West virginia workers compensation 2026

1. Click ‘Get Form’ to open the West Virginia Workers Compensation document in the editor.
2. Begin by entering your Claim Number in the designated field. This is crucial for identifying your case.
3. Fill in the Date of Injury (DOI) and Date Last Employed (DLE) fields accurately to ensure proper processing of your appeal.
4. In the Employer section, provide the name of your employer as it appears on official documents.
5. For the Motion to Withdraw Appeal section, indicate the date of the Office of Judges’ ruling that you are referencing.
6. Complete your address details in the Appellant section, ensuring all information is current and correct.
7. Finally, sign and date the form where indicated, and if applicable, include your counsel's information below.

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