W. Va. Code R. § 85-20-23
Current through Register Vol. XLI, No. 50, December 13, 2024
Section 85-20-23 - Miscellaneous Coverage and Reimbursement Issues23.1. Hernia. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, shall not approve payment for conservative treatment of an otherwise compensable hernia condition, except for the initial examination for diagnostic purposes, and except where it is shown that the employee has some chronic disease or is otherwise in such physical condition that it is considered unsafe for him to undergo such operation. Payment for surgical repair of a hernia cannot be considered until all required forms have been filed and the claim determined compensable.23.2. Amputation reports. In cases involving amputations, the physician must mark the exact line of amputation on the prescribed form (Amputation Chart). To avoid error, the exact point of amputation must also be described in the written report and the Amputation Chart and report must be carefully checked to be certain that they agree. IV. SPECIFIC TREATMENT GUIDELINES
The following are treatment guidelines for specific conditions. However, the usage of the term "guidelines" should not be interpreted to suggest that the guidelines are to be given any less legal weight than an exempt legislative rule is otherwise given. The provisions of Section 4 of this Rule apply in their entirety to these guidelines.
W. Va. Code R. § 85-20-23