West Virginia's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers.
Exemptions from coverage may apply to certain employees, including employees of very small employers, small agricultural enterprises, casual labor, and domestic servants working in the private homes of their employers.
Medical Benefits are provided to employees entitled to workers' compensation benefits, with coverage for necessary medical care.
If the employer does not utilize a managed care plan, the employee may choose the initial treating physician. If the employer utilizes a managed health care plan, the employee must choose an initial treating physician from doctors who participate in the plan. An employee may change doctors with the permission of the workers' compensation insurance company or self-insured employer.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 3 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 7 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's pre-injury average weekly wage, subject to a cap, and continue for up to 104 weeks. Offsets may apply for wage replacement benefits provided by the injured worker's employer.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In West Virginia PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury weekly wage, subject to a cap, and may continue until age 70.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In West Virginia PPD benefits are determined based on a statutory schedule, and are calculated based upon 2/3 of the worker's average weekly wage, subject to a cap.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In West Virginia, temporary partial rehabilitation benefits are paid based upon 70% of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable for up to 52 weeks., and may be extended for up to an additional 104 weeks as part of an approved vocational rehabilitation plan for retraining.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on the benefits available to the injured worker, subject to a cap in amount. Benefits may continue for minors until the age of 18, the age of 25 if the dependent is a student, or indefinitely in the event of disability, subject to the cap. Spousal benefits end upon remarriage.
Attorney fees are limited by statute, and are capped at 20% of indemnity benefits up to a maximum of 20% of 208 weeks of benefits.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
West Virginia Offices of the Insurance Commission
1124 Smith Street
P.O. Box 50540
Charleston, WV 25305-0540
(304) 558-3386 or 1-888-879-9842