W. Va. Code R. § 85-9-3

Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-9-3 - Application for Benefits from the UEF
3.1. If an individual believes that he or she may be entitled to benefits under the UEF, then he or she shall complete an application for benefits from the UEF on a form created by the Commissioner. The Commissioner reserves the right to change the UEF application form from time to time as deemed necessary. Completion of the application for benefits is an absolute prerequisite for any entitlement to benefits from the UEF.
3.2. Upon receipt of an application for benefits, the Commissioner shall send a letter to the employer which notifies the employer that one of its employees has made a claim against the UEF.
3.3. The Commissioner shall determine whether:
(1) the claimant's employer was required to carry workers' compensation coverage on the date of the injury or last exposure; and
(2) if the claimant's employer was required to carry workers' compensation coverage on the date of the injury or last exposure, whether applicable workers' compensation coverage existed on the date of injury or date of last exposure.
3.3.a. If the Commissioner determines that:
(1) applicable workers' compensation coverage existed on the date of injury or date of last exposure; or
(2) the employer was not required to carry workers' compensation coverage on the date of injury of last exposure, then the Commissioner shall send the claimant a letter, copied to the employer, informing the claimant of this determination, and that the claim is not eligible to receive benefits from the UEF. Additionally, in the case that the Commissioner determines that applicable workers' compensation coverage existed on the date of injury or date of last exposure, the letter described in this subdivision shall also be copied to the insurance carrier which provided such coverage.
3.3.b. If the Commissioner determines that:
(1) the employer was required to carry workers' compensation coverage on the date of injury or date of last exposure; and
(2) no applicable workers' compensation coverage existed on the date of injury or date of last exposure, then the Commissioner shall send the claimant a letter, copied to the employer, informing the claimant of this determination, and that the claim is eligible to receive benefits from the UEF. If the claim is deemed eligible to receive benefits from the UEF, the Commissioner shall begin to administer the claim consistent with the provisions of chapter twenty-three of the West Virginia Code and the rules promulgated thereunder.
3.4. If, after rendering a determination as described in subdivisions a. and b., subsection 3.3. of this section, the Commissioner receives evidence to indicate that the determination was erroneous, the Commissioner reserves the right to enter a corrective determination remedying the previous erroneous determination.
3.5. Decisions made by the Commissioner as described in this section are protestable to the Workers' Compensation Office of Judges pursuant to the provisions of W. Va. Code § 23-5-1et seq.

W. Va. Code R. § 85-9-3