WVOIC Claim Index Profile

Upon the completion of the WVOIC Claim Index Contact Registration Form, an auto response email will be sent to the primary contact, and to the jurisdiction. This will serve as notification, to all parties, that the WVOIC Claim Index Contact Registration Form has been received.

Required fields are indicated in bold.

Insurer Information:

New

The Insurer Name should be the entire name as listed on any licensing/registration applications filed with the Offices of the Insurance Commissioner and not an acronym.
(nine digit FEIN, no punctuation)

Preparer Contact Information:


Insurer Primary Business Contact:


WVOIC Claim Index Contact:

This is the person who is the primary contact in your organization to respond to queries about claims information. The name of this person and the contact information will be displayed in the WVOIC Claims Index. The purpose of the Claims Index is to provide a uniform system of gathering injured workers' claim information filed with one insurer and making it available to other insurers.

If the business and claim index contact is the same we request a secondary business contact in case one contact retires / leaves the company. The secondary Business Contact (Name, Phone, Email) can be put in the comment field.

Attention: Claims Index Contact Must be a Carrier employee, not a TPA representative.