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Wc 1 form west virginia

Oic wc1 form 2026

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The document is a West Virginia Workers' Compensation form (OIC-WC-1) used for reporting occupational injuries or diseases by employees and physicians. It includes sections for employee claim information, details about the injury, and healthcare provider assessments. The form requires personal information from the employee, specifics about the injury, and certification from both the employee and healthcare provider regarding the accuracy of the information provided.

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Click ‘Get Form’ to open the OIC-WC-1 form in the editor.
Begin by filling out Section I, which includes your personal information. Enter your name, address, telephone number, date of birth, and social security number. Ensure all fields are completed accurately.
Next, provide details about your employer and job title. Include the employer's name, address, and supervisor's contact information.
In the injury details section, describe how the injury occurred and specify any body parts injured. Be thorough to ensure clarity.
Complete Section II by having your healthcare provider fill in their information and treatment details. This includes their name, address, and the date of initial treatment.
Finally, review all entries for accuracy before signing the form electronically within our platform for a seamless submission process.

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