W. Va. Code R. § 85-20-7 - Initial Reporting of Injury

7.1. It is the responsibility of the injured worker to notify the employer, Commission, and medical provider when there is reason to believe the injury or condition is industrial in nature. Conversely, if the medical provider discovers a condition which he or she believes to be work related or has reason to believe an injury is work related, he or she must so notify the injured worker. Once such a determination is made by either the injured worker or the medical provider, the appropriate form(s) must be immediately submitted. Failure of the medical provider to timely submit the appropriately completed forms may be considered as an abusive practice for purposes of W. Va. Code § 23-4-3c. Failure of the injured worker to timely submit appropriately completed forms may be considered and given appropriate weight by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, in determining compensability or any other matter.

7.2. It is the medical provider's responsibility to ascertain whether he or she is the first attending practitioner. If so, the medical provider will take the following action:

a. Give emergency treatment.

b. Immediately complete and forward the Initial Report of Injury to the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, and the employer.

c. Instruct and give assistance to the injured worker in completing his or her portion of the report of accident. The Initial report of Injury shall include a narrative report containing the following information so there is no delay in adjudication of the claim or payment of compensation:

1. Complete history of the industrial accident or exposure.

2. Comprehensive description of physical findings and prognosis.

3. Specific diagnosis with ICD-9-CM code(s) and narrative definition relating to the injury.

4. Type of treatment rendered.

5. Known medical, emotional or social conditions which may influence recovery or cause complications.

6. Estimated time loss due to the injury.

d. To the extent the information called for in (c)(1) - (c)(6) is not required on the Initial Report of Injury in use by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, the medical provider shall complete the appropriate form in its entirety and provide the additional information in the form of a narrative report.

Notes

W. Va. Code R. § 85-20-7