reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-02 - Workers' Compensation Claims Index › Section 85-2-5 - Access to Claims Index

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				Upon application to the Commissioner on forms prescribed by the Commissioner, a
				private carrier, self-insured employer or any designated agent thereof,
				including, but not limited to, an attorney for the private carrier or
				self-insured employer, may be granted access to the claims index. Such access
				shall be permitted in a method and manner prescribed by the
				Commissioner.
5.2. Any information
				in the claims index may be used only for the purposes of administering and
				defending the workers' compensation claim upon which the request was based in a
				manner consistent with chapter twenty-three of the West Virginia Code and the
				rules promulgated thereunder.
5.3.
				A claimant, an attorney representing a claimant or a healthcare provider duly
				authorized by the claimant may request a list of the claimant's prior claims
				available from the claims index. Such request shall be permitted in a method,
				manner and form created by the Commissioner.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-02 - Workers' Compensation Claims Index › Section 85-2-6 - Duty to Timely Report Claims Data

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. All private carriers, special funds and
				self-insured employers shall report claims data to the Commissioner consistent
				with the provisions of the WV OIC EDI IG.
6.2. Failure of an insurer or self-insured
				employer to timely report data to the Commissioner as required in subsection
				6.1. of this section may subject the private carrier or self-insured employer
				to a fine not to exceed $500 per occurrence of untimely reporting.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. This
				exempt legislative rule to relats to the Employers' Excess Liability Fund to
				provide definitions and prescribe procedures and criteria for subscriptions,
				payroll reporting, premium payment, termination of subscriptions,
				reinstatement, reclassification of groups, classes or subscribers, changes in
				premiums based upon claims and awards, petitions for settlement including the
				contents and approval thereof.
1.2.
				Authority. -W.Va. Code §§ 23-1-1j(3) and
				23-4C-3.
1.3. Filing Date.
1.4. Effective Date.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-3 - Subscription and Premiums

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1.
				Subscription. -An employer shall apply for subscription to the Fund on forms
				approved by the commission. Coverage shall not commence until a signed
				application, along with the required deposit, are received by the Fund and
				approved by the commission.
a. The
				commission, in the exercise of its fiduciary responsibility to the Fund and in
				its sole discretion, may reject an application for subscription to the
				Fund.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-4 - Premiums and Rates

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Exposure
				base. Premium taxes shall be based on the total gross wages paid or payable to
				employees covered by the Act.
4.2.
				Determinations. The board of managers shall have the authority to make the
				following determination or determinations regarding employers' excess liability
				coverage at any time and from time to time in accordance with the procedures
				set out in subsection 4.3 of this rule.
a.
				Classify into classes the employers who desire to subscribe for employers'
				excess liability coverage.
b.
				Restructure classes and create or eliminate classes. The board of managers may
				establish additional classifications on the basis of the number of employees,
				size of payroll, type of operations, claims experience or any combination of
				the aforementioned, or on any other basis which the board of managers deems
				appropriate.
c. Prepare a premium
				tax rate schedule based on an actuarially sound model, which shall specify the
				base rate for each classification.
d. Adjust the premium tax rate schedule in
				whole or in part.
e. Determine the
				expected loss ratios.
f. Determine
				the method for limiting losses.
g.
				Determine such other matters as the board of managers deems appropriate in the
				exercise of its ratemaking authority.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-5 - Coverage of insuring agreement

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Coverage. -In consideration of the
				payment of premiums and subject to the limits of liability, exclusions,
				conditions and other requirements of the policy and is rule, the Commission
				agrees with the insured:
a. To pay on behalf
				of the insured, an amount up to the Fund's limit of liability, that is payable
				by the insured on account of an injury or death to one of its employees, where
				all five (5) of the following facts are proven:
1. That a specific unsafe working condition
				existed in the insured's workplace which presented a high degree of risk and a
				strong probability of serious injury or death;
2 That the insured had a subjective
				realization and an appreciation of the existence of such specific unsafe
				working condition and of the high degree of risk and the strong probability of
				serious injury or death presented by such specific unsafe working condition;
3. That such specific unsafe
				working condition was a violation of a state or federal safety statute, rule or
				regulation, whether cited or not, or of a commonly accepted and well-known
				safety standard within the industry or business of the insured, which statute,
				rule, regulation or standard was specifically applicable to the particular work
				and working condition involved, as contrasted with a statute, rule, regulation
				or standard generally requiring safe workplaces, equipment or working
				conditions;
4 That notwithstanding
				the existence of the facts set forth in 5.1.a.1, -2 and -3 of this rule, the
				insured nevertheless thereafter exposed an employee to such specific unsafe
				working condition intentionally, and
5. That such employee so exposed suffered
				serious injury or death as a direct and proximate result of such specific
				unsafe working condition.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-6 - Limit of liability

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Maximum limits. - The Fund's maximum liability for any one "Occurrence" is the
				amount stated in the declarations. A single "Occurrence" includes all injuries
				to one or more employees that arise out of the same specific unsafe working
				condition, referred to in the insuring agreement. The Fund's maximum liability
				for two (2) or more occurrences within four (4) consecutive quarters shall be
				double the Fund's per occurrence limit.
6.2. Excess coverage. - The Fund's liability
				shall not extend to cover nor be required to contribute to any claim by an
				employee of the insured to the extent that such claim is recoverable through
				the Workers' Compensation Fund or a qualified self-insurer. Subject to the
				maximum limits of liability of each policy, no proceeds shall be paid from the
				Fund unless such proceeds shall represent compensation in excess of the amount
				recovered or recoverable from the Workers' Compensation Fund or a qualified
				self-insurer.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-7 - Policy exclusions

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				Exclusions. - This policy does not apply to:
a
				Any liability of the insured, arising out of any specific unsafe working
				condition, referred to in the insuring agreement, where a valid citation was
				issued before the injured employee was exposed to the specific unsafe working
				condition and no corrective action was taken by the insured within a reasonable
				time following the issuance of the citation to correct the cited condition:
b. Any liability of the insured
				for an injury to an employee where the injury occurred at a time at which the
				insured was deprived of its common law defenses for failure to comply with the
				West Virginia Workers' Compensation Law;
c. Any liability of the insured arising out
				of a cause of action which is not reported to the commission within ten (10)
				days of the date of service on the insured:
d. Any liability of the insured for punitive
				or exemplary damages or for any fines or penalties assessed against the insured
				for violation of any state or federal statute, rule or regulation; or any
				obligation to represent or defend the insured at any administrative hearing or
				proceeding;
e. Any liability of the
				insured, arising out of a conscious, subjective and deliberate intention to
				produce the specific result of any injury to an employee;
f. Any liability of the insured for an injury
				to an employee, where the total required gross wages of that employee has not
				been reported to the for commission for any period of time during which this
				policy has been in effect;
g. Any
				liability of the insured for compensation recoverd or recoverable from the
				Workers' Compensation Fund or a qualified self ensurer or the success or to the
				commission or other private carrier of industrial insurance; or
h. Any liability excluded under the terms of
				a policy of employers' excess liability coverage issued by the successor to the
				commission or other private carrier.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-03 - Administration Of The Employers' Excess Liability Fund › Section 85-3-10 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of these rules or the application thereof to
				  any entity or circumstance shall be held invalid, such invalidity shall not
				  effect the provisions or the applications of these rules which can be given
				  affect without the invalid provisions or application and to this end the
				  provisions of these rules are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-04 - Attorney's Fees › Section 85-4-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule relates to compliance with orders of the Office of
				Judges directing private carriers to attorney fees and costs with regard to
				certain types of denials of benefits issued by a private carrier.
1.2. Authority. -- W. Va. Code ''23-1-1;
				23-1-1a(j)(3)
				and 23-2C-21(c). Pursuant to W. Va. Code '23-1-1a(j)(3),
				rules adopted by the board of managers and the commission are not subject to
				legislative approval as would otherwise be required under W. Va. Code,
				'29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing Date. --
				October 28, 2005.
1.4. Effective
				Date. -- December 1, 2005.
1.5.
				Repeal of former rule. This rule repeals and replaces 85 C.S.R. 4, "Payment of
				Attorney's Fees by the Worker's Compensation Commissioner" filed and effective
				on May 23, 1985.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-04 - Attorney's Fees › Section 85-4-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms have the stated
				  meanings unless the context of a specific use clearly indicates another meaning
				  is intended.
2.1. "Act" means the
				workers' compensation laws of the state of West Virginia which are codified at
				W. Va. Code '23-1-1
				et seq.
2.2. " Board" means the
				workers== compensation board of managers created pursuant to the provisions of
				W. Va. Code '23-1-1a.
2.3. " Commission" means the workers=
				compensation commission created pursuant to the provisions of W. Va. Code
				'23-1-1.
2.4. "Code", "Code of West Virginia" and
				"West Virginia Code" mean the West Virginia Code of 1931, as amended.
2.5. "Executive Director" means the executive
				director of the Workers= Compensation Commission as provided pursuant to the
				provisions of W.Va. Code '23-1-1b.
2.6. "Insurance Commissioner" means the
				insurance commissioner of West Virginia as provided in section one, article
				two, chapter thirty-three of the West Virginia Code.
2.7. "Office of Judges" refers to the Office
				of Judges, as set forth in W. Va. Code '23-5-8.
2.8. "Private Carrier" means any insurer,
				including the successor to the Commission, authorized by the insurance
				commissioner to provide workers= compensation insurance pursuant to chapters
				twenty-three and thirty-three of the West Virginia Code, but shall not include
				self-insured employers.
2.9.
				"Self-insurer" and "self-insured employer" mean employers who are eligible and
				have been granted self-insured status under the provisions of W. Va. Code
				'23-2-9.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-04 - Attorney's Fees › Section 85-4-3 - Denial rulings; types

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The Office
				of Judges may determine that certain denial rulings by a private carrier or
				self-insured employer are unreasonable and, upon reversal of the denial, award
				attorney's fees to the claimant to be paid by the private carrier or
				self-insured employer.
3.2. Denial
				rulings; limited types.
a. The Office of
				Judges may only award attorney's fees to a claimant when the unreasonable
				denial ruling:
1. Denies the compensability
				of a claim;
2. Denies an initial
				award of temporary total disability; or
3. Denies an authorization for medical
				benefits.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-04 - Attorney's Fees › Section 85-4-4 - Payment of awards

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. An award
				of reasonable attorneys= fees and costs actually incurred in reversing an
				unreasonable denial decision shall be paid by a private carrier or self-insured
				employer.
4.2. Reasonable
				attorneys= fees incurred in reversing an unreasonable denial of compensability
				or an initial award of temporary total disability shall be the attorney's fees
				allowed pursuant to W. Va. Code '23-5-16.
				Attorney's fees shall be payable only upon the conclusion of all litigation and
				appeals if the denial decision has been reversed and if the Office of Judges
				has determined that the denial decision is unreasonable.
a. Attorneys shall not be entitle to receive
				attorney fees under both the provisions of W. Va. Code '23-5-16
				and this rule. Any amounts received in excess of the statutory amount shall be
				reimbursed to the claimant for incurred attorney's fees.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-04 - Attorney's Fees › Section 85-4-5 - Appeals of Office of Judges= decisions

Current through Register Vol. XLI, No. 28, July 12, 2024
Determinations made by the Office of Judges to award or not
				  award attorney's fees to the claimant shall be appealable in accordance with
				  the provisions of W. Va. Code '23-5-10.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-04 - Attorney's Fees › Section 85-4-6 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this rule or the application thereof to
				  any entity or circumstance shall be held invalid, such invalidity shall not
				  affect the provisions or the applications of this rule which can be given
				  effect without the invalid provisions or application and to this end the
				  provisions of this rule are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule implements the provisions of West Virginia Code Section
				23-4-6(j)(1)
				regarding the proper completion and support for an application for permanent
				total disability benefits and the provisions of West Virginia Section
				23-4-16(d) regarding the continuous monitoring of permanent total disability
				awards.
1.2. Authority. -- W. Va.
				Code §§ 23-4-6(j)(1); § 23-4-16(d). Pursuant to W. Va. Code,
				§
									23-1-1a(j)(3),
				rules adopted by the Workers Compensation Board of Managers are not subject to
				legislative approval as would otherwise be required under W. Va. Code, §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing Date. --
				June 29, 2005.
1.4. Effective Date.
				-- August 1, 2005.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
The following terms and words have the meanings stated,
				  unless the context clearly indicates otherwise.
2.1. Executive Director" means the executive
				director of the West Virginia Workers' Compensation Commission pursuant to W.
				Va. Code §
									23-1-1b.
2.2. "Commission" means the West Virginia
				Workers' Compensation Commission as provided for by W. Va. Code §
									23-1-1,
				and where appropriate, reference to the Commission shall include the
				self-insured employer."
2.3. "Act"
				means the workers' compensation laws of the State of West Virginia that are
				codified at chapter twenty-three of the Code of West Virginia.
2.4. "Code of West Virginia" and "West
				Virginia Code" means the West Virginia Code of 1931 as amended.
2.5. "This rule" means the present exempt
				legislative rule that is designated in the caption here as title 85, series
				5.
2.6. "Board" means the Workers'
				Compensation Board of Managers created pursuant to the provisions of West
				Virginia Code Section 23-1-1a, et seq.
2.7. "PTD Application" shall mean an
				application for permanent total disability benefits provided for in West
				Virginia Code Section 23-4-6(d), et seq.
2.8. "PTD Recipient" shall mean any
				individual receiving permanent total disability benefits from the Commission or
				its predecessor agencies, self-insured employers or private carriers, whichever
				may be applicable, regardless or date of injury, date of last exposure, or date
				of award.
2.9. "PTD Award" shall
				mean an award of permanent total disability benefits, regardless or date of
				injury, date of last exposure, or date of award.
2.10. "Insurance Commissioner" means the
				insurance commissioner of West Virginia as provided in section one, article
				two, chapter thirty-three of the West Virginia Code.
2.11. "Insurer" shall mean 1) as self-insured
				employer; or 2) a private carrier.
2.12. "Private carrier" means any insurer
				authorized by the insurance commissioner to provide workers' compensation
				insurance pursuant to chapters twenty-three and thirty-three of the West
				Virginia Code.
2.13. "Reviewing
				body" means the interdisciplinary examining board or, upon termination of the
				Commission, the reviewing body who has jurisdiction over the claim as set forth
				in the provisions of W. Va. Code §
									23-4-6(j).
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-3 - Completion and Support of PTD Application

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. A PTD Application will not be processed
				by the Commission, self-insured employer or private carrier, whichever is
				applicable, unless and until a Commission or insurance commissioner approved
				application is filed with the Commission, self-insured employer or private
				carrier that has been properly and fully completed, and is accompanied by all
				supporting information requested by the Commission, self-insured employer, or
				private carrier in its sole discretion. The PTD Application shall be on a form
				provided by the Commission or insurance commissioner which shall solicit the
				following information:
a. Applicant's
				name;
b. Applicant's social
				security number;
c. Applicant's
				injuries and dates of injuries;
d.
				Applicant's date of birth;
e.
				Applicant's address;
f. Applicant's
				phone number;
g. Applicant's
				current employment status (employed, unemployed, self-employed, off due to
				injury);
h. Details regarding any
				efforts by the Applicant to apply for and/or receive social security benefits,
				of any type;
i. Details regarding
				any efforts by the Applicant to apply for and/or receive a retirement benefit
				of any type, include, but not limited to, receipt of a defined benefit or
				disability pension plan. The Applicant shall advise as to whether he or she
				contributed to the retirement plan and whether the plan benefit is being paid
				under the terms and conditions of a collective bargaining agreement;
j. All workers' compensation claims
				indicating their claim number, the date of injury, the injured body part, the
				impairment rating, if any, awarded in the claim, and the name of the employer
				and the employer's insurer in the claim;
k. All disability claims filed with any other
				state or federal agencies;
l.
				Copies of all medical reports indicating that the claimant has a permanent
				impairment;
m. Information
				regarding any non-work related injuries or diseases suffered by the
				Applicant;
n. Medical
				history;
o. Prescription drug
				history;
p. Employment history,
				including dates on employment for each employer;
q. Military history; and r. Education
				history.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-4 - Program to Update Disability Status of Those Receiving PTD Benefits as of July 1, 2003

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Upon the
				effective date of this Rule, the Commission will begin a program requiring each
				person receiving permanent total disability benefits as of July 1, 2003, who
				had been granted a permanent total disability award on or after April 8, 1993,
				to 1) submit his or her tax returns for the preceding three (3) years; and 2)
				an affidavit demonstrating level of income, recreational activities, and work
				activities. Any permanent total disability award granted prior to April 8, 1993
				but reopened for a benefit level adjustment shall be eligible for this
				review.
4.2. Each month, the
				Commission shall contact, by certified mail, approximately five hundred (500)
				PTD Recipients in an effort to secure the information set forth in Section 4.1.
				The mailing shall include an appropriate Internal Revenue Service authorization
				which can be completed in full and returned to the Commission, a form
				affidavit, and a self-addressed, postage pre-paid return envelope so that the
				documents can be returned to the Commission at no charge to the PTD
				Recipient.
4.3. The mailing shall
				instruct the recipient that he or she has forty-five (45) days from receipt to
				return the requested information or otherwise fully and adequately respond to
				the Commission's inquiry. Failure to so respond shall result in a second notice
				being sent to the PTD Recipient in the manner set forth in Section 4.2. The PTD
				Recipient will be given another forty-five (45) days to respond to this second
				notice and the PTD Recipient will be advised that failure to fully and
				adequately respond will result in a suspension of permanent total disability
				benefits.
4.4. Failure of a PTD
				Recipient to fully and adequately respond to the second notice as described in
				Section 4.3 above shall result in the suspension of permanent total disability
				benefits. The suspension shall remain in effect until the PTD Recipient has
				fully complied with the Commission's request. Benefits may be reinstated
				prospectively if and when the PTD Recipient fully complies with the
				Commission's request, but the benefits lost during the suspension shall not be
				paid.
4.5. The Commission will
				identify those injured workers who appear to be working, receiving income, not
				reporting any medical care, or are believed to otherwise not meet the current
				eligibility criteria for a permanent total disability award and make these
				individuals a priority review. Otherwise, the PTD review shall generally begin
				with those most recently awarded a permanent total disability award and will
				work in reverse chronological order thereafter.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-5 - Monitoring of PTD Recipients

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				The Commission, self-insured employer, or private carrier shall continuously
				monitor permanent total disability awards and may reopen a claim for
				reevaluation of the continuing nature of the disability and possible
				modification of the award. In evaluating whether to reopen a claim, the
				Commission, self-insured employer, or private carrier may employ one (1) or
				more of the following methods:
a. Require the
				PTD Recipient to provide documents as more fully set forth in Section 4 above
				and other information to the Commission, self-insured employer, or private
				carrier, including, but not limited to, tax returns, financial records,
				affidavits demonstrating level of income, recreational activities, work
				activities, and any other information set forth in Section 3.1.a.-r. of this
				Rule;
b. Require the PTD Recipient
				to appear under oath before the Commission, self-insured employer, or private
				carrier or its duly authorized representative and answer questions;
c. Any claimant who willfully fails to
				provide the information called for in Section 5.1.a. or willfully fails to
				appear as required by Section 5.1.b. shall have his or her permanent total
				disability benefits suspended. The suspension shall remain in effect until the
				PTD Recipient has fully complied with the Commission's, self-insured
				employer's, or private carrier's request. Benefits will be reinstated
				prospectively if and when the PTD Recipient complies with the Commission's,
				self-insured employer's, or private carrier's request, but the benefits lost
				during the suspension shall not be paid.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-6 - Termination of the Commission

Current through Register Vol. XLI, No. 28, July 12, 2024
Upon termination of the commission, the application
				  requirements set forth in Section 3 of this exempt legislative rule and all
				  duties set forth in Sections 4 and 5 of this exempt legislative rule as they
				  are to be performed in connection with Old Fund liabilities as set forth in W.
				  Va. Code §
									23-2C-2(m)
				  shall be required and performed by the insurance commissioner and/or the
				  insurance commissioner's administrator of the Old Fund or the administrator of
				  other various funds regulated by the insurance commissioner. The application
				  requirements set forth in Section 3 of this exempt legislative rule and all
				  duties set forth in Section 5 of this exempt legislative rule as they are to be
				  performed in connection with liabilities other than those contained in the Old
				  Fund may be required and performed by insurers as defined
				  above.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-05 - Permanent Total Disability › Section 85-5-7 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this rule or the application thereof to
				  any entity or circumstance is held invalid, such invalidity does not affect the
				  provisions or the applications of this rule which can be given effect without
				  the invalid provisions or application and to this end the provisions of this
				  rule are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-06 - Workers' Compensation Debt Reduction Fund Assessments And Regulatory Surcharges › Section 85-6-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule provides for the establishment and collection of
				statutory percentage surcharges to be remitted to the Insurance Commissioner
				for deposit in the Workers' Compensation Debt Reduction Fund created in W. Va.
				Code §
									23-2D-5
				and for statutory percentage surcharges to be remitted to the Insurance
				Commissioner for the regulatory costs associated with regulating West
				Virginia's workers' compensation market.
1.2. Authority. -- W. Va. Code §§
									23-2C-3(f)(1)
				through (3);
				23-2C-5(c)(2);
				23-2C-22;
				23-2D-5;
				23-2D-6;
				33-2-10(b);
				and
				33-2-21(a).
				Pursuant to W. Va. Code §§
									23-2C-5(c)(2)
				and
				33-2-10(b),
				workers' compensation rules proposed by the Insurance Commissioner and approved
				by the Industrial Council are not subject to legislative approval as would
				otherwise be required under W. Va. Code §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing Date. --
				July 18, 2008.
1.4. Effective Date.
				-- August 17, 2008.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-06 - Workers' Compensation Debt Reduction Fund Assessments And Regulatory Surcharges › Section 85-6-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule provides for the implementation of the
				  following:
2.1. Pursuant to W. Va.
				Code §
									23-2C-3(f)(3),
				a premiums surcharge on private carrier workers' compensation policy holders
				for deposit into the "West Virginia Workers' Compensation Debt Reduction
				Fund;"
2.2. Pursuant to W. Va. Code
				§
									23-2C-3(f)(3)
				an assessment on the self-insured employer community for deposit into the "West
				Virginia Workers' Compensation Debt Reduction Fund;"
2.3. Pursuant to W. Va. Code §
									23-2C-3(f)(1),
				a percentage surcharge on private carrier workers' compensation policy holders
				to pay for the costs attributable to the regulation of the workers'
				compensation insurance market; and
2.4. Pursuant to W. Va. Code §
									23-2C-3(f)(2),
				a percentage surcharge on self-insured employers to be remitted to the
				Insurance Commissioner to pay for the costs attributable to the regulation of
				the self-insured employer market.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-06 - Workers' Compensation Debt Reduction Fund Assessments And Regulatory Surcharges › Section 85-6-4 - Surcharges on Private Carrier Premiums

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The Insurance Commissioner shall assess
				private carriers the following statutory percentage surcharges:
a. The private carrier regulatory surcharge;
				and
b. The WCDRF premiums
				surcharge.
Beginning on July 1, 2008, the private carrier regulatory
				  surcharge shall be 5.5% and the WCDRF premiums surcharge shall be 9%. The
				  Insurance Commissioner may annually change the percentage of the private
				  carrier regulatory surcharge as the Commissioner deems necessary beginning on
				  July 1, 2013:
Provided
, That the Commissioner shall provide
				  private carriers at least ninety (90) days notice prior to changing the private
				  carrier regulatory surcharge percentage. The private carrier shall collect and
				  remit the surcharges to the Insurance Commissioner. Any change to the
				  percentage may be implemented by private carriers only in policies issued or
				  renewed on or after the effective date of the change.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-06 - Workers' Compensation Debt Reduction Fund Assessments And Regulatory Surcharges › Section 85-6-5 - Surcharges on the Self-insured Employer Community

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The Insurance Commissioner shall assess
				self-insured employers the following statutory percentage surcharges:
a. The self-insured employer regulatory
				surcharge; and
b. The WCDRF
				self-insured employer surcharge.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-06 - Workers' Compensation Debt Reduction Fund Assessments And Regulatory Surcharges › Section 85-6-6 - Surcharge and Assessment Methodology for Collections of Surcharges Made Pursuant to W. Va. Code Section 23-2C-3(f)(3)

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The surcharges imposed by section four
				of this rule shall be reflected on each premium invoice issued by a private
				carrier, regardless of the payment interval. The surcharge percentage shall be
				applied against the total assessable workers' compensation premium
				due.
6.2. The surcharges shall be
				remitted by the private carrier no later than the twenty-fifth day of the month
				succeeding the end of the calendar quarter in which they are collected, except
				if the surcharges are collected in the fourth quarter, the surcharges shall be
				remitted no later than the first day of March the succeeding year.
6.3. Each self-insured employer, group
				self-insurer, or insurance carrier shall provide any information and submit any
				reports the Insurance Commissioner may require to effectuate the provisions of
				this rule.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				procedural rule is intended to set forth the procedures for administrative
				hearings which are conducted pursuant to the West Virginia Administrative
				Procedures Act, W. Va. Code, §
									29A-5-1
				et seq. While not all of the hearings conducted by the commission are held
				pursuant to that act, those hearings that are subject to the act will be
				conducted in accordance with this rule. This procedural rule does not affect
				any matter residing in the jurisdiction of the Office of Judges under the
				provisions of W. Va. Code §
									23-5-1
				et seq.
1.2. Authority. -- W. Va.
				Code §
									23-2-17.
				Pursuant to W. Va. Code, §
									23-1-1a(j)(3),
				rules adopted by the Workers Compensation Board of Managers are not subject to
				legislative approval as would otherwise be required under W. Va. Code, §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing Date. --
				June 29, 2005.
1.4. Effective Date.
				-- August 1, 2005.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms, words, and
				  phrases have the meanings stated unless in any instance where such term, word,
				  or phrase is employed the context expressly indicates that another meaning is
				  intended.
2.1. "Act" means the
				workers' compensation laws of the State of West Virginia which are codified at
				chapter twenty-three of the Code of West Virginia.
2.2. "Code of West Virginia" and "West
				Virginia Code" mean the West Virginia Code of 1931, as amended.
2.3. "Executive Director" means the executive
				director of the West Virginia Workers' Compensation Commission pursuant to
				section one-b, article one, chapter twenty-three of the West Virginia
				Code.
2.4. "Commission" means the
				West Virginia Workers' Compensation Commission as provided for by section one,
				article one, chapter twenty-three of the West Virginia Code.
2.5. "Insurance Commissioner" means the
				insurance commissioner of West Virginia as provided in section one, article
				two, chapter thirty-three of the West Virginia Code.
2.6. "This rule" means the present procedural
				rule which is designated in the caption hereof as title 85, series 7.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-3 - Article Two Decisions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1.
				"Article two decision or action," means a decision or action taken under the
				provisions of article two, chapter twenty-three of the West Virginia
				Code.
3.2. Language. On and after
				the effective date of this rule, each written article two decision or action
				shall include language to inform the employer that it is afforded the right to
				file a request for reconsideration of the decision or action.
3.3. Requirement. Each employer who desires
				to dispute an article two decision or action is required to file a complete and
				timely request for reconsideration as a condition precedent to filing a
				petition for an article two hearing under the provisions of W. Va. Code §
									23-2-17.
				No request for reconsideration is required to be filed in petitions for relief
				filed under the provisions of W. Va. Code §
									23-2-15.
3.4. Time limits. A request for
				reconsideration shall be filed with the commission within thirty (30) days of
				the employer's receipt of notice of the disputed commission's decision or
				action or, in the absence of such a receipt, within sixty days of the date of
				the commission's making such disputed decision or taking such disputed action.
				Such time limitations are a condition of the right to litigate the decision or
				action and are jurisdictional.
3.5.
				Contents of the request for reconsideration. In its request for
				reconsideration, the employer shall clearly identify the decision or action
				disputed. The employer shall also clearly identify the bases upon which the
				employer disputes the decision or action.
3.6. Review. Upon the filing of an employer's
				request for reconsideration, the commission shall review the bases for the
				request. Such a review may include a meeting with the employer, a review of the
				employer's records, or any other process calculated to provide the commission
				with the relevant information necessary to perform its review. After reviewing
				the request, the commission shall enter its final decision.
3.6.1. The commission is required to enter a
				final decision or enter into an extension agreement with the employer within
				one hundred-twenty (120) days from the date the employer's request for
				reconsideration is filed.
3.6.2.
				The commission and the employer may enter into a written extension agreement to
				provide no more than an additional sixty (60) days for the commission to enter
				a final decision.
3.6.3. The
				commission's failure to enter a final decision within the initial time period
				or extended time period, where applicable, triggers an employer's right to file
				a petition for hearing under the provisions of W. Va. Code §
										23-2-17.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-6 - Correction of the Record

Current through Register Vol. XLI, No. 28, July 12, 2024
Upon motion in writing served by any party as notice may be
				  served pursuant to subsection 4.2 of this rule and therein assigning error or
				  omission in any part of any transcript of the proceedings had and testimony
				  taken at any such hearing, the hearing officer shall settle all differences
				  arising as to whether such transcript truly discloses what occurred at the
				  hearing or shall direct that the transcript be corrected and revised in the
				  respects designated by the hearing officer, so as to make it conform to the
				  whole truth.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-8 - Discovery

Current through Register Vol. XLI, No. 28, July 12, 2024
Discovery shall be engaged in only with the consent of the
				  hearing officer or, if a hearing officer has not yet been assigned, with the
				  consent of the commission or the executive director. All discovery requests
				  will be submitted to the appropriate official at the same time as the discovery
				  request is served upon the other party. If the official determines that the
				  requested information is relevant and material to the issues to be heard and
				  not unduly burdensome, the official will permit the discovery and set a
				  reasonable time frame for the disclosure of the information. Determination of a
				  reasonable time frame will be premised upon the nature and scope of the
				  information requested and the date on which the hearing is scheduled. The
				  official shall attempt to avoid continuing a previously scheduled
				  hearing.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-07 - Rules For Selected Hearings › Section 85-7-9 - Hearing Officers

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Every
				hearing officer appointed by the commission to conduct a hearing under this
				rule shall be an attorney licensed to practice law in this state.
9.1.1. The commission may delegate the
				authority necessary for the conduct of proceedings under this rule to the chief
				administrative law judge of the office of judges. The chief administrative law
				judge is authorized to assign attorneys from the office of judges as hearing
				officers.
9.1.2. The commission
				retains the right to appoint other attorneys as hearing officers for purposes
				of conducting specific hearings under this rule.