W. Va. Code R. § 102-1-17

Current through Register Vol. XLII, No. 1, January 3, 2025

Section 102-1-17 - Failure to Timely Rule on Application, Petition, or Motion

17.1. Scope. W. Va. Code § 23-4-1c(a)(3) provides a remedy to the claimant when the private carrier or self-insured employer fails to timely issue a ruling, as provided by law, on any application or motion. The Offices of the Insurance Commissioner, and its third-party administrators, are not specifically included in the statute and are, therefore, not subject to this process.

17.2. Initiation of process. In order to initiate this process, the claimant must submit in writing to the Board of Review a statement setting forth the following information:

17.2.1. The claimant's name, address, phone number, date of injury (or last exposure), employer's name and address, and insurer's name;

17.2.2. The policy number, claim number, and case number, if known;

17.2.3. The nature of the action requested of the insurer or self-insured employer, whichever is applicable;

17.2.4. The date the action was requested of the insurer or self-insured employer, whichever is applicable;

17.2.5. The address to which the request was mailed or delivered.

17.3. The written submission or statement shall be provided by the claimant to the employer and the employer's private carrier or the employer's claim administrator, whichever is applicable.

17.4. Upon receipt of a properly completed written submission or statement, the Board of Review will immediately provide notice to the employer and the employer's private carrier or employer's claim administrator, whichever is applicable, setting forth a deadline for submission of any statements or evidence that any party wishes to submit for consideration by the Board of Review.

17.5. Reports to the Offices of the Insurance Commissioner. Upon entry of an expedited decision, if the Board of Review has made a finding that a private carrier or self-insured employer has failed to timely issue a ruling on any application or motion, the Board of Review shall transmit a copy of the decision to the Offices of the Insurance Commissioner. Upon receipt thereof, the Offices of the Insurance Commissioner will review the decision and may undertake any further investigation, initiate a regulatory or administrative action, or initiate a civil enforcement action, or undertake any combination thereof, against the applicable private carrier or self-insured employer, as is determined to be necessary and appropriate by the Offices of the Insurance Commissioner.

W. Va. Code R. § 102-1-17