

     Forms - -

  Employee’s and Physician’s Report of Occupational Injury or Disease [OIC-WC-1] 
  Employer’s Report of Occupational Injury or Disease [OIC –WC-2]
 

 Zurich Forms  

                       

 BrickStreet Forms  

  Application for Fatal Dependent Benefits     Application for Fatal Dependent Benefits
  Attending Physicians Report     Attending Physicians Report
  Change of Address Notification     Change of Address Notification
  Change of Physician     Change of Physician
  Claimant Travel Voucher     Claimant Travel Voucher
  Claim Reopening Form     Claim Reopening Form
  Diagnosis Update     Diagnosis Update
  Functional Job Description     First Report of Injury - Employer
  Pharmacy Invoice     First Report of Injury - Employee / Physician
  Physician Statement of Physical Capabilities     Functional Job Description
  Report of Hearing Loss     Job Analysis
  Report of OP - Employee     Pharmacy Invoice
  Report of OP - Employer     Physician Statement of Physical Capabilities
  Report of OP - Physician     Report of Hearing Loss
  Report of OP - Physician Interpretation     Report of OP - Employee
  Service Invoice     Report of OP - Employer
  Transitional Employment Agreement     Report of OP - Physician
  Wage Report     Report of OP - Physician Interpretation
      Service Invoice
      Wage Report
     

Contact Information:

 
P. O. Box 968044
Schaumburg, IL  60196-8044
Phone: 1-(800)-987-3373
Fax: 1-(973)-394-5262
 

 
P. O. Box 3151
Charleston, WV  25332-3151
Phone: 1-(866)-452-7425
Fax: 1-(304)-941-1294            
 

Email Inquiry – OICSAWC@wv.gov
Tom Judy, Program Manager (policy & coverage inquiries)
Phone: (304)-558-6279, ext. 1127
Email: Thomas.G.Judy@wv.gov


Tonya Montez, WC Systems Specialist III (claims questions)
Phone: (304)-558-1966, ext. 3132
Email: Tonya.R.Montez@wv.gov



   






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