W. Va. Code R. § 85-20-17

Current through Register Vol. XLI, No. 24, June 14, 2024

Section 85-20-17 - Unusual treatment

17.1. In cases requiring unusual treatment not contemplated under ordinary circumstances, the medical vendor must inform the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, immediately of the condition or complications present. If the necessity for additional treatment and its causal relationship with the compensable injury is clearly indicated, authorization for such treatment may be granted by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, if it otherwise is deemed to be medically reasonable and additional professional fees may be paid at a rate commensurate with the services rendered in addition to the fee specified by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable.

17.2. New or experimental therapies always require prior authorization from the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, will require a detailed, credible and otherwise sufficient explanation of the anticipated outcomes of the proposed therapy. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, may authorize a trial of the therapy, for a duration identified by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, prior to acceptance of any modality. Approval of new or experimental therapies is within the sole discretion of the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable.