West Virginia Workers' Compensation Form OIC-WC-1
This document is the West Virginia Workers' Compensation Employee's and Physicians' Report of Occupational Injury or Disease. It must be filled out by employees reporting injuries. This form provides essential information needed for a workers' compensation claim.
Edit, Download, and Sign the West Virginia Workers' Compensation Form OIC-WC-1
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To complete this form, begin by filling out all fields in Section I with accurate information about the employee. Next, the physician must complete Section II to provide details of the initial treatment. Lastly, ensure all signatures are present before submission.
How to fill out the West Virginia Workers' Compensation Form OIC-WC-1?
1
Begin with the employee's claim information including name, address, and injury details.
2
The healthcare provider should fill out Section II with treatment details and verify the information.
3
Sign the form to confirm that all provided information is true and correct.
4
Submit the completed form to the designated administrator or insurance company.
5
Keep a copy for personal records after submission.
Who needs the West Virginia Workers' Compensation Form OIC-WC-1?
1
Employees who have experienced workplace injuries require this form for compensation claims.
2
Physicians need to complete this form to officially document the treatment provided.
3
Human Resources departments must collect this form for processing worker's compensation.
4
Insurance claims adjusters need this form to evaluate and approve claims.
5
Legal representatives may require this document for workers’ compensation cases.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the West Virginia Workers' Compensation Form OIC-WC-1 along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your West Virginia Workers' Compensation Form OIC-WC-1 online.
Editing this PDF on PrintFriendly allows you to customize the document easily. You can add or modify information in the required fields without hassle. Enjoy a seamless editing experience for your PDF files with our user-friendly interface.
Add your legally-binding signature.
Signing your PDF on PrintFriendly is quick and efficient. You can use our electronic signature feature to authenticate your document. Enjoy the convenience of signing anywhere, anytime, right from your browser.
Share your form instantly.
Sharing your PDF on PrintFriendly is simple and effective. Easily generate shareable links to your edited documents. Collaborate with colleagues by sending them the PDFs directly through email or messaging platforms.
How do I edit the West Virginia Workers' Compensation Form OIC-WC-1 online?
Editing this PDF on PrintFriendly allows you to customize the document easily. You can add or modify information in the required fields without hassle. Enjoy a seamless editing experience for your PDF files with our user-friendly interface.
1
Open the PDF file in the PrintFriendly editor.
2
Select the fields you wish to edit or fill out.
3
Make the necessary changes or add your information.
4
Review your edits for accuracy.
5
Download the updated PDF for your records.
What are the instructions for submitting this form?
Submit the completed OIC-WC-1 form via email to the claims department of Zurich Insurance at claims@zurichinsure.com. Alternatively, you can fax the document to 973-394-5262. Physical submissions can be sent to PO Box 968044, Schaumburg, IL 60196. It is important to ensure that all sections are filled accurately to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
Important dates for filing claims using this form typically align with the injury date and the reporting deadlines set by the West Virginia Workers' Compensation Board. Please ensure that you are aware of specific deadlines that may apply to your employer or insurer.
What is the purpose of this form?
The purpose of the OIC-WC-1 form is to document employee injuries and facilitate the workers' compensation claims process. This form collects essential information from the injured employee and their healthcare provider, ensuring that all necessary details are available for processing the claim. By accurately completing this form, employees and providers help to expedite the approval of benefits covered under West Virginia's Workers' Compensation Law.
Tell me about this form and its components and fields line-by-line.
- 1. Employee Information: Includes the employee’s name, address, contact details, employment information, and specifics about the injury.
- 2. Physician Information: Details recorded by the initial healthcare provider including their name, treatment dates, and medical findings.
- 3. Injury Details: Description of how the injury occurred, the body parts affected, and the circumstances surrounding the injury.
- 4. Witness Information: Field to identify any witnesses present during the incident.
What happens if I fail to submit this form?
Failing to submit this form on time can delay your workers' compensation benefits. It's crucial to provide accurate and timely information to avoid potential penalties or denial of claims.
- Delayed Claims Processing: If the form is not submitted, your claim may be processed slower, leading to delayed benefits.
- Potential Denial of Benefits: Incomplete or late submissions may result in the denial of your workers' compensation claim.
- Legal Implications: Failure to comply with submission requirements can lead to legal actions from employers or insurers.
How do I know when to use this form?
- 1. Occupational Injuries: Used when an employee suffers significant injuries while performing job duties.
- 2. Occupational Diseases: Applicable for illnesses that are directly linked to job-related activities or environments.
- 3. Medical Documentation: Needed to provide healthcare providers with a structured way to report related injuries.
Frequently Asked Questions
How do I edit the form on PrintFriendly?
You can easily edit the form by opening it in our PrintFriendly editor and making your changes directly in the fields.
Can I save the changes I make?
Currently, you can download the edited PDF directly after making your changes without needing to save them online.
What types of information can I edit?
You can edit any field in the form, including personal information, injury details, and physician statements.
Is my information secure while editing?
All edits you make are only visible to you while you're working on them, ensuring your information is kept private.
How do I print the edited form?
After editing, simply download the PDF and print it using your local printer.
What if I make a mistake while editing?
You can easily correct any mistakes by editing the form again before finalizing your download.
Can multiple users edit the form simultaneously?
Currently, editing is designed for single users, but you can share the document with others for collaboration.
How do I fill out the medical provider section?
Fill out the physician's information, treatment dates, and any necessary medical details required in Section II.
What is the purpose of this form?
This form is used to officially report occupational injuries and diseases for workers' compensation claims.
How do I submit the completed form?
You can submit the form by sending it via email, fax, or through your employer’s designated submission method.
Related Documents - WV Workers' Comp Form OIC-WC-1
Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.
Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.
TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.
Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.
Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.
Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.
Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.
MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.
Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.
Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.
Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.
Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.
