Current through Register Vol. XLI, No. 24, June 14, 2024
Section 85-20-8 - Additional Reporting Requirements8.1. Whenever requested by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, and at least every ninety (90) days in situations regarding the continuation of temporary total disability benefits, the medical provider shall report on the condition and treatment of the injured worker. The following information must be included in this type of report. a. The condition(s) diagnosed including ICD-9-CM codes and the objective and subjective findings.b. Their relationship, if any, to the industrial injury or exposure.c. Outline of proposed treatment program, its length, components, and expected prognosis including an estimate of when treatment should be concluded and condition(s) stable. An estimated return to work date should be included. The probability, if any, of permanent partial disability resulting from industrial conditions should be noted.d. If the worker has not returned to work, the attending doctor should indicate whether a vocational assessment will be necessary to evaluate the worker's ability to return to work and why.e. If the worker has not returned to work, a doctor's estimate of physical and functional capacities should be included with the report. If further information regarding physical and functional capacities is needed or required, a performance-based functional capacity evaluation can be requested. Functional capacity evaluations shall be conducted by a licensed health care provider approved by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, to perform this testing.8.2. To the extent the information called for in Section 8.1 is not required on Attending Physician's Report in use by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, the medical provider shall complete the Attending Physician's Report in its entirety and provide any additional information set forth in Rule 8.1 in the form of a narrative report.8.3. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, may request, and the medical provider shall provide all chart notes relating to the evaluation and treatment of an injured worker.8.4. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, in its sole discretion, may require additional reporting on forms and in intervals as it deems necessary. Medical providers shall comply with the requests of the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, in this regard. Failure to make reports promptly may result in the delay of payments of benefits to the injured worker and denial of payment to the medical vendors for services rendered.8.5. By application for benefits, an injured worker irrevocably waives patient-physician confidentiality and agrees that physicians and health care providers may release and discuss the injured worker's medical history and medical reports pertaining to the compensable injury or disease to the injured worker's employer, employer's representative, or representatives of the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, assuming such discussions are otherwise permissible under applicable law. Such discussion includes the injured worker's condition, treatment, prognosis, anticipated period of disability and dates when the injured worker will reach maximum medical improvement or be released to return to work. Any prior injury or disease of the injured worker which impacts the alleged injury or treatment is covered by this agreement. The claimant's agreement to the release of information from physicians and health care providers includes agreement to the release of information held by facilities where the treatment was provided. Such facilities include, but are not limited to hospitals, clinics, emergency care facilities, surgical centers, outpatient care facilities, diagnostic testing facilities and rehabilitation facilities. 8.6 In any claim where only medical benefits are being paid, the medical provider shall provide the report described in section 8.1 within thirty (30) days of being requested to do so by the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable.8.7. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, shall make referrals of claimants to physicians for independent medical examinations and evaluations as required by the West Virginia Code within twenty (20) days of the end of the one hundred twenty (120) period of temporary total disability, unless from the record the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, has a reasonable belief that the period of temporary total disability exceeds one hundred twenty (120) days.