Wage Earner

If you were employed by a business that was Shut Down or Partially Shut Down due to the Freedom Chemical Spill and you were paid on an hourly basis, then you are eligible to make a claim for lost hourly wages during the shut down using the Wage Earner Individual Review Claim Form. To be eligible for a payment, you must provide certain documents that show your wage loss.

Two ways to submit your form

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Wage Earner Form Online

SUBMIT YOUR FORM ONLINE

Start your online form here. You will need to submit this form online with all necessary documents. If you do not want to itemize your claimed losses you may submit the Simple Claim Form instead of this form.

Start Form Online
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OR DOWNLOAD FORM

PRINT AND MAIL IN YOUR SIMPLE CLAIM FORM

Download the Wage Earner 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