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 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-2 - Application and Enforcement

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1.
				Application. This procedural rule applies to the Workers' Compensation Board of
				Managers created pursuant to W. Va. Code §
									23-1-1a et
				seq. The enforcement of this rule is vested with the chairperson of the Board.
				In accordance with the provisions of Senate bill 1004, as passed in the First
				Special Session of the two thousand-five Legislature, the board of managers
				terminates upon termination of the commission. Upon that occurrence, this rule
				will also terminate.
2.2. Except as
				specifically required by this rule, the Board shall not use any formal points
				of parliamentary order, personal privilege, parliamentary inquiry or other
				technical forms.
2.3. Any matter,
				procedure or order not covered by these rules shall be referred to the
				presiding officer who shall decide the matter in conformity with the purpose of
				these rules in a fair and expeditious manner. The decision of the presiding
				officer may be reversed by an affirmative vote of six (6) Members of the
				Board.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. "Chairperson"
				means the member elected as provided for by W. Va. Code §
									23-1-1a(f).
3.2. "The Board" means the Workers'
				Compensation Board of Managers created under W. Va. Code §
									23-1-1a.
3.3. "Decision" means any determination,
				action, vote or final disposition of a motion, proposal, resolution, order or
				measure on which a vote of the Board is required at any meeting at which a
				quorum is present.
3.4. "Meeting"
				means the convening of the Board for which a quorum is required in order to
				make a decision or to deliberate toward a decision on any matter. For the
				purposes of West Virginia Code Section §23-1-1a(h)(1), subcommittee
				meetings shall meet the definition of "Meeting" for those Members required to
				attend the subcommittee meeting.
3.5. "Quorum" means the presence of six (6)
				voting members of the Board. W. Va. Code §
									23-1-1a(f).
3.6. "Member" means a voting member as more
				fully set forth in W. Va. Code §
									23-1-1a(b)(1),
				et seq.
3.7. "Advisory Member"
				means a non-voting member as more fully set forth in W. Va. Code §
									23-1-1a(b)(2),
				et seq.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-5 - Agenda

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Prior to each
				regular meeting, the secretary of the committee shall publish an agenda that
				contains all items the Board anticipates acting upon at the meeting. The
				committee may adopt the agenda as presented, or may amend the agenda.
a. The secretary may utilize, for purposes of
				accomplishing his or her duties under this rule, clerical staff of the
				Commission as designated by the Executive Director or such clerical staff as
				the Board of Managers may employ. This utilization may include, but is not
				limited to, the designation of staff to receive proposed Agenda items,
				preparation of the Agenda, and all necessary public filing duties.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-6 - Opening the Meeting

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Call to
				order. The chair or vice chair of the Board shall call the meeting to order at
				the appointed hour. In the absence of the chair or vice chair, the secretary
				shall call the meeting to order and a temporary presiding officer shall then be
				selected under subsection 6.2.
6.2.
				Presiding officer. The chair, or in the chair's absence or incapacity, the vice
				chair, shall be the presiding officer at the meeting of the Board. If both the
				chair and the vice chair are absent, the secretary shall call the meeting to
				order and the Members present shall select a presiding officer by an
				affirmative vote of six (6) Members. In the absence of such an affirmative
				vote, the secretary shall remain and continue to be the presiding officer of
				the meeting.
6.3. Roll call. Before
				proceeding with the business of the Board, the secretary shall call the roll
				call of Members and Advisory Members present, and enter the name in the minutes
				of the meeting. The secretary shall determine the presence of a quorum as
				required by these rules.
6.4. Order
				of consideration of agenda items. Except as otherwise provided in these rules,
				each Agenda item shall be considered in the numerical order assigned by the
				secretary. Each Agenda item shall be separately announced by the presiding
				officer, or the secretary, for purposes of discussion and consideration. To
				announce an item it shall be sufficient to identify the item by the number
				assigned and summary provided by the secretary.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-7 - Discussion

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The presiding
				officer shall control the discussion of the Board on each Agenda item to assure
				full participation in accordance with these rules.
a. A Member or Advisory Member shall speak
				only after being recognized by the presiding officer. A Member or Advisory
				Member recognized for a specific purpose shall limit his or her remarks to that
				purpose. A Member or Advisory Member, after being recognized, shall not be
				interrupted except by the presiding officer to enforce these rules.
b. Each Member and Advisory Member shall
				limit his or her remarks to a reasonable length.
c. The presiding officer as a Member of the
				Board may enter into any discussion. The presiding officer has the right to
				close debate and speak last on any item.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-8 - Motions; Voting

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Motion to
				act on matters. At any appropriate place on the Agenda, any Member of the Board
				may make a motion for the Board to act upon any matter if the motion is germane
				to the matter then under consideration.
8.2. Motion required. All action requiring a
				vote shall be moved by a Member and seconded by a different Member of the
				Board.
8.3. Recording names of
				moving members. The secretary shall record the name of the Board Member moving
				and seconding each motion.
8.4.
				Call for vote. At the conclusion of debate, the presiding officer shall call
				for a vote: Provided, That an affirmative vote of six (6) Members may require a
				vote at any time.
8.5. Prevailing
				vote required; Vote by Proxy Prohibited. The vote of six (6) Members of the
				Board shall be necessary to take any action.
8.6. Motion to reconsider. A motion to
				reconsider must be made by a Member who was on the prevailing side in the
				original action.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-9 - Proceeding to be Open; Exceptions; Executive Session Permitted

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. All meetings
				of the Board shall be open to the public; Except that, an executive session
				closed to the public may be held during a regular or emergency meeting, after
				the presiding office has identified the authorization under W. Va. Code §
									6-9A-4 for the holding
				of such executive session and has presented it to the Board and to the general
				public, but no decision shall be made in such executive session.
9.2. An executive session may be held only
				upon an affirmative vote of six (6) Members for the following (as stated in W.
				Va. Code §
									6-9A-4) reasons:
a. Matters of war, threatened attack from a
				foreign power, civil insurrection or riot; or
b. The appointment, employment, retirement,
				promotion, demotion, disciplining, resignation, discharge, dismissal or
				compensation of any public officer or employee, or other personnel matters, or
				for the purpose of conducting a hearing on a complaint against a public officer
				or employee, unless such public officer or employee requests an open meeting;
				or
c. The issuance, effecting,
				denial, suspension or revocation of a license, certificate or resignation under
				the laws of this State or any political subdivision, unless the person seeking
				such license, certificate or registration or whose license, certificate or
				registration was denied, suspended or revoked requests an open meeting;
				or
d. The physical or mental health
				of any person, unless such person requests an open meeting; or
e. Matters which, if discussed in public,
				would be likely to affect adversely the reputation of any person; or
f. The development of security personnel or
				devices; or
g. Matters involving or
				affecting the purchase, sale or lease of property, advance construction
				planning, the investment of public funds or other matters involving competition
				which, if made public, might adversely affect the financial or other interest
				of the state or any political subdivision.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-10 - Citizen's Right to Address Board

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. Persons other than Members and Advisory
				Members shall be permitted to address the Board only upon specific Agenda
				items, which may include an Agenda item called "General Public Comment
				Period."
10.2. Persons desiring to
				address the Board shall register to speak prior to the start of the Board
				meeting. The form for registration shall require the following information:
(1) name of the person,
(2) mailing address,
(3) telephone number where the person may be
				reached during the day,
(4) the
				person's group affiliation, if any, and
(5) the Agenda item to which the person
				desires to speak. If the person does not desire to speak to a particular Agenda
				item, the person shall identify the subject matter about which he or she wishes
				to speak.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-11 - Subcommittees

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. There shall
				be the following subcommittees:
1) Audit;
2) Claims;
3) Finance and Administration
4) Risk Management; and
5) Executive. Each subcommittee shall consist
				of three (3) Members. The chairperson shall designate each subcommittee's
				membership and chairperson. In addition, the Board chairperson may designate
				the subject matter to be considered by each such subcommittee and may create
				additional subcommittees. Only those Members assigned to the Subcommittee shall
				be required to attend a meeting of the subcommittee.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-12 - Minutes

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. The Board
				shall provide for the preparation of written minutes of all its meetings. All
				such minutes shall be available to the public within a reasonable time after
				the meeting and shall include the following information:
a. The date, time and place of the
				meeting;
b. The name of each Member
				and Advisory Member present or absent;
c. All motions, proposals, resolutions,
				orders, ordinances and measures proposed, the name of the person proposing the
				same and their disposition; and d. The results of all votes and, upon request
				of a Member, the vote of each Member, by name.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-14 - Procedural Rules For The Workers' Compensation Board Of Managers › Section 85-14-13 - Records of the Board - Public

Current through Register Vol. XLI, No. 28, July 12, 2024
Records of the Board are public records that may be
				  inspected in accordance with W. Va. Code §
									29B-1-3
				  and copied at a charge reasonably calculated by the Commission to recover its
				  reasonable costs associated with the production of 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 85-15 - Vocational And Physical Rehabilitation › Section 85-15-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule establishes the requirements and procedures to be
				followed by the West Virginia Workers' Compensation Commission, Insurance
				Commissioner, private carriers, self-insured employers, parties to pending
				claims, health care providers, vocational professionals, and others involved in
				the delivery or proposed delivery of physical or vocational rehabilitation
				services to claimants pursuant to W. Va. Code §
									23-4-9.
				Other types of health care services provided or proposed to be provided to
				injured workers under other provisions of W. Va. Code §
									23-4-3,
				are not within the scope of these rules.
1.2. Authority. -- W. Va. Code §
									23-4-9(b)
				and (e). Pursuant to W. Va. Code §
									23-1-1a(j)(3),
				rules adopted by the Workers' Compensation Board of Managers 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. Filing Date. --
				August 31, 2005.
1.4. Effective
				Date. -- October 1, 2005.
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 85-15-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this exempt legislative rule, the following terms
				  have the stated meanings unless the context of a specific use clearly indicates
				  another meaning is intended.
3.1.
				"Executive Director" means the executive director of the West Virginia Workers'
				Compensation Commission pursuant to W. Va. Code §
									23-1-1b.
3.2. "Commission" means the West Virginia
				Workers' Compensation Commission as provided for by W. Va. Code §
									23-1-1.
3.3. "Injury" and derivative words have the
				meaning ascribed to the term "injury" by W. Va. Code §
									23-4-1.
3.4. "Injured worker" and "claimant" mean an
				employee entitled to workers' compensation benefits as the result of a
				work-related injury, as provided under W. Va. Code §
									23-4-1.
3.5. "Injured worker's employer" or
				"employer" means an employer of the injured worker who is a chargeable employer
				in the claim either through its experience or through its private carrier.
3.6 "Suitable gainful employment"
				means employment which restores the injured worker as closely as possible to
				his or her pre-injury level of earnings. If this is not possible, suitable
				gainful employment means other work for which the employee is, or may become,
				suited by training, experience, or education, but not limited by his or her
				previous level of earnings.
3.7.
				"Physical rehabilitation services" means physician approved health care
				services, which will likely increase the injured worker's ability to return to
				suitable gainful employment. Physical rehabilitation services include but are
				not limited to work hardening and work conditioning programs or other
				Commission, Insurance Commissioner, self-insured employer or private carrier,
				whichever is applicable, approved physical rehabilitation program.
3.8. "Physical rehabilitation services
				provider" means a provider of health care services, provided the provider is:
a. A medicare certified rehabilitation
				agency;
b. A certified outpatient
				rehabilitation facility;
c. A duly
				licensed health care practitioner;
d. A physical rehabilitation
				hospital;
e. A duly licensed acute
				care hospital.
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 85-15-4 - Priorities

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Vendors of
				vocational rehabilitation services and qualified rehabilitation professionals
				must utilize the following priorities. No higher numbered priority may be
				utilized unless the Commission, Insurance Commissioner, self-insured employer
				or private carrier, whichever is applicable, has determined all lower numbered
				priorities are unlikely to result in placement of the injured worker into
				suitable gainful employment. If a lower numbered priority is clearly
				inappropriate for the injured worker, the next higher numbered priority must be
				considered. The rehabilitation plan must explicitly state the reasons and
				rationale for the rejection of any lower numbered priority. The priorities are
				as follows:
1. Return to the same employer
				and pre-injury job;
2. Return to
				the same employer and pre-injury job with modification;
3. Return to the same employer in a different
				position;
4. Return to the same
				employer in a different position with on-the-job-training;
5. Employment by a new employer without
				retraining;
6. Employment by a new
				employer with on-the-job-training;
7. Return to work following enrollment of the
				injured worker in a retraining program which consists of a goal-oriented period
				of formal retraining designed to lead to suitable gainful employment in the
				labor market.
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 85-15-6 - Implementation of the Rehabilitation Plan

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Until the termination of the Commission,
				an employer is permitted to object to the plan pursuant to section 5.4 of this
				rule. However, the implementation of the plan will proceed notwithstanding the
				objection. In the event that the employer is successful in challenging the
				plan, the employer's account will be adjusted to reflect the appropriate charge
				associated with the rehabilitation plan. In the event the plan has not been
				completed at the time of the ultimate decision on the protest, the plan will be
				modified, if necessary, to conform with the ultimate decision.
a. Upon termination of the Commission, the
				private carrier, and not the employer, will register objections and adjudicate
				claims matters on behalf of the employer in appropriate cases.
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 85-15-8 - Rehabilitation Closure Report

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1.
				The qualified rehabilitation professional authorized to assist the injured
				worker must file a rehabilitation closure report with the Commission, Insurance
				Commissioner, self-insured employer or private carrier, whichever is
				applicable, and all parties to the claim when it is determined that their
				involvement in the rehabilitation services are no longer necessary unless
				otherwise specified by the Commission, Insurance Commissioner, self-insured
				employer or private carrier, whichever is applicable.
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 85-15-9 - Registration of Rehabilitation Providers

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Qualified rehabilitation professionals
				and other vocational rehabilitation vendors must register with the Commission,
				using forms prescribed by the Commission. Any rehabilitation provider who does
				not meet the requirements set forth in Rule 27 of Title 85 of the Code of State
				Rules cannot be accepted for registration.
a.
				Upon termination of the Commission, no registration is required of qualified
				rehabilitation professionals. Qualified rehabilitation professionals are
				required to verify and provide proof of their certification or qualifications
				to the Insurance Commissioner, self-insured employer or private carrier,
				whomever services are provided under this rule, or to their third party
				administrator or managed care provider. In turn the Insurance Commissioner,
				self-insured employer or private carrier, or their third party administrator or
				managed care provider is required to maintain this proof of certification or
				qualifications of the qualified rehabilitation professional.
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 85-15-11 - Trial Return to Work

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. The
				provisions of W. Va. Code §
									23-4-7b
				regarding trial return to work have been reinstated and will be implemented by
				the Commission, Insurance Commissioner, self-insured employer or private
				carrier, whichever is applicable, until such time as the statutory provisions
				regarding trial return to work are terminated.
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 85-15-12 - Employer-Preferred Vocational Rehabilitation Services

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Prior to termination of the Commission,
				any employer who desires to contract directly with one or more preferred
				vocational rehabilitation providers to provide vocational rehabilitation
				services to its injured workers and require its employees to use the preferred
				provider(s), shall notify the Commission of its contract and designation on
				forms prescribed by the Commission. Such selected providers must be registered
				with the Commission as required by Section
				85-15-9.
				Notwithstanding the employer's ability to select a preferred provider, the
				Commission shall remain the sole referral authority. An employer may identify
				to the Commission claimants whom it wants to be considered for rehabilitation
				services.
a. Upon motion by the injured
				worker or the employer, or upon its own initiative, the Commission may, with a
				showing of just cause, assign or reassign the injured worker to a qualified
				rehabilitation provider other than the provider designated by the employer.
				Such cause might include, but not be limited to, past or present family or
				social relationships between the injured worker and the employer's preferred
				rehabilitation services provider, common financial interests between the
				injured worker and the employer's preferred rehabilitation services provider,
				or evidence that the rehabilitation process or provider is not in compliance
				with this rule.
b. All preferred
				vocational rehabilitation providers shall comply with this Rule and
				Commission's established guidelines, rules, regulations, and policies.
				Additionally, all preferred vocational rehabilitation providers shall utilize
				all reporting forms and reporting processes adopted by the
				Commission.
c. A vocational
				rehabilitation provider must be in good standing with the Commission in order
				to be designated an/or maintain its designation as a preferred provider.
				Additionally, the preferred provider shall adhere to the Commission's fee
				schedule for reimbursement of expenses and any expenses which exceed the fee
				schedule shall be the sole responsibility of the employer.
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 85-15-13 - Transfer to the Insurance Commissioner

Current through Register Vol. XLI, No. 28, July 12, 2024
Upon termination of the Commission, responsibility for the
				  regulatory enforcement of this exempt legislative rule shall transfer to the
				  Insurance Commissioner to be administered in a manner otherwise consistent with
				  chapter twenty-three of the West Virginia Code. All other provisions of this
				  rule which have been rendered moot by, or are otherwise in conflict with Senate
				  Bill 1004, shall be administered by the Insurance Commissioner in a manner
				  consistent with chapter twenty-three of the West Virginia
				  Code.
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 85-15-14 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of these rules or the application thereof
				  to any entity or circumstance is held invalid, the invalidity will not effect
				  the provisions or the applications of these rules which can be given affect
				  without the invalid provisions or application and to this end the provisions of
				  these rules 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 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 85-16-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1.
				Scope.- -- This rule implements the provisions of
				West Virginia. Code, §
									23-4-3
				b(b), § 23-4-6(i), § 23-4-7 a(h), and § 23-4-8 -, regarding the
				procedures, forms, evidence, and standards for the evaluation of claimants and
				the determination of a claimant's degree of whole body medical impairment for
				workers' compensation benefits. -
1.2. Authority. -- West Virginia Code,
				§2lA-2-6(2); § 21A-3-7(b) & -7(c); §
									23-1-1;
				§ 23-1-13, and" §2 3.-4-6 (i) . Pursuant to West Virginia Code,
				§2lA-3-7(c), rules adopted by the compensation programs performance
				council and the commissioner are not subject to legislative approval as would
				otherwise be required under west Virginia Code, § 29A-3-1 et seq. Public
				notice requirements of that chapter and article, however, must be" followed.
				pursuant to enrolled committee substitute for house ""bill -403 0/ regular
				session, 1994, the department of commerce, labor and environmental resources
				was abolished. Pursuant to that same bill and to executive order no. 5-94 by
				the governor, the commissioner of the bureau of employment programs is
				empowered to promulgate rules and regulations without the consent or approval
				of a departmental secretary.
1.3.
				Filing Date. -- January 24, 1996.
1.4. Effective Date. -- February 26,
				1996.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 85-16-2 - Purpose of rule

Current through Register Vol. XLI, No. 28, July 12, 2024
The purpose of this rule is to implement the provisions of
				  West Virginia Code, §
									23-4-3
				  b(b), § 23-4-6(i), § 23-4-7 a(h), and § 23-4-8, which .relate to
				  the development of standards for the rating of permanent whole body medical
				  impairments suffered by claimants as a proximate result of their compensable
				  injuries or diseases. The standards adopted by this rule have been approved by
				  the health care advisory panel and recommended to the compensation programs
				  performance council for its adoption. The rule is applicable to all ratings for
				  permanent whole body medical impairment. The rule is applicable to evidence
				  submitted by any party to a claim, to evidence gathered by the division and to
				  recommendations made to the division by the interdisciplinary examining board
				  pursuant to West Virginia Code, § 23-4-6(j) & -6(n).
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 85.16-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule, the following terms have
				  the stated meanings unless the context of a specific use clearly indicates
				  another meaning is intended.
3.1.
				"Commissioner" means the commissioner of the bureau of employment programs
				pursuant to West Virginia Code, §2lA-2-l, and West Virginia Code, §
									23-1-1,
				and any deputies designated pursuant to West Virginia Code, §2lA-2-12
				& -13.
3.2. "Division" means
				the workers1 compensation division within the bureau
				of employment programs as provided for by West Virginia Code, §21A-l-4,
				and West Virginia Code, §
									23-1-1
				et seq.
3.3. "Guides" means the
				"Guides to the Evaluation of Permanent impairment," (4th ed. 1993) , as
				published by the American Medical Association.
3.4. "Permanent impairment" means an
				impairment that is related to a compensable injury . ."that has become static
				or stabilized during a period of time sufficient to., allow optimal tissue
				repair, and one that is unlikely to. change in spite of further medical or
				surgical therapy." Guides at page 1/1. An "impairment" is defined as "an
				alteration of an individual's health status" and is "assessed by medical means
				and is a medical issue. An impairment is a deviation from normal in a body part
				or organ system and its functioning. " Id. Reference should also be made to the
				Glossary beginning at page 315 of the Guides. A claimant's degree of permanent
				whole body medical impairment is to be determined in keeping with the
				determination of whole person permanent impairment as set forth in the Guides.
				For the purposes of these rules, the Guides' use of the term "whole person"
				impairment is the equivalent of the term "whole body" impairment.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 85-16-4 - Adoption of Standards

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Except
				as provided for in section 6 of this rule, on and after the effective date of
				this rule all evaluations, examinations, reports, and opinions with regard to
				the degree of permanent whole body medical impairment which a claimant has
				suffered shall be conducted and composed in accordance with the "Guides to the
				Evaluation of Permanent Impairment," (4th ed. 1993) , as published by the
				American Medical Association. If in any particular claim, the examiner is of
				the opinion that the Guides or the section 6 substitutes cannot be
				appropriately applied or that an impairment guide established by a recognized
				medical speciality group may be more appropriately applied, then the examiner's
				report must document and explain the basis for that opinion. Deviations from
				the requirements of the Guides or the section 6 substitutes shall not be the
				basis for excluding evidence from consideration. Rather, in any such instance
				such deviations shall be considered in determining the weight that will be
				given to that evidence. An example of an acceptable recognized medical
				speciality group's own guides is the "Orthopaedic Surgeons Manual in Evaluating
				Permanent Physical Impairment."
4.2. These revised rules are not applicable
				to . any permanent impairment rating examination performed prior to the
				effective date of these revised rules. Accordingly, the revised rules are not
				applicable to any reports or opinions based upon those examinations, in whole
				or in part, which are submitted either before or after" ""the effective date of
				these revised rules.
4.3. These
				rules are applicable to examinations and - -opinions provided to the division
				by a claimant's treating physician pursuant to West Virginia Code, §
				23-4-7 a(c)(1).
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 23-16-5 - Evidentiary Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				The evidentiary weight to be given to a report will be determined by how well
				it demonstrates that the evaluation and examination that it memorializes were
				conducted in accordance with the Guides and that the opinion with regard to the
				degree of permanent whole body medical impairment suffered by a claimant was
				arrived at and composed in accordance with the requirements of the Guides.
5.1.1. The report must state the factual
				findings of all tests, evaluations, and examinations that were conducted and
				must state the manner in which they were conducted so as to clearly indicate
				their performance in keeping with the requirements of the Guides. For any
				evaluation and examination of a. compensable back injury, the back" examination
				form previously adopted, by the health care advisory panel must be completed
				and submitted with the narrative report. A copy of the current edition of the
				back examination form is attached hereto and is incorporated herein as if fully
				set forth. A report and opinion submitted regarding the . degree of permanent
				whole body medical impairment as a result of a back injury without a completed
				back examination form shall be disregarded.
5.1.2. The .opinion stated in the report as
				to the degree of permanent whole body medical impairment must reflect the
				process of calculation as .stated in the Guides so as to demonstrate how the
				degree of permanent whole body medical impairment was arrived at and
				calculated.
5.1.3. As stated in the
				Guides, at page 1/5, section 1.5: "The physician performing an impairment
				evaluation must provide more than a number or percentage. The physician should
				provide as comprehensive a medical picture of .the patient as possible, using
				the Report of Medical Evaluation form (p.11) as an outline. If this is done,
				the person receiving the evaluation will be able to determine how the medical
				information fits with the nonmedical information and will have the basis for an
				improved understanding of how the impairment may affect the patient's
				employability and daily activities." (Insertion in the original).
5.1.4. To the extent that factors other than
				the compensable injury may be affecting the claimant's whole body medical
				impairment, the opinion stated in the report must, to the extent medically
				possible, determine the contribution of those other impairments whether
				resulting from an occupational or a nonoccupational injury, disease, or any
				other cause.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 23-16-6 - Exceptions to the Guides

Current through Register Vol. XLI, No. 28, July 12, 2024
The following portions of the Guides or their successor
				  provisions shall not be used in the determination of the degree of permanent
				  impairment that has been suffered by a claimant for workers' compensation
				  benefits.
6.1. In claims for
				occupational pneumoconiosis benefits, the provisions of Chapter 5, "The
				Respiratory System," are exempted from this rule. The provisions of the statute
				related to occupational pneumoconiosis, rules adopted in accordance with the
				statute, and policies and procedures adopted by the occupational pneumoconiosis
				board adequately and separately control the determination of the degree of
				permanent impairment suffered by such a claimant. The occupational
				pneumoconiosis board may, in any given case and in its discretion, utilize the
				Guides to the extent the board deems appropriate.
6.2. In claims for noise induced hearing
				loss, the provisions of section 9.1, Chapter 9, "Ear, Nose, Throat, and Related
				structures," are exempted from this rule. The legislative rule styled
				"Protocols and Procedures for Performing Medical Evaluations in Noise-Induced
				Hearing Loss Claims," 85 CSR 13 (1993), were previously promulgated for such
				claims.
6.3. In claims for mental
				and emotional loss, the provisions of chapter 14, "Mental and Behavioral
				Disorders," are exempted from this rule. The legislative rule styled
				"Guidelines for Psychiatric Permanent Impairment Evaluations, Evidence, and
				Ratings of Psychiatric Impairment Due to Workers' Compensation Injuries," 85
				CSR 22 (1995), shall be utilized in lieu of chapter 14. It is expressly noted
				that chapter 4, "The Nervous System, " is not excluded and shall be used when
				applicable.
6.4. In those claims
				affected by the provisions of West Virginia Code, §23 -4 -6(f), the degree
				of disability stated there shall be applied.
6.5. In those claims affected by the
				provisions of West Virginia Code, § 23-4-6(m), the conclusive presumption
				of total disability stated there shall be applied.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 85-16-7 - Payment for evaluations

Current through Register Vol. XLI, No. 28, July 12, 2024
The division shall not make payment to any impairment
				  examiner whose reports, opinions, examinations, or evaluations are not
				  conducted,, performed, and composed in accordance with this rule. In the event
				  payment was made prior to a determination that the report, opinion, -
				  examination, or evaluation .was not conducted, performed, or composed in
				  accordance with this rule, then the amount so paid shall be recovered from the
				  examiner either by way of a direct repayment to the - division or by way of an
				  offset against any future sums that may be owed by the division to the examiner
				  for any services rendered for or to the division or for or to a claimant. A
				  later submission or supplement to the report which demonstrates compliance with
				  these rules shall serve to permit such payment.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-16 - Guidelines For Permanent Impairment Evaluations, Evidence, And Ratings › Section 85-16-8 - 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 circumstance shall be held invalid, such invalidity shall not
				  effect 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 85-17 - Electronic Payments › Section 85-17-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				exempt legislative rule establishes a program to require acceptance of
				disbursements by electronic transfer from the State-Administered Workers'
				Compensation Funds to vendors and claimants, pursuant to the provisions of W.
				Va. Code §
									23-3-5.
1.2. Authority. -- W. Va. Code §§
									23-1-1(e),
				23-2C-5,
				23-2C-8
				and
				23-3-5.
				Pursuant to W. Va. Code §
									23-2C-5(c)(2),
				rules adopted by the Workers' Compensation 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. Filing Date. -- May 28, 2021.
1.4. Effective Date. -- July 1,
				2021.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-17 - Electronic Payments › Section 85-17-2 - Purpose

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1 The purpose of
				this rule is to implement the provisions of W. Va. Code §
									23-3-5
				and to establish a program to require acceptance of disbursements by electronic
				transfer from the State-Administered Workers' Compensation Funds to vendors and
				claimants.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-17 - Electronic Payments › Section 85-17-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms have the stated
				  meanings unless the context of a specific use clearly indicates another meaning
				  is intended.
3.1. "Claimant" means an
				employee of an employer subject to Chapter 23 of the West Virginia Code who has
				sustained or received a personal injury in the course of and resulting from his
				or her covered employment, or in the case of death, an employee's dependents,
				if any, and who makes a timely application for compensation or
				benefits.
3.2. "State-Administered
				Workers' Compensation Funds" means the "Old Fund," "Uninsured Employer Fund,"
				"Self-Insured Employer Guaranty Risk Pool," and the "Self-Insured Employer
				Security Risk Pool," all created pursuant to W. Va. Code §
									23-2C-6,
				and further includes the "Coal-Workers' Pneumoconiosis Fund," created pursuant
				to W. Va. Code §
									23-4B-2.
				The State Treasurer is the custodian of the State-Administered Workers'
				Compensation Funds, and each individual fund is a separate and distinct fund
				upon the books and records of the State Auditor and State Treasurer.
				Disbursements from the State-Administered Workers' Compensation Funds are made
				upon requisition from the Insurance Commissioner to those entitled to receive
				benefits from the funds.
3.3. An
				"invoice" is any legal demand, whether written, oral, or by computer-generated
				medium, for the payment by the Insurance Commissioner to a vendor.
3.4. "Vendor" means any health care provider
				or other entity who performs a service or provides a thing of value to a
				claimant or who performs a service or provides a thing of value to the
				Insurance Commissioner in relation to the Insurance Commissioner's
				responsibilities in regard to the State-Administered Workers' Compensation
				Funds or who performs a service or provides a thing of value to the Insurance
				Commissioner's third-party administrators in relation to their responsibilities
				in regard to the State-Administered Workers' Compensation Funds, and who then
				submits an invoice or otherwise seeks payment from the Insurance Commissioner
				or the Insurance Commissioner's third-party administrators for the rendering of
				that service or thing of value.
3.5. "Insurance Commissioner" means the
				Insurance Commissioner of West Virginia.
3.6. "Private Carrier" means any insurer
				authorized by the Insurance Commissioner to provide workers' compensation
				insurance pursuant to Chapters 23 and 33 of the West Virginia Code, but shall
				not include self-insured employers.
3.7. "Self-insured employer" means an
				employer who has been granted self-insured status under the provisions of W.
				Va. Code §
									23-2-9.