Current through Register Vol. XLI, No. 45, November 8, 2024
Section 85-21-3 - 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.
3.1. "Executive Director" means the executive director of the West Virginia Workers' Compensation Commission pursuant to W. Va. Code § 23-1-1b.3.2. "Commission" means the West Virginia Workers' Compensation Commission as provided for by W. Va. Code § 23-1-1.3.3. "Injury" and derivative words have the meaning ascribed to the term "injury" by W. Va. Code § 23-4-1.3.4. "Injured worker" and "claimant" mean an employee entitled to workers' compensation benefits as the result of a work-related injury, as provided under W. Va. Code § 23-4-1.3.5. "Employer" has the meaning ascribed to that term by W. Va. Code § 23-2-1, which includes, but is not limited to, any individual, sole proprietor, firm, partnership, limited partnership, limited liability company, joint venture, association, corporation, company, organization, receiver, estate, trust, guardian, executor, administrator, government entity or any other entity regularly employing another person or persons for the purpose of carrying on any form of industry, service or business in this state.3.6. "Managed health care plan" means a plan that establishes, operates, or maintains a network of health care providers that have entered into agreements with the plan to provide health care services to injured workers to whom the plan has the ultimate obligation to arrange for the provision of or payment for services through organizational arrangements for ongoing quality assurance, utilization review programs, or dispute resolution.3.7. "Provider" means any physician, hospital or other person or organization, which is licensed or otherwise authorized in this state to provide health care services or supplies.3.8. "Utilization review" means the critical examination of health care services provided to patients especially for the purpose of controlling costs and monitoring the quality of care.3.9. "Insurance Commissioner" means the insurance commissioner of West Virginia as provided in section one, article two, chapter thirty-three of the West Virginia Code. 3.10. "Insurer" shall mean 1) a self-insured employer; or 2) a private carrier.3.11. "Private Carrier" means any insurer authorized by the insurance commissioner to provide workers' compensation insurance pursuant to chapters twenty-three and thirty-three of the West Virginia Code, but shall not include self-insured employers.