Medical

Residents who went to the ER, Doctor’s Office, Urgent Care or Hospital because they believed they may have been harmed by the contamination or disruption of the water supply are eligible to make a claim for certain medical costs and for payments relating to specific injuries caused by the Freedom Chemical Spill.

Two ways to submit your form

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MEDICAL CLAIM FORM

SUBMIT YOUR FORM ONLINE

Click here to start your claims process online. A medical claim is a claim for compensation for medical treatment for a physical injury that you incurred as a result of Freedom Chemical Spill.

Start Form Online
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OR DOWNLOAD FORM

PRINT AND MAIL IN YOUR FORM

Download the Medical claim form and mail it in. Once you print this form, you can complete it and mail it with all supporting documentation to:

WV Water Claims
PO BOX 4227
Charleston, WV 25364

Download form