W. Va. Code R. § 85-24-6

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-24-6 - Qualifications For Loss Management Service Providers

In order to offer a credit to its client employers, a loss management service provider must submit and receive approval of its loss management program from the commission following the procedures outlined below and containing the key elements indicated.

6.1. Loss management service providers must submit a loss management program to the workers' compensation commission. The program shall be submitted in a time frame and form as prescribed by the commission. Such submission shall be in a manner prescribed by the commission and in accordance with the rules of the purchasing division of the West Virginia department of administration. Each loss management service provider shall meet the following minimum qualifications.

6.2. A loss management service provider must be recognized by the commission.

6.3. Personnel. A loss management service provider must evidence its ability to perform services based upon qualifications of its operating personnel. All elements of operating personnel qualifications shall be reviewed.

6.3.1. Information regarding the job-related training and experience of all operating personnel must be submitted to the commission.

6.3.2. Each loss management service provider shall have specialists on staff including experienced and qualified specialists in safety and occupational health.

6.4. Safety. A loss management service provider must have a structured approach to focus top level management of the employer, as well as other employer personnel, on safety.

6.4.1. A loss management service provider must provide a means of measuring and insuring the employer's commitment to implementing safe workplace practices.

6.4.2. A loss management service provider must provide for the implementation of a joint labor and management safety committee as part of its loss management program.

6.5. Safety audit. A loss management service provider shall provide an annual safety audit of each client employer. Such an audit shall include, but not be limited to, a report of all occupational injuries or illnesses.

6.5.1. Where such client employer is subject to the recording and reporting provisions of 29CFR Part 1904, the report shall include the information required in the format prescribed by the commission (form OSHA No. 200 or successor).

6.5.2. Where such client employer is subject to the recording and reporting provisions of 30CFR Part 50, the report shall include the information required in the format prescribed by the commission (MSHA Mine Accident, Injury, and Illness Report Form 7000-1 or successor).

6.5.3. Where such client employer is not subject to either of the foregoing federal reporting regulations, the report shall include the information required in the format prescribed by 29CFR Part 1904 (form OSHA No. 200 or successor).

6.6. Post injury response. A loss management service provider must provide a loss management program which:

6.6.1. Contains plans of action and specific techniques, consistent with the Act, which are designed to assist an injured worker in obtaining necessary medical care;

6.6.2. Contains specified means of maintaining contact with the injured worker and continuing claims control throughout the recuperation period;

6.6.3. Contains specified means of maintaining contact with medical providers throughout the recuperation period; and

6.6.4. Contains specified means to encourage an injured worker to return to work at the earliest possible time, including the development of modified work programs.

6.7. These additional elements must be included in a loss management program:

6.7.1. The approved loss management service provider may not discriminate against any eligible client employer desiring to avail itself of the credit assigned to the service provider by the commission;

6.7.2. The program must contain a provision stating that the credit factor applicable to the first year is subject to change in the second and third years;

6.7.3. The program must contain a provision stating that a credit will not apply after the client employer has received a credit for three (3) years; and

6.7.4. The program must contain a provision stating that a client employer must be involved in the program for three (3) years before eligibility for the credit is established.

6.7.5. The program must contain a provision that the qualified loss management service provider shall notify the commission, prior to commencement of qualified loss management services, of each participating client employer.

6.7.6. The program shall contain a provision to allow a qualified loss management service provider to terminate its services to a client employer or to a member or members of an employer group prior to the expiration of the one year eligibility requirement in the event the client employer is not committed to workplace safety, resulting in a reduction of occupational injuries and illnesses, and post injury assistance to the worker.

a. Disputes under this provision between qualified loss management service providers and client employers are not subject to resolution under the provisions of this rule.

b. Wrongful termination by a qualified loss management service provider may, in the commission's discretion, result in withdrawal of plan approval under section nine of this rule.

W. Va. Code R. § 85-24-6