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 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-3 - Overpayments: Notification and Reconsideration

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Notification of decision. The Commission
				shall notify each health care vendor of any alleged overpayment by United
				States mail, first class, postage pre-paid.
3.1.a. In overpayment matters the
				notification shall detail and provide an itemized statement of the alleged
				overpayment and the audit reason.
3.1.b. The notification shall include
				language to inform the health care provider that it is afforded the right to
				file a request for reconsideration of the decision and provide an address where
				the request for reconsideration shall be filed.
3.1.c. The notification may be sent by the
				Commission's agent. The notification may require that the request for
				reconsideration be filed with the Commission's agent or the Commission as
				specified in the notification.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-4 - Suspension or Termination

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				Consultation. The Executive Director shall consult with any of the following
				medical experts for purposes of determining whether a health care provider
				should be suspended or terminated pursuant to W. Va. Code Section §
									23-4-3c:
(1) Medical experts in the Workers'
				Compensation Commission's Office of Medical Services, including the Director or
				Associate Director;
(2) The Health
				Care Advisory Panel, or one or more of its members; or
(3) Any other medical expert selected by the
				Executive Director, in his or her sole discretion.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-5 - Final decision; Petition for Hearing

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Notice of final decision. The Commission
				shall notify each health care vendor of its final decision by United States
				mail, first class, postage pre-paid.
5.1.a.
				The notice of final decision shall include language to inform the health care
				provider that it is afforded the right to file a petition for hearing of the
				decision and provide an address where the request for reconsideration shall be
				filed.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-6 - Hearings; General Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. All administrative hearings conducted
				pursuant to this rule will be held in accordance with the provisions of W. Va.
				Code Section § 29A-5-1 et seq. and the provisions of this rule.
6.2. Representation. Corporations and the
				Commission may only be represented by an attorney duly licensed to practice law
				in the state of West Virginia.
6.3.
				Notice of scheduling/status conference or hearing. Unless waived by all
				parties, all such conferences or hearings shall be preceded by at least ten
				(10) calendar days written notice.
6.4. Counsel for the health care provider
				shall file a notice of appearance with the hearing officer, the Commission, and
				with the Commission designee along with the request for a hearing, or as soon
				thereafter as the attorney assumes representation of the health care
				provider.
6.5. The conference and
				hearings shall be held in Kanawha County, West Virginia, telephonically, or in
				the county designated by the Commission. The decision to hold the hearing in
				person or telephonically shall vest in the discretion of the hearing officer.
				The initial scheduling/ status conference shall be held within forty (40)
				calendar days from the receipt of protest, unless continued by agreement of the
				hearing officer and parties.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-7 - Parties and Conduct of Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. At the initial scheduling/status
				conference, the hearing officer shall enter an Order establishing the
				following:
1. Hearing date;
2. The specific issues to be
				addressed;
3. The amount of
				contested overpayment;
4. Discovery
				cutoff, if discovery is requested by either party and deemed necessary by the
				hearing officer; and
5. Deadline
				for disclosure of all witnesses and documents to be offered by either
				party
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-8 - Burden of Proof

Current through Register Vol. XLI, No. 28, July 12, 2024
There is a presumption that the Commission's decisions or
				  actions are valid. The party contesting the Commission's decisions or actions
				  has the burden of overcoming this presumption by satisfactory
				  proof.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-9 - Standard for Medically Unsupported Treatment

Current through Register Vol. XLI, No. 28, July 12, 2024
West Virginia Code Section §
									23-4-3
				  c(a)(5) requires the Commission to establish criteria for determining whether a
				  health care provider has made medically unsupported recommendations regarding a
				  percentage of disability or has prescribed medically unsupported treatment,
				  including medication. The criteria shall include, but not be limited to, the
				  following:
9.1. Recommendations and
				treatment must be reflective of accepted standards of good practice, within the
				scope of practice of the provider's license or certification;
9.2. Treatment must be curative or
				rehabilitative. Care must be of a type to cure the effects of a work-related
				injury or illness, or it must be rehabilitative. Curative treatment produces
				permanent changes which eliminate or lessen the clinical effects of an accepted
				condition. Rehabilitative treatment allows an injured or ill worker to regain
				functional activity in the presence of an interfering accepted condition.
				Curative and rehabilitative care produce long-term changes. On a case-by-case
				basis, the Commission may, in its sole discretion, authorize the use of
				treatment for conditions that are defined as long-term or chronic even though
				the treatment is not curative or rehabilitative;
9.3. Treatment shall not be proposed or
				delivered primarily for the convenience of the claimant, the claimant's doctor,
				or any other provider;
9.4.
				Treatment shall be provided in the most cost-effective manner and in the least
				intensive setting consistent with the other criteria set forth
				herein;
9.5. Treatment shall not
				present hazards in excess of the expected medical benefits;
9.6. Treatment which is controversial,
				obsolete, investigational or experimental will be subject to strict scrutiny by
				the Commission and must be pre-authorized by the Commission; and
9.7. Recommendations regarding a percentage
				of disability shall reflect a consistent and correct application of the
				guidelines for the calculation of permanent partial disability as contained in
				the applicable rules of the Commission.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-10 - Correction of the Record

Current through Register Vol. XLI, No. 28, July 12, 2024
Correction of the record shall be made by the hearing
				  officer upon his or her own motion, or upon the written motion of either of the
				  parties to the 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 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-12 - Hearing Officers

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. 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.
12.1.a. The Commission may delegate the
				authority necessary for the conduct of certain 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.
12.1.b.
				The Commission retains the right to appoint other attorneys as hearing officers
				for purposes of conducting specific hearings or types of hearings under 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 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-13 - Conclusion of Hearing

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1. At the
				conclusion of the hearing, the parties shall be permitted to file closing
				arguments, proposed findings of fact, conclusions of law, and such legal briefs
				or memoranda as they wish. The parties shall be permitted ten (10) calendar
				days to file such items which filings shall be concurrent.
13.2. The parties shall be permitted five (5)
				calendar days to respond to the filing of the other party, if desired. No
				further argument shall be permitted.
13.3. Thereafter, the hearing officer shall
				prepare a report and recommendation that shall contain proposed findings of
				fact and conclusions of law as suggested by the hearing officer for the
				Commission's approval.
13.4. The
				parties to the hearing shall then be permitted ten (10) days to file objections
				or comments upon the report and recommendations and five (5) more days to
				respond to each other's objections and comments.
13.5. Thereafter, the Commission shall decide
				whether to accept the report and recommendation, to reject it, to modify it, or
				to remand the matter back to the hearing officer for further proceedings or
				upon other instructions.
13.6. The
				Commission retains the right to review any and all proposed findings of fact
				against the record and to disagree therewith provided that the Commission
				states the basis for the disagreement in the final order.
13.7. The Commission shall render either a
				final order or an interlocutory order as the decision may require in which the
				Commission accepts in whole or in part the proposed findings of fact and
				conclusions of law submitted by the hearing officer and, to the extent that the
				Commission rejects or modifies the report or recommendation of the hearing
				officer, the Commission shall furnish his or her own findings of fact and
				conclusions of law.
13.8. A copy of
				the final order or decision of the Commission shall be served upon each party
				and the parties' attorneys of record, if any, either in person or by certified
				mail.
13.9. All appeals from the
				final order or decision of the Commission shall be taken pursuant to W. Va.
				Code §
									29A-5-4,
				in the circuit court of Kanawha County.
13.10. Upon appeal from the Commission's
				final decision, hearing officer shall transmit the entire record to the circuit
				court of Kanawha County, by either paper copy or any other electronic media
				that can be accommodated by the court in which relief is
				sought.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-14 - Pending Petitions

Current through Register Vol. XLI, No. 28, July 12, 2024
All petitions for hearings filed pursuant to recovery
				  letters generated or other administrative actions taken by the Commission or
				  its agent or filed by health care providers pursuant to the provisions of
				  85CSR7, "Rules for Selected Hearings", prior to May 5, 2003, for which no
				  hearing has been held shall be transferred to hearing officers designated by
				  the Commission under 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 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-15 - Notices

Current through Register Vol. XLI, No. 28, July 12, 2024
15.1. General.
				Except as hereinafter provided, the name and address given by the health care
				vendor on the vendor application shall be used by the Commission for giving any
				notice required by the statute or by this rule, unless a formal request for a
				change of name or address is made by the health care vendor as hereinafter
				provided.
15.2. Change of name or
				address. Any health care vendor changing the name or the address of the
				business must promptly notify the Commission, in writing, and request that the
				name or address be changed on the Commission's records. Every health care
				vendor required to register with the Office of the Secretary of State shall
				provide evidence of any name change from that office.
15.3. Effect of failure to request change of
				name or address. In the absence of a written request for a change of name or
				address by the health care vendor, any notice given by the Commission to the
				health care vendor at the address and in the name shown on the Commission's
				records shall constitute constructive notice to the health care vendor of any
				action taken.
15.4. Legal notice to
				attorney or agent. In any matter arising under this rule in which the
				Commission is required to give notice to a party, if a party is represented by
				an attorney or other representative, then notice to the attorney or other
				representative shall be sufficient notice to the party so
				represented.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-16 - Transition

Current through Register Vol. XLI, No. 28, July 12, 2024
16.1. Upon
				termination of the commission, disputes between health care providers and the
				insurance commissioner shall continue to be administered by the insurance
				commissioner in accordance with these rules.
16.2. Upon termination of the commission,
				disputes between health care providers and payors, such as the successor to the
				commission or other private carrier and self insured employers, shall not be
				subject to these rules, but shall be resolved in accordance with the
				arrangement between the health care provider and the payor.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-17 - 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 circumstances shall be held invalid, such invalidity shall not
				  affect the provisions or the applications of this rule which can be given
				  affect 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 85-31 - Professional Employer Organizations › Section 85-31-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule provides for the adoption and implementation of rules
				to regulate professional employer organizations ("PEOs") regarding workers'
				compensation.
1.2. Authority. -- W.
				Va. Code §§
									23-2C-22;
				33-2-10(b);
				33-2-21(a);
				and
				33-46A-7.
				Pursuant to W. Va. Code §§
									23-2C-5(c)(2)
				and
				33-2-10(b),
				workers' compensation rules proposed by the Commissioner and adopted 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. Repeal of former
				rule. -- This exempt legislative rule repeals and replaces WV 85CSR31 "Employee
				Leasing" filed December 2, 2005 and effective January 2, 2006.
1.4. Filing Date. -- October 22,
				2008.
1.5. Effective Date. --
				November 21, 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 85-31 - Professional Employer Organizations › Section 85-31-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
The purpose of this rule is to establish certain standards
				  and provisions applicable to workers' compensation insurance being provided to
				  entities known a "PEOs", as defined in this rule. The rule does not apply to
				  temporary help agencies or those businesses engaged in the provision of
				  contracted services, which are the primary or only services provided. However,
				  it does apply to any temporary help agency which also enters into agreements to
				  provide professional employer services to client employers, but the
				  applicability of this rule is limited to such instances.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-31 - Professional Employer Organizations › Section 85-31-3 - 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 used, the context expressly indicates that another meaning is
				  intended.
3.1. "Agreement" means a
				written contract by and between a client-employer and a PEO under which a PEO
				contracts to provide professional employer services for an administrative fee,
				as otherwise consistent with the provisions of W. Va. Code §
									33-46A-6.
3.2. "Client employer" means an entity who
				enters into a professional employer agreement with a PEO.
3.3. "Commissioner" means the Insurance
				Commissioner of West Virginia.
3.4.
				"Covered employee" means a person employed by a client-employer for whom
				certain employer responsibilities are shared or allocated pursuant to a PEO
				agreement. Persons who are officers, directors, shareholders, partners and
				managers of the client-employer will be covered employees only to the extent
				expressly set forth in the professional employer agreement.
3.5. "Direct hire employee" means an
				individual who is an employee of the PEO and has no employment or working
				relationship with any client employer.
3.6. "Direct purchase basis" means an
				arrangement in which all contractual obligations under the insurance policy run
				directly between the insurer and the client employer without the involvement of
				the PEO.
3.7. "Master Policy Basis"
				means an arrangement under which a single policy issued to a PEO covers more
				than one client-employer.
3.8.
				"Multiple Coordinated Policy Basis" or "MCP Basis" means an arrangement under
				which a separate policy is issued to or on behalf of each client-employer but
				certain payment obligations and policy communications are coordinated through
				the PEO.
3.9. "PEO" is a
				professional employer organization as defined in W. Va. Code §
									33-46A-2(g).
3.10. "Private Carrier" means any
				insurer authorized by the Commissioner to provide workers' compensation
				insurance pursuant to chapters twenty-three and thirty-three of the West
				Virginia Code.
3.11. "Residual
				Market" is the market of workers' compensation insurance written pursuant to
				the assigned risk plan developed pursuant to W. Va. Code §
									23-2C-10.
3.12. "Voluntary Market" has the same meaning
				ascribed to it in W. Va. Code §
									23-2C-2(u).
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-31 - Professional Employer Organizations › Section 85-31-4 - PEO Workers' Compensation Insurance Policies

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The purpose of this section is to
				implement W. Va. Code §
									33-46A-7
				relating to workers' compensation policies for PEOs and their
				client-employers.
4.2. In the
				voluntary market, workers' compensation policies for PEOs and their client
				employers may be issued on a master policy basis, MCP basis or such other form
				as approved by the Commissioner.
4.3. Policies of worker's compensation
				insurance for PEOs and their client employers in the residual market shall not
				be issued on a master policy basis. Such policies shall only be issued on forms
				submitted by servicing carriers and approved by the Commissioner.
4.4. Every policy form of workers'
				compensation insurance to be used for PEOs and their client-employers must be
				filed by the private carrier using the policy or the Commissioner's designated
				rating organization no less than sixty (60) days in advance of such policy
				being used by the private carrier. At the expiration of the sixty (60) day
				period, unless the period was extended by the Commissioner to obtain additional
				information from the private carrier, the form is deemed to be approved unless
				prior thereto it was affirmatively approved or disapproved by the Commissioner.
				Approval of any form under this subsection by the Commissioner constitutes a
				waiver of any unexpired portion of the sixty (60) day period.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-31 - Professional Employer Organizations › Section 85-31-5 - Data Collection and Proof of Coverage Reporting

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Regardless of the basis on which
				coverage is provided for PEOs and their client employers, the private carrier
				shall collect and maintain payroll and claims data for each client employer in
				a manner that will permit an experience modification factor to be calculated
				separately for each client-employer who is eligible to be experience
				rated.
5.2. When a client employer,
				for whatever reason, purchases workers' compensation coverage on a direct
				purchase basis, the client employer's experience modification factor shall be
				based solely upon the client-employer's own experience, including experience
				under past direct purchase policies and PEO policies, as applicable.
5.3. Carriers providing workers' compensation
				insurance to PEOs shall comply with all data reporting requirements pursuant to
				the appropriate rating manual and rules submitted by the Commissioner's
				designated rating organization for workers' compensation.
5.4. Regardless of the basis on which
				coverage is provided for PEOs and their client employers, the private carrier
				is required to timely and accurately report information regarding policy
				issuance, renewal and cancellation as required by the provisions of W. Va. Code
				§
									23-2C-15(f)
				and W. Va. Code St. R. §
									85-8-9.
				The carrier must be able to report such information separately regarding both
				the PEO and each client employer.
5.5. Failure of the private carrier to
				collect, maintain and report data as required by this section may result in
				appropriate regulatory measures being taken against the carrier pursuant to
				chapter thirty-three of the West Virginia Code, including, but not limited to,
				fines, termination of ability to write workers' compensation coverage to PEOs
				and termination of the carrier's certificate of authority in West
				Virginia.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-31 - Professional Employer Organizations › Section 85-31-6 - Scope of Coverage for Master Policies

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. A workers' compensation policy of
				insurance issued to a PEO on a master policy basis shall provide workers'
				compensation to:
a. All the direct hire
				employees of the PEO;
b. All
				covered employees working for each client employer of the PEO; and c. All other
				employees of the PEO or client employer required to be provided West Virginia
				workers' compensation coverage for whom there is no other workers' compensation
				policy providing coverage effective on the relevant date of injury.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-31 - Professional Employer Organizations › Section 85-31-7 - Notice of Coverage and Cancellation

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Upon issuing a workers' compensation
				policy to a PEO and its client employer on a master policy or MCP basis, the
				carrier shall promptly issue a certificate of coverage to each client covered
				under the policy.
7.2. Upon
				receiving notice that the PEO has added a client employer approved by the
				carrier to its master policy, a private carrier or its agent, if applicable,
				shall promptly issue a certificate of coverage to the newly added client
				employer.
7.3. A certificate of
				coverage issued under this section shall specify the effective date of the
				client employer's coverage and the expiration date of the master policy under
				which such coverage is being provided.
7.4. In all workers' compensation policies
				issued to PEOs and their client employers, the private carrier shall comply
				with W. Va. Code §
									23-2C-15(e)
				and W. Va. Code St. R. §
									85-8-9
				regarding providing notice of cancellation, renewal and non-renewal: Provided,
				That, under a master policy, notice of cancellation of coverage to any client
				employer for any reason shall not be effective without thirty (30) days advance
				written notice. Every notice provided under this subsection shall be sent both
				to the PEO and client: Provided, That the client employer does not need to be
				provided notice of a renewal under the provisions of W. Va. Code St. R. §
									85-8-9.9.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. - This
				legislative exempt rule is intended to set forth the procedures enabling the
				implementation of the provisions of W. Va. Code §§23-l"lb(g)(16),
				23-2C-15(d) and 23-2C-19(e) that requires agencies to revoke and prohibits
				agencies from granting, issuing, or renewing any contract, license, permit,
				certificate, or other authority to conduct a trade, profession, or business to
				or with any employing unit which is on the workers' compensation default
				list.
1.2. Authority. -
				W.Va.Code§§23-l-lb(g)(16),23-2C-15(d)and23-2C-19(e). Pursuant to W.
				Va. Code §§
									23-2C-22;
				33-2"10(b) and 33-2-21(a), workers' compensation rules proposed by the
				Insurance Commissioner and approved by the Industrial Council are not subject
				to W. Va. Code §§
									29A-3-9
				through
				29A-3-16,
				inclusive.
1.3. Filing Date. -
				October 9, 2009.
1.4. Effective
				Date. - November 8,2009.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms and words have the
				  meanings stated, unless the context clearly indicates otherwise.
2.1. "Agency" includes any unit of state
				government such as officers, agencies, divisions, departments, boards,
				commissions, authorities, or public corporations.
2.2. "Applicant" means an employing unit that
				is seeking the issuance, granting or renewal of an approval document.
2.3. "Application" means a completed form or
				other document, including a proposed contract, seeking the issuance, granting
				or renewal of an approval document regardless of the name assigned to
				it.
2.4. "Approval document" means
				any contract, license, permit, certificate, or other authority to conduct a
				trade, profession, or business
2.5.
				"Default" means being on the Workers' Compensation Default List as defined in
				W. Va.CSR §
									85-11-2.12.
2.6. "Employing unit" means an employer
				subject to chapter twenty-three of the West Virginia Code, as defined in the
				provisions of W. Va. Code §
									23-2-1.
2.7. "Grant" and "issue" include not only the
				original issuance or granting of an approval document but also any renewal,
				transfer, assignment or sale of the document, if otherwise, allowed.
2.8. "Default list" means the Workers'
				Compensation Default List as defined in W. Va. CSR §
									85-11-2.12.
2.9. "Person" means any public or private
				corporation, institution, association, firm or company organized or existing
				under the laws of this or any other state or county; any governmental agency;
				political subdivision; county commission; municipality; industry; public
				service district; partnership; trust; estate; person or individual; and group
				of persons or individuals acting individually or as a group or any other legal
				entity whatever.
2.10. "Payment
				agreement" means an agreement under the provisions of W. Va. CSR §
									85-11-12.
2.11. "Review" means either to query a
				computerized database or list to determine if the applicant's name is included
				as being in default by the Commission or, upon termination of the Commission,
				the Insurance Commissioner.
2.12.
				"Insurance Commissioner" means the Insurance Commissioner of West Virginia as
				provided in section one, article two, chapter thirty-three of the West Virginia
				Code.
2.13. "Insurer" shall mean 1)
				a self-insured employer; or 2) a 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 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-3 - General Prohibition

Current through Register Vol. XLI, No. 28, July 12, 2024
Pursuant to the provisions of W. Va. Code §§23-1
				  -1b(g)(16), 23-2C-15(d) and 23-2C-19(e), an agency shall not grant, issue, or
				  renew any approval document to, or enter into an approval document with, any
				  applicant who is on the Default List.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-4 - Timing of Review

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. After an
				application is complete and no further changes may be made to it prior to its
				final approval and before it is issued, an agency shall review the Default
				List. This does not prevent a review prior to that time and notifying the
				applicant of the results.
4.2. If
				the applicant's name appears on the Default List, an agency shall notify the
				applicant in writing, as in their normal course of business, that the agency
				has been informed that the applicant is on the Default List and that the
				approval document can not be issued until the applicant is no longer on the
				list.
4.3. Nothing in this section
				shall prevent the agency from providing any applicant, employing unit or person
				the standard due process which the agency avails to any party aggrieved by
				action of the agency with regard to the refusal to issue approval
				documents.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-5 - Revocation

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Pursuant to
				the provisions of W.Va. Code
				§§23-l-lb(g)(16),23-2C-15(d)and23-2C-19(e), an agency shall revoke
				any approval document of any employing unit whose account is on the Default
				List.
5.2. If the Insurance
				Commissioner has reason to believe that an employing unit that is in default is
				conducting its business in West Virginia under the authority of an approval
				document issued by an agency, the Insurance Commissioner shall notify the
				agency of its duty to revoke the approval document.
5.3. If the agency determines that an
				employing unit subject to the notification in subsection 5.2. is conducting
				business under the authority of an approval document issued by the agency, the
				agency shall notify the employing unit in writing, as in their normal course of
				business, that the agency has been notified that the employing unit is on the
				Default List and that the approval document must be revoked until the employing
				unit is no longer on the list.
5.4.
				Nothing in this section shall prevent the agency from providing any applicant,
				employing unit or person the standard due process which the agency avails to
				any party aggrieved by action of the agency with regard to the revocation of
				approval documents.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-6 - Procedure for Petitioning for Exemption

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. An agency may petition the Insurance
				Commissioner for an exemption from the provisions of this rule.
6.2. If the agency petitions to be exempt, it
				must clearly demonstrate to the Insurance Commissioner that the provisions of
				the rule are unduly burdensome and that its efforts in complying with the rule
				do not result in an incentive for any significant number of employers to comply
				with West Virginia's workers' compensation laws.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-32 - State Agency Revocation Or Refusal To Grant, Issue Or Renew Contracts, Licenses, Permits, Certificates Or Other Authority To Conduct A Trade, Profession Or Business To Or with an Employing Unit In Default Of its Workers' Compensation Obligations › Section 85-32-7 - Procedures for Implementation

Current through Register Vol. XLI, No. 28, July 12, 2024
Notwithstanding other provisions of this rule, the Insurance
				  Commissioner and the Tax Commissioner may adopt mutually agreed procedures for
				  automated review and matching of Tax Department databases with databases of the
				  Insurance Commissioner for implementation of this rule.
PUBLIC HEARING
JULY 30, 2009
OFFICES OF THE WEST VIRGINIA INSURANCE COMMISSIONER
				  WORKERS' COMPENSATION INDUSTRIAL COUNCIL
TITLE 85, SERIES 32
State Agency Revocation or Refusal to Grant, Issue or
				  Renew Contracts,
Licenses, Permits, Certificates or Other Authority to
				  Conduct a Trade,
Profession or Business to or with an Employing Unit in
				  Default of its
Workers' Compensation Obligations
Transcript of the Public Hearing held on Thursday, July 30,
				  2009, at 3:00 p.m., Offices of the West Virginia Insurance Commissioner, 1124
				  Smith Street, Room 400, Charleston, West Virginia.
Industrial Council Members Present:
Bill Dean, Chairman
Kent Hartsog
Dan Marshall
Walter Pellish (via telephone)
Chairman Bill Dean: This is Title 85, Series 32, State
				  Agency Revocation or Refusal to Grant, Issue or Renew Contracts, Licenses,
				  Permits, Certificates or Other Authority to Conduct a Trade, Profession or
				  Business to or with an Employing Unit in Default of its Workers' Compensation
				  Obligations. Ryan, do you have anything you would like to comment on?
Ryan Sims (Associate Counsel, OIC): No. We did not receive
				  any written comments on Title 85, Series 32.
Chairman Dean: Does anybody from the general public have
				  anything they would like to comment on? We will close the public hearing on
				  Title 85, Series 32.
[There were no comments.]
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- These regulations establish general rules for the operation of the State Home for Veterans at Barboursville, West Virginia.
1.2. Authority. -- W. Va. Code §
									9A-2-3.
1.3. Filing Date. -- February 26, 2010.
1.4. Effective Date. -- March 30, 2010.
1.5. Repeal and Replace. -- This rule supersedes and replaces procedural rule filed January 19, 1979.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-2 - General Plan of Filing

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. General purposes. -- The general purpose of these rules and procedures is to establish who is a qualified veteran and the processes involved in the operation of the West Virginia Home in Barboursville.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-3 - West Virginia Veterans Home in Barboursville

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The law authorizing the establishment of the West Virginia State Home for Veterans is published in the forward of this section.
3.2. A qualified veteran is defined as follows:
3.2.1. A qualified veteran must be ambulatory and independent in all activities of daily living such as eating in an open mess, dressing, bathing, self-medicating and light housekeeping. The Home will assist the eligible veteran who suffers from a disability, disease or defect, to such a degree that they are incapacitated from substantial gainful employment, but who are not in need of hospitalization or nursing care services.
3.2.2. Served on active duty with the armed forces of the United States during a period of declared war. Any veteran discharged since September 7, 1980, must have served a minimum of twenty-four (24) consecutive months on active duty.
3.2.3. Priority will be established for a veteran who was a resident of the State of West Virginia for one (1) year or more immediately prior to the date of application, or was a resident of the State of West Virginia at the time of enlistment or induction as documented by Department of Defense Form 214.
3.2.4. Was discharged from active duty with an Honorable Discharge or a General Discharge Under Honorable Conditions. All veterans discharged since May 8, 1975, must have an Honorable Discharge.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-4 - Leaves of Absence, Furloughs, or Discharges

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Passes are authorized for a period of time not to exceed 72 hours within any consecutive seven (7) days.
4.2. Furloughs are defined as any non-medical absence which is greater than 95 consecutive hours. Furloughs must be pre-approved by the Registrar or his designee. Residents are permitted to take 30 days of furlough during the prescribed 12 month period.
4.3. Discharges from the Veterans Home are divided into three categories: voluntary, involuntary and medical.
4.4. Residents requesting a voluntary discharge must submit, in writing, such request and complete all necessary procedures as outlined in current resident manual.
4.5. Involuntary discharges are issued whenever resident misconduct so merits.
4.6. Medical discharges are made after consultation with appropriate medical personnel who deem resident physically or mentally inappropriate for continued residency.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-5 - Discipline

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The Veterans Home Administrator or his/her designee will hear all cases of misconduct and will pass judgement according to the nature of the infraction. The decision of the Administrator or his/her designee will be final.
5.2. The Administrator will be assisted in the enforcement of the Rules and Regulations by the Registrar and by one (1) other employee of the Home, who will be selected by the Administrator.
5.3. The following are examples which constitute grounds for disciplinary action to be taken: (these completely supersede 5.4 and 5.5 of existing code)
5.3.1. AWOL for any period of time.
5.3.2. Habitual intoxication on premises.
5.3.3. Disorderly conduct.
5.3.4. Gambling on premises.
5.3.5. Any act of a violent nature.
5.3.6. Transporting or possession of alcohol or unauthorized drugs on premises.
5.3.7. Transporting or possession of weaponry on premises.
5.3.8. Habitual lack of compliance with Home policies.
5.3.9. Writing or speaking false charges against another.
5.3.10. Creating dissension.
5.3.11. Theft and vandalism.
5.3.12. Any and all violations as deemed appropriate by the Home Administrator or his/her designee.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-6 - Floor Leaders

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. A floor leader will be a resident of the Home, will be selected by the Administrator or his/her designee, and will be responsible for a specific resident area.
6.2. Floor leaders will be responsible for completing a daily census of the residents in their assigned areas and reporting same to the Registrar on a daily basis, seven (7) days a week. Floor leaders will assist administration with the observance of all rules and regulations of the facility.
6.3. Floor leaders will report to nursing personnel any resident in need of medical attention who is unable to come to the nursing area.
6.4. Floor leaders will inspect their respective areas and report any gross violation of hygiene, safety and/or noncompliance.
6.5. Floor leaders will submit such reports and perform related duties as described by the Registrar.
6.6. Floor leaders will accompany the Registrar or his/her designee whenever so directed for the purpose of entering resident's quarters.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-7 - Clothing

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Any resident admitted to the Home in need of clothing will be directed to the Home clothing room. Donated clothing received by the Home will be made available to all residents regardless of income. Donated clothing distributed to any resident becomes their personal property.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-8 - Medical Care

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A complete clinical record will be kept under the direction of the Director of Nursing as approved by the contract physician.
8.2. Residents in need of nursing assistance will report to the nursing station for proper disposition. In the event of a medical emergency, nursing service will notify the proper authorities.
8.3. All residents are assumed to be capable of rational and competent decisions. However, resident refusal to follow a prescribed course of treatment may result in disciplinary action up to and including involuntary discharge.
West Virginia Code of State Rules › Agency 86 - Veterans' Affairs › Title 86 - LEGISLATIVE RULE WEST VIRGINIA DIVISION OF VETERANS AFFAIRS › Series 86-01 - State Home For Veterans › Section 86-1-9 - Burials

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. The remains of deceased veterans will be sent to the local U. S. Department of Veterans Affairs Medical Center for certification of death. Nursing personnel will immediately notify next of kin, if known, and also notify the Registrar's office.
9.2. All personal effects not claimed by the resident's designee as indicated on the personal property form, will be removed and placed in storage by the Registrar and the Storekeeper. Small items of special value will be placed in the Home safe. All cash will be turned in to the fiscal department for safekeeping. Personal property not claimed within 60 days may be disposed of in an appropriate manner such as given to other needy veterans or service agencies or simply discarded.