Current through Register Vol. XLI, No. 16, April 19, 2024
Section 85-1-2 - Definitions 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.
2.1. "Acted upon" means, but is not limited to, any one of the following: 1) received and processed; 2) contacted a claimant, employer, or medical provider in any fashion requesting more information; 3) reviewed and examined by medical personnel; 4) conducted a potential overpayment analysis; 5) cross-checked with other state agencies for relevant information; and 6) and other similar administrative steps which must be taken before a request can be ruled upon.2.2. "Board of Review" means the workers' compensation board of review created pursuant to W. Va. Code § 23-5-1 et seq.2.3. "Decision" means any determination by a responsible party regarding the compensability of a claim, the award or denial of any type of benefit in a claim, or any other substantive request by a claimant in a claim.2.4. "File" means: 2.4.a. If mailed, the date on which document being postmarked;2.4.b. If faxed, the date on which fax is sent;2.4.C. If emailed, the date on which email is sent to the email address for the recipient; and2.4.d. If hand delivered, the date on which the document is delivered.2.5. "Employer" means an employer within the meaning of W. Va. Code § 23-2-1, et seq.2.6. "Injury" and derivative words have the meaning ascribed to the term "injury" by W. Va. Code § 23-4-1.2.7. "Commissioner" means the Insurance Commissioner of West Virginia or any designated third-party administrator of the Insurance Commissioner.2.8. "Office of Judges" means the workers' compensation office of administrative law judges pursuant to W. Va. Code § 23-5-1 et seq.2.9. "Paid" means the time a check is deposited in the mail or presented in person to the claimant, claimant's attorney or anyone acting in his or her behalf. 2.10. "Private carrier" means an insurer authorized by the Insurance Commissioner to provide workers' compensation insurance pursuant to chapters twenty-three and thirty-three of the West Virginia Code and any third-party administrator designated by the private carrier to adjust West Virginia workers' compensation claims.2.11. "Receipt" means: 2.11.a. If mailed or hand delivered, the date on which the document is delivered into the possession of the responsible party;2.11.b. If emailed, the date on which the document is received in the email inbox of the responsible party; or2.11.c. If faxed, the date on which the document is received in the fax machine of the responsible party. 2.12. "Responsible party" means the Insurance Commissioner, private carrier or self-insured employer, whichever is applicable.2.13. "Self-insured employer" means an employer who is eligible and has been granted self-insured status pursuant to the provisions of W. Va. Code § 23-2-9 and the rules promulgated thereunder, and any third-party administrator designated by the self-insured employer to adjust West Virginia workers' compensation claims.2.14. "West Virginia workers' compensation coverage" means workers' compensation coverage which provides the employees of an insured employer workers' compensation benefits consistent with chapter twenty-three of the West Virginia Code and the rules promulgated thereunder.