Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-18-3 - Definitions As used in this rule, the following terms, words, and phrases have the meanings stated unless in any instance where such term, word, or phrase is employed and the context expressly indicates that another meaning is intended.
3.1. "Audited financial statements" mean the financial statements accompanied by an independent auditor's report which provide reasonable assurance about whether the audited employer has presented fairly the financial position, results of operations, and cash flows in conformity with generally accepted accounting principles or those of another recognized accounting body. This assurance is derived through a systematic process, governed by generally accepted auditing standards or Public Company Accounting Oversight Board standards, of objectively obtaining and evaluating evidence regarding assertions about economic actions and events to determine whether (1) financial information is presented in accordance with established or stated criteria, (2) the entity has adhered to specific financial compliance requirements, if applicable, or (3) the entity's internal control structure over financial reporting and/or safeguarding assets is suitably designed and implemented to achieve the control objectives.3.2. "Commissioner" means the Commissioner of Insurance of the State of West Virginia.3.3. "Decision" means a written statement issued by the Commissioner containing the Commissioner's findings of facts and conclusions as to any issue presented to the Commissioner under this rule. Such decisions include, but are not limited to, notices of delinquency and notices of default. Any purported "decision" which is not in writing has no legal effect under this rule. "Decision" does not include a written statement in the form of e-mail.3.4. "Default" for the purposes of a self-insured employer means the failure by a self-insured employer to cure a delinquency after notification within the time specified in the notice.3.5. "Delinquent" means a self-insured employer has failed, without good cause, to timely pay workers' compensation benefits or to make any other payment due under the terms of chapter twenty-three of the West Virginia Code or the rules promulgated thereunder. For purposes of this subsection, "good cause" means the self-insured employer has:
a. Failed to receive notice of a properly entered order; or b. Failed to act on an order that has been entered in substantive error, is on its face obviously in error as to the amount due or mandates the payment of temporary total disability benefits in excess of those permitted by law.3.6. "Dependent" has the meaning ascribed to that term by W. Va. Code, § 23-4-10(d).3.7. "Employee" has the meaning ascribed to that term by W. Va. Code §§ 23-2-1 and 23-2-1a.3.8. "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.3.9. "Injury" means compensable injuries or illnesses within the meaning of W. Va. Code § 23-4-1 et seq. 3.10. "Payments" are obligations of the self-insured employer for workers' compensation benefits to their injured employees or any other obligations due under the terms of chapter twenty-three of the West Virginia Code or the rules promulgated thereunder.3.11. "Payroll" means the term as defined in the most current approved filing of the Commissioner's designated rating organization for workers' compensation.3.12. "Quarter" means the four calendar quarters: January 1 through March 31; April 1 through June 30; July 1 through September 30; and October 1 through December 31 of each calendar year.3.13. "Self-insurer" and "self-insured employer" mean employers who are eligible and have been granted self-insured status under the provisions of W. Va. Code § 23-2-93.14. "Industrial Council" is the body created pursuant to W. Va. Code § 23-2C-5.