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Workers' Compensation

Contact Information
Telephone:
  (304)-558-5838
Fax:
  (304)-558-8948
Correspondence:
  WV Offices of the Insurance Commissioner
  Attn: Claim Services Division
  P.O. Box 50540
  Charleston, West Virginia 25305
Physical Address:
  900 Pennsylvania Ave.
  Charleston, West Virginia 25302
Claims Services Division

The Claims Services Division provides oversight and support of multiple workers’ compensation programs. The Old Fund is the legacy claims liability that existed upon the privatization of workers’ compensation, which is administered by the Third Party Administrators (TPAs); Sedgwick CMS and HealthSmart. In addition, this Division provides claims oversight of the Uninsured Employer Fund (UEF), the Federal Black Lung program with dates of last exposure prior to January 1, 2006, and the State Agency Workers’ Compensation (SAWC) program. A primary focus is to ensure the claims are properly reserved and administered to the Best Claims Practice standards, and that the claims are in compliance with statutory and regulatory provisions.

The West Virginia Offices of the Insurance Commissioner (WVOIC) contracts with two TPA’s to administer claims. The two TPAs are:

  • Sedgwick CMS, which administers the largest portion of the Old Fund Trauma and UEF claims
  • HealthSmart Disability Management, which administers the majority of State Occupational Pneumoconiosis (OP)  and Federal Black Lung (FBL) claims, Security, and Guaranteed funds

The West Virginia Office of the Insurance Commissioner and the International Workers' Compensation Foundation are jointly sponsoring a Workers' Compensation Educational Conference which is unique in West Virginia. The goal of this conference is to educate all those who participate in the West Virginia workers' compensation system regarding current rules, procedures, policies and forms, and to provide an opportunity for dialogue among these participants. The conference includes an exhibit hall, and participants may earn continuing education credits.

Registration is now open!

Registration is now open for the 2017 West Virginia Workers' Compensation Educational Conference at the Marriott Charleston Town Center Hotel on May 4-5, 2017.
 

There are two ways to sign up.
 
For a copy of the conference brochure or to pay by check, click on the button below to download the conference registration form, or you may visit
http://www.iwcf.us
 

 

To pay by credit card, please visit https://www.compevent.com/west_virginia.
 
We hope to see you at the conference this spring. For more information, you may contact us via email at iwcf@bellsouth.net
 
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The West Virginia Offices of the Insurance Commissioner (WVOIC) contracts with two TPAs and a carrier to administer claims on its behalf. The two TPAs and carrier currently under contract are:

  • Sedgwick CMS, which administers the largest portion of the Old Fund Trauma and UEF claims
  • HealthSmart Disability Management, which administers the majority of State Occupational Pneumoconiosis (OP)  and Federal Black Lung (FBL) claims, Security, and Guaranteed funds
If you have an issue accessing any of the information or forms via the links on the Claims Services Division webpages, please contact:

Paul D. Dixon II, MBA
Insurance Program Specialist
Phone: (304)-558-1966, ext. 3114
Email: Paul.D.Dixon@wv.gov
Old Fund Claims

Sedgwick CMS:
  P.O. Box 14490
  Lexington, KY 40512
  Phone: 1-(877)-925-5580
  Fax: 1-(866)-828-8550

HealthSmart Disability Management
  P.O. Box 3389
  Charleston, WV 25333-3389
  Phone: (304)-556-1100
  Fax: (304)-556-1112

Click on the applicable links below to download an information brochure for each third party administrator (TPA):

Please make safety a priority!
Every individual is responsible for helping ensure his or her work environment is safe and free of hazards. Let us all work to eliminate potential risk. When an unavoidable accident does happen, and there is a compensable injury, please assist the injured worker in receiving timely and adequate indemnity and medical care for the compensable injury. If you do not have a return to work program, consider the options your company has available to assist an injured worker with returning to work.