W. Va. Code R. § 85-20-63

Current through Register Vol. XLI, No. 24, June 14, 2024
Section 85-20-63 - Expected period of time to reach maximum medical improvement

Pursuant to W. Va. Code § 23-4-3b(b), the Commission or Insurance Commissioner, whichever is applicable, hereby incorporates by reference the Medical Disability Advisor, Workplace Guidelines for Disability Duration, Presley Reed, MD (4th Edition) ("Presley Reed Guide") for purposes of establishing the expected period of time to reach maximum medical improvement and for continued treatment for various injuries and diseases. The requirements, standards, parameters and limitations of the Presley Reed Guide shall have the same force and effect as this Rule. All requirements, standards, parameters and limitations of the Presley Reed Guide are hereby deemed medically reasonable and any requirements, standards, parameters and limitations which exceed those set forth in the Presley Reed Guide are hereby deemed medically unreasonable. A preponderance of evidence, including but not limited to, detailed and documented medical findings, peer reviewed medical studies, and the elimination of causes not directly related to a compensable injury or disease, must be presented to establish that requirements, standards, parameters and limitations in excess of those provided for in the Presley Reed Guide are medically reasonable.

Nothing in this rule shall prohibit employers, private carriers or self-insured employers, whichever is applicable, from using other guidelines for the purpose of establishing the expected period of time and medical treatment protocols necessary to reach maximum medical improvement for various injuries and diseases, as long as such guidelines are part of a managed care plan otherwise approved by the Commission or Insurance commissioner, whichever is applicable, pursuant to W. Va. Code § 23-4-3(b)(2)(2003).

VII. RANGE OF PARTIAL DISABILITY AWARDS FOR COMMON INJURIES AND DISEASES

W. Va. Code R. § 85-20-63