West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-15 - Vocational And Physical Rehabilitation › Section 85-15-5 - Identification of Rehabilitation Candidates; the Rehabilitation Assessment/ Evaluation Process

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The
				Commission, Insurance Commissioner, self-insured employer or private carrier,
				whichever is applicable, may, in its sole discretion, determine whether a
				claimant would be assisted in returning to suitable gainful employment with the
				provision of rehabilitation services.
5.2. The Commission, Insurance Commissioner,
				self-insured employer or private carrier, whichever is applicable, may
				authorize a rehabilitation evaluation by a qualified rehabilitation
				professional of its sole choosing to determine whether physical and/or
				vocational rehabilitation services are appropriate for an injured worker. No
				provider is entitled to referrals from the Commission, Insurance Commissioner,
				self-insured employer or private carrier, whichever is applicable. The
				Commission, Insurance Commissioner, self-insured employer or private carrier,
				whichever is applicable, is in no way required to adopt any referral method or
				system designed to include any or all of the vocational rehabilitation service
				providers or qualified rehabilitation providers, and the Commission, Insurance
				Commissioner, self-insured employer or private carrier, whichever is
				applicable, has the sole discretion in the assignment of any referrals for an
				evaluation.
5.3. The rehabilitation
				evaluation process is comprised of a series of steps, as set forth in the
				following subsections.
a. Once referred to a
				vocational rehabilitation service provider or qualified rehabilitation
				professional, a qualified rehabilitation professional shall conduct a
				rehabilitation evaluation. In doing so, a qualified rehabilitation professional
				must:
1) conduct a personal interview of the
				injured worker;
2) contact, by
				telephone or otherwise, the injured worker's employer to ascertain return to
				work options and otherwise discuss the case;
3) obtain necessary input from the injured
				worker's attending physician and other treatment providers; and
4) analyze information about the injured
				worker's medical, educational, vocational, social, legal, and economic
				circumstances, including present physical and mental ability to participate in
				vocational rehabilitation services. The evaluation may also include additional
				vocational testing if the qualified rehabilitation professional opines that the
				testing is warranted in order to provide a full evaluation and the Commission,
				Insurance Commissioner, self-insured employer or private carrier, whichever is
				applicable, preauthorized the additional testing. The qualified rehabilitation
				professional must then decide and report in the form of a rehabilitation
				evaluation report, the format of which and method of transmission of which
				shall be approved by the Commission, Insurance Commissioner, self-insured
				employer or private carrier, whichever is applicable, as to whether the injured
				worker is likely to benefit from vocational rehabilitation services based upon
				the rehabilitation evaluation. The qualified rehabilitation professional must
				also report whether or not the evaluation was complete, and if not why not, and
				whether the injured worker, the injured worker's employer, or the injured
				worker's attending physician and other treatment providers cooperated in the
				process and must state the facts that form the basis of the
				conclusion.