Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-5-3 - Completion and Support of PTD Application3.1. A PTD Application will not be processed by the Commission, self-insured employer or private carrier, whichever is applicable, unless and until a Commission or insurance commissioner approved application is filed with the Commission, self-insured employer or private carrier that has been properly and fully completed, and is accompanied by all supporting information requested by the Commission, self-insured employer, or private carrier in its sole discretion. The PTD Application shall be on a form provided by the Commission or insurance commissioner which shall solicit the following information: b. Applicant's social security number;c. Applicant's injuries and dates of injuries;d. Applicant's date of birth;f. Applicant's phone number;g. Applicant's current employment status (employed, unemployed, self-employed, off due to injury);h. Details regarding any efforts by the Applicant to apply for and/or receive social security benefits, of any type;i. Details regarding any efforts by the Applicant to apply for and/or receive a retirement benefit of any type, include, but not limited to, receipt of a defined benefit or disability pension plan. The Applicant shall advise as to whether he or she contributed to the retirement plan and whether the plan benefit is being paid under the terms and conditions of a collective bargaining agreement;j. All workers' compensation claims indicating their claim number, the date of injury, the injured body part, the impairment rating, if any, awarded in the claim, and the name of the employer and the employer's insurer in the claim;k. All disability claims filed with any other state or federal agencies;l. Copies of all medical reports indicating that the claimant has a permanent impairment;m. Information regarding any non-work related injuries or diseases suffered by the Applicant;o. Prescription drug history;p. Employment history, including dates on employment for each employer;q. Military history; and r. Education history.3.2. The PTD Application shall contain a Fraud Warning and shall reference applicable criminal and civil penalties as set forth in Chapter 23 and Chapter 61 of the West Virginia Code and, upon termination of the Commission, shall also reference applicable penalties under Chapter 33 of the West Virginia Code.3.3. The Commission, self-insured employer or private carrier may utilize an Application for determining whether a claim should be opened for consideration as more fully set forth in West Virginia Code Section 23-4-6(n)(1) which solicits the information set forth in 3.1 that is pertinent to such determination and may thereafter utilize an Application Addendum or Supplemental Application to solicit more detailed information if the Commission, self-insured employer or private carrier determines that the requirements of West Virginia Code Section 23-4-6(n)(1) have been met. A claim will not be re-opened for PTD consideration unless the Application has been filed within five (5) years of the date of closure of the claim, or within five (5) years of the date of the initial PPD award, whichever is applicable, as required by West Virginia Code Section 23-4-16. Further, any request for reopening shall be subject to the limitation on the number of requests (two) as contained within the provisions of W. Va. Code § 23-4-16(a)(1).3.4. The Applicant shall submit detailed and complete information regarding any benefits being paid to the Applicant through a retirement plan, wage replacement plan, salary continuation plan or other benefit plan provided by any current or former employer. The Applicant shall supply any evidence illustrating that he or she contributed to the plan and/or that the benefits being paid under the terms and conditions of a collective bargaining agreement.3.5. The Applicant shall execute and update any and all Releases or Authorizations required by the Commission, self-insured employer or private carrier, including, but not limited to, those Releases and Authorizations required for the Commission, self-insured employer, or private carrier to obtain state and federal tax records, financial records, affidavits, income records, social security records, employment records, military service records, medical records, education records and records held by other insurers, including self-insured employers.3.6. All material information required in Sections 3.1-3.5 must be received by the Commission, self-insured employer, or private carrier before the PTD Application will be deemed complete and adequately supported.3.7. No issue of permanent total disability may be referred to reviewing body unless a properly completed and supported application for permanent total disability benefits has been received by the Commission, self-insured employer, or private carrier. Prior to the referral of any issue to the reviewing body, the commission, self-insured employer or private carrier shall conduct examinations of a claimant that it finds necessary and obtain all pertinent records concerning a claimant's medical history and reports of examinations and forward them to the reviewing body at the time of the referral.3.8. Claimants' whose applications for permanent total disability benefits do not satisfy the re-opening requirements of West Virginia Code Section 23-4-6(n)(1), as determined in the sole discretion of the Commission, self-insured employer, or private carrier, shall not be referred to the reviewing body and said decision shall be issued as a protestable order.3.9. For all applications received on or after June 1, 2005, a claim determined to be eligible for evaluation for a permanent total disability award shall be ruled on by the reviewing body within one (1) year from the date such eligibility was determined. Nevertheless, for good cause, this period may be extended by the Commission, self-insured employer, or private carrier at the request of the employer or injured worker