Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-17-3 - DefinitionsAs 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.