- Adjustment/correction RequestFile .pdf (63.7 Kbytes)
- Application For Coverage, West Virginia Coal-workers Pneumoconiosis Fund (form InFile .doc (35.5 Kbytes)
- Application For Dependents` BenefitsFile .pdf (128 Kbytes)
- Application For Extraterritorial CoverageFile .pdf (37 Kbytes)
- Application For Independent Medical ExaminerFile .doc (49 Kbytes)
- Application For Permanent Total Disability AwardFile .pdf (96.8 Kbytes)
- Attending Physician`s ReportFile .pdf (13.7 Kbytes)
- Business Registration FormFile .pdf (258.1 Kbytes)
- Certificate Of Deposit Assignment Forms 1 & 2 - These Forms Must Accompany Certificates Of Deposit Which Are Posted As A Wage Bond.File .pdf (111.6 Kbytes)
- Claim Reopening ApplicationFile .pdf (112.8 Kbytes)
- Claimant Travel Voucher (form InFile .doc (37 Kbytes)
- Contractor License AffidavitFile .pdf (451.5 Kbytes)
- Diagnosis UpdateFile .pdf (27.6 Kbytes)
- Direct Deposit Authorization (form InFile .doc (25.5 Kbytes)
- Employers Assessment Of Rehabilitation NeedsFile .pdf (29.6 Kbytes)
- Employers Excess Liability Fund ApplicationFile .pdf (108.5 Kbytes)
- Employers Report Of Occupational PneumoconiosisFile .pdf (60.1 Kbytes)
- Employer`s Proposal For Alternate/modified Job DutiesFile .pdf (77.5 Kbytes)
- Employer`s Response To Petition For Lump-sum SettlementFile .pdf (25 Kbytes)
- H.b. 4140 Meal Breaks PosterFile .pdf (35.9 Kbytes)
- Independent Medical Examiner (ime) Fee ScheduleFile .doc (28 Kbytes)
- Information On Extraterritorial CoverageFile .pdf (53.5 Kbytes)
- Instructions For Claimant Travel VoucherFile .doc (37 Kbytes)
- Irrevocable Letter Of CreditFile .doc (29.5 Kbytes)
- Job Safety & Health Protection PosterFile .pdf (146.2 Kbytes)