WV BrickStreet BI-3 2008-2026 free printable template
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This document is used by employers to report injuries or diseases sustained by employees to BrickStreet Insurance, complying with West Virginia law.
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How to fill out WV BrickStreet BI-3
How to fill out WV BrickStreet BI-3
01
Obtain the WV BrickStreet BI-3 form from the BrickStreet website or your employer.
02
Fill in your personal information in the designated fields, including your name, address, and contact information.
03
Indicate your employer's name and address in the appropriate section.
04
Specify the dates of the injury or illness in the specified fields.
05
Provide a detailed description of the injury or occupational disease, including how it occurred.
06
List any medical treatments you have received related to your injury or illness.
07
Sign and date the form at the bottom.
Who needs WV BrickStreet BI-3?
01
Employees who have sustained a work-related injury or illness.
02
Employers who need to file a claim on behalf of an injured employee.
03
Workers' compensation insurance providers handling claims in West Virginia.
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People Also Ask about
Does West Virginia require workers compensation insurance?
Workers' Compensation WV Nearly all employers in West Virginia must carry workers' compensation insurance. The WV workers' compensation system provides benefits if your employees get an injury or illness from their job. Workers' comp also helps protect your business from the liability of work-related incidents.
Is workers comp mandatory in WV?
All West Virginia employers are statutorily required to maintain workers' compensation insurance coverage. Visit the West Virginia Offices of the Insurance Commissioner Employer Coverage Unit online to file workers' compensation.
How long does workers comp last in West Virginia?
Maximum period of payments is 104 weeks. Note: West Virginia Workers Comp Division established guides for disability periods who are on TTD. Check with the state website below for details about these guides.
How long does an employer have to file a workers comp claim in Virginia?
Your employer should file a report of the accident or disease with the Commission within ten days Failure to report your injury or illness to your employer within thirty (30) days could result in your claim being denied. See Va.
How does workers compensation work in WV?
To make up for missed wages, an employee with a work-related injury or illness is eligible to receive up to two-thirds of their pre-injury average weekly earnings. Temporary total disability benefits begin after they can't work for more than three consecutive calendar days.
How long do you have to file a workers comp claim in WV?
Claims Must Be Filed Within Six Months West Virginia requires injured workers to file an application for benefits within six months of the date of injury. Do not allow yourself or your loved one to miss out on valuable financial help to replace lost wages, cover medical expenses, and more.
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What is WV BrickStreet BI-3?
WV BrickStreet BI-3 is a form used to report and calculate the business information needed for workers' compensation insurance in West Virginia.
Who is required to file WV BrickStreet BI-3?
Employers in West Virginia who are required to report their workers' compensation insurance data must file the WV BrickStreet BI-3.
How to fill out WV BrickStreet BI-3?
To fill out the WV BrickStreet BI-3, employers must provide specific details about their business, employee classifications, payroll amounts, and any other relevant data as instructed on the form.
What is the purpose of WV BrickStreet BI-3?
The purpose of the WV BrickStreet BI-3 is to ensure that businesses accurately report their payroll and employee classifications for determining workers' compensation premiums.
What information must be reported on WV BrickStreet BI-3?
The information that must be reported on WV BrickStreet BI-3 includes details about the company's employees, payroll sizes, job classifications, and any other relevant business information necessary for compliance.
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