West Virginia Code of State Rules › Agency 93 - Workers' Compensation Office Of Judges › Title 93 - PROCEDURAL RULE WORKERS' COMPENSATION OFFICE OF JUDGES › Series 93-01 - Litigation Of Protests › Section 93-1-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Claim Administrator
Where used
				  within this rule, "claim administrator" shall mean the entity with legal
				  authority to administer workers' compensation claims, make awards, and take any
				  other administrative actions as authorized in Chapter Twenty-three of the W.
				  Va. Code. In some places in the code, the term "issuing entity" is used. For
				  purposes of this rule, "claim administrator" and "issuing entity" mean the same
				  thing.
"Claim administrator" includes the Offices of the Insurance
				  Commissioner, any self-administering employer who has been granted self-insured
				  status, any authorized Third Party Administrator, or any private insurance
				  carrier authorized to issue workers' compensation coverage in West
				  Virginia.
3.2.
				Party
"Party" shall mean the injured worker (claimant), claimant's
				  dependants, the employer, and, with respect to claims involving funds created
				  in 23-2C-1
et seq.
of the W. Va. Code, the Offices of
				  Insurance Commissioner. Private carriers, insurance agents, and third party
				  administrators are not parties to the litigation.
3.3. Expedited Hearing
"Expedited hearing", as contemplated by W. Va. Code §
									23-4-1c(a)(3), shall mean the final resolution of the issue. The term "hearing" is used in the sense of an opportunity for a party to offer evidence or argument and have his or her cause considered (heard), rather than used in the sense of a formalized appearance before a judge.
3.4. Most Compelling of Good Cause
"Most
				  compelling of good cause", shall mean some extraordinary circumstance and
				  contemplates a more compelling reason than the ordinary "good cause" required
				  elsewhere in the Rule. A reason that might be sufficient for "good cause" may
				  well not be sufficient for "most compelling of good cause".
3.5. Closing Argument and Case
				Summation
"Closing argument" or "case summation" shall mean a written
				  discussion of the facts and controlling law of the case. Such written summary
				  may be submitted at any time up to ten days after the expiration of the time
				  frame. An argument that is filed later than ten days after the expiration of
				  the time frame may be considered at the discretion of the ALJ. Such summary
				  does not constitute argument in lieu of evidence as defined in subsection 3.6,
				  below, for purposes of section ten [93-1-10 et seq.]
3.6. Argument in Lieu of
				Evidence
"Argument in lieu of evidence" shall mean a written statement
				  explaining why the claim administrator's ruling is incorrect on its face. Such
				  statement may be submitted instead of submitting new evidence when the party
				  believes that additional evidence is not necessary. Such statement avoids
				  having the claim administrator's ruling automatically affirmed for failure to
				  prosecute under section ten [93-1-10 et seq.]. Such statement must be filed
				  during the protesting party's time frame.
3.7. Record
The "record" upon which a
				  protest is decided shall mean evidence timely submitted by a party to the
				  Office of Judges and evidence taken at hearings conducted by the Office of
				  Judges. For protests acknowledged before April 2, 2007, any documents compelled
				  under the former version of this Rule will remain a part of the
				  record.