Worker’s Compensation Teleclaim Questions



This information is valid for employees located in West Virginia ONLY.

Employees located in the following states who need to file a workers’ compensation claim should refer to the accompanying information:

North Dakota Washington

Ohio Wyoming

Puerto Rico

Employees in all other states who need to file a workers’ compensation claim should refer to the Hartford TeleClaim information.

If an OCA employee has an accident while at work, the employee should notify his or her supervisor IMMEDIATELY. It is the supervisor’s responsibility to contact the West Virginia Workers’ Compensation Division and report the employee’s injury by the end of the day. IF THE EMPLOYEE IS IN A LIFE-THREATENING SITUATION AND IS IN NEED OF IMMEDIATE CARE, HE OR SHE SHOULD BE TRANSPORTED TO AN EMERGENCY MEDICAL CENTER RIGHT AWAY. In this instance, the supervisor is permitted to report the injury after the employee has received medical attention.

BrickStreet First Reports

304-926-3470 or 1-866-45BRICK

Supervisors should be prepared to answer the following questions. The more information you have available to you when you call, the less time the call will take, and less time will be needed for follow-up. Phone reports last approximately ten minutes.

Employer Information

Company Name: Orthodontic Centers of West Virginia. You MUST specify that the employer is Orthodontic Centers of West Virginia

Policy Number: WC10034145-03

Injured Worker Information

Name

Address

Social Security Number

Age

Sex

Marital Status

Number of dependents

Date of hire

Length of time in current job position

Wage information

Injury

When the injury occurred

Where the injury occurred

How the injury occurred

Type of injury (cut, burn, etc.)

Exact part of body injured

Names of witnesses

Name and address of physician or hospital

Anticipated return to work date

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