Wv claim certificate 2026

1. Click ‘Get Form’ to open the wv claim certificate in the editor.
2. Begin by filling out the EMPLOYEE INFORMATION section. Enter the employee's name, date of birth, and social security number. Ensure accuracy as this information is crucial for processing.
3. Next, complete the EMPLOYER INFORMATION section. Input your BrickStreet Insurance Policy Number, FEIN or SSN, and nature of business. This helps identify your organization in relation to the claim.
4. In the INFORMATION ABOUT INJURY / DISEASE section, provide details about the injury including date of injury, what the employee was doing at that time, and how it occurred. Be specific to avoid delays.
5. Fill out WAGE AND LOST TIME INFORMATION by entering last day worked, number of workdays lost, and wage details on the date of injury. This information is vital for calculating benefits.
6. Finally, review all entries for accuracy before signing and dating the form. Attach any additional documents if necessary.

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