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 93-1-20 - Disputes Between Claim Administrators: Reopening Versus New Injury Issues

Current through Register Vol. XLI, No. 28, July 12, 2024
20.1.
				Scope
W. Va. Code §
									23-5-1(b)(2) provides that the Office of Judges resolves disputes between claim administrators, without prejudicing the right of the injured worker to immediate workers' compensation benefits, in claim filings in which the claim is otherwise compensable but the only matter of dispute is whether the claim should have been filed as a new injury application or a application to reopen an old claim.
This process applies only to applications for benefits - either in the form of an initial application for a new injury or an application to reopen an old injury - filed with a carrier on, or after, July 1, 2008.
20.2. Initiation of Process
When a claim administrator determines to deny a request for benefits filed on, or after July 1, 2008, and the only basis for denial of benefits is the determination that the application was improperly filed as a new claim or a reopening of an old claim, the claim administrator shall issue a decision denying benefits and providing the right of the claimant to object.
If the claimant files a timely protest, then the following subsections apply. The Office of Judges shall acknowledge the protest and enter a Time Frame as provided for in any other type of protest.
20.3. Administration of Claim and Conditional
				Payment of Benefits
Upon receipt of notice of the filing of a protest to
				  the denial of the claim, the claim administrator shall begin conditional
				  payment of benefits within fifteen (15) working days. Conditional payment of
				  benefits shall continue until affected by subsequent order or decision of the
				  Office of Judges.
20.4.
				Notice to Office of Judges
Upon receipt of notice of the filing of a
				  protest to the denial of the claim, the claim administrator shall promptly
				  notify the Office of Judges that another identifiable person may be
				  liable.
Pursuant to the provisions of Section 15 [93-1-15] of this
				  Rule, the burden is on the claim administrator to provide sufficient claim
				  identifying information in order for the Office of Judges to determine to
				  change the responsible administrator.
20.5. Notice to Other Allegedly Liable
				Person; New Claim Defenses
A. Form of
				Notice
Upon receipt of sufficient information from the claim
				  administrator, the Office of Judges will join the other potential claim
				  administrator to the proceeding. The Office of Judges will notify the alleged
				  responsible claim administrator:
1. Of
				the existence of the claim for benefits;
2. Of the existence of the protest;
3. The allegation that the claim is otherwise
				compensable;
4. The possibility
				that the claim responsibility may ultimately be assigned to the new claim
				administrator;
5. The possibility
				that conditional payments being made may ultimately be transferred to the new
				administrator; and
6. Of any time
				limit for raising any claim defenses not raised by the initial claim
				administrator, or for filing evidence.