West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-08 - Workers' Compensation Policies, Coverage Issues And Related Topics › Section 85-8-8 - The Workers' Compensation Insurance Policy

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Each policy for West Virginia workers'
				compensation insurance shall comply with chapters twenty-three and thirty-three
				of the West Virginia Code.
8.2.
				Each West Virginia workers' compensation insurance policy shall provide
				coverage and benefit payments consistent with the provisions of chapter
				twenty-three of the West Virginia Code and the rules promulgated thereunder for
				any bodily injury with a date of injury within the policy period and for all
				benefit types thereafter awarded, including all dependent benefits and related
				death benefits provided for under chapter twenty-three of the West Virginia
				Code. Each workers' compensation policy shall also provide coverage for any
				occupational disease or occupational pneumoconiosis award with a date of last
				exposure within the policy period, including all dependent benefits and related
				death benefits provided for under chapter twenty-three of the West Virginia
				Code.
8.3. Dependent and Death
				Benefits.
8.3.1. All dependent benefits
				payable to a claimant pursuant to W. Va. Code §
										23-4-10(a)-(d),
				for claims in which the decedent dies on or after January 1, 2006, shall, for
				purposes of responsibility and chargeability, be derivative of the decedent's
				underlying compensable injury or exposure which caused his or her death. This
				means that the carrier, self-insured employer, or other fund responsible for
				paying the dependent benefits is the private carrier, self-insured employer or
				other fund providing workers' compensation coverage on the date of injury or
				last exposure giving rise to such dependent benefits. For all other purposes,
				including benefit rate and duration, the dependent benefits shall be a new
				right, separate and apart from the original date of injury or last exposure, to
				be paid in a manner otherwise consistent with statutory, regulatory and case
				law applicable to the same:
Provided
, That should the
				decedent's death result from a workplace injury or exposure for which there was
				no underlying attributable workers' compensation claim during the decedent's
				lifetime, the carrier, self-insured employer or other fund assigned to the
				compensable injury or exposure which is proven to have caused the decedent's
				death is responsible for the payment of the dependents' benefits.
8.3.2. All "104 weeks awards" payable to a
				dependent, pursuant to W. Va. Code §
										23-4-10(6),
				for claims in which the claimant dies on or after January 1, 2006, shall for
				purposes of responsibility and chargeability, be derivative of the deceased
				claimant's previously granted permanent total disability award. This means that
				the carrier, self-insured employer, or other fund responsible for paying the
				"104 weeks award" is the private carrier, self-insured employer or other fund
				providing workers' compensation coverage for the permanent total disability
				award giving rise to the "104 weeks award." For all other purposes, including
				benefit rate and duration, the "104 weeks awards" shall be a new right,
				separate and apart from the original date of injury or last exposure, to be
				paid in a manner otherwise consistent with statutory, regulatory, and case law
				applicable to the same.
8.3.3.
				Nothing in subsections 8.3.1 or 8.3.2 of this rule shall alter the terms of any
				contract or agreement entered into prior to January 1, 2006, whereby any entity
				agreed to pay specified workers' compensation benefits.
8.3.4. A private carrier, self-insured
				employer or other responsible fund that pays a "104 weeks award" to a dependent
				pursuant to W. Va. Code §
										23-4-10(c)
				has a right to full reimbursement from another private carrier, self-insured
				employer or other responsible fund that pays dependent benefits pursuant to W.
				Va. Code §
										23-4-10(a)-(d),
				no later than when the issue of compensability of the dependents' claim is
				finally determined.