West Virginia’s insurance commissioner is reminding workers’ compensation stakeholders about statutory changes that took effect this month on claims and adjudication of claims.
“As a result of these changes, it is critical that all stakeholders comply with this regulatory guidance,” the Office of Insurance Commissioner said in a bulletin. “Failure to follow this guidance may result in regulatory action and/or monetary penalty.”
Claims decisions: When a carrier or self-insured employer reaches a decision on any issue, it must now send the decision and the reasons for the decision to all parties. Parties include the injured worker, the employer and the claimant’s dependents, if applicable. The OIC should be notified on claims involving the state’s Old Fund (the state-run system prior to 2008), the Uninsured Employer’s Fund, the Self-Insured Employer Guaranty Risk Pool, the Self-Insured Employer Security Risk Pool, or the Coal Workers’ Pneumoconiosis Fund.
The notice should be in writing and should include the time allowed for filing objections to the decision (60 days). Those objections, filed with the state’s Workers’ Compensation Board of Review, should also be sent to all parties.
The decision notice from the insurer or self-insurer must list all the parties involved, the complete names of the carrier and third-party claims administrator, along with mailing address, jurisdictional claim number, date of injury and other details.
“This information is necessary for parties to file objections at the Board of Review. Failure to include this information on a written decision or notice may hinder the parties in filing objections,” the bulletin reads. “If this information is missing from a written decision or notice, the Workers’ Compensation Board of Review may find ‘good cause’ or ‘excusable neglect’ to expand the timeframe for filing an objection, as permitted by state law.”
The changes were needed after West Virginia revamped its workers’ comp adjudication and appeal system, the OIC said.
Comp coverage notice: All employers must continuously post a notice identifying the workers’ compensation insurance carrier, along with contact information. The OIC also maintains a website to verify coverage.
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