Pregnant

A Pregnancy Related Claim is a claim for compensation because you were pregnant on January 9, 2014. You may NOT submit a Pregnancy Related Claim if you are submitting a separate Medical Claim.

Two ways to submit your form

Online Form

Submit your form online

Submit the Pregnancy claim form online if your residence (single family home, apartment, condominium) was provided tap water service from West Virginia American’s Kanawha Valley Water Treatment Plant (the “KVTP”) as of January 9, 2014.

Start Online Form

OR Download Form

Print and mail in your simple claim form

Download the Pregnancy review 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