W. Va. Code R. § 93-1-18

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

Section 93-1-18 - Failure of Administrator to Timely Rule on Application, Petition, or Motion

18.1. Scope

W. Va. Code § 23-4-1c(a)(3) provides a remedy to the claimant when the private carrier or self-insured employer fails to timely issue a ruling, as provided by law, on any application or motion. The Offices of the Insurance Commissioner, and its third party administrators, are not specifically included in the statute and are, therefore, not subject to this process.

18.2. Initiation of Process

In order to initiate this process, the claimant must submit in writing to the Office of Judges a statement setting forth the following information:

A. The claimant's name, address, phone number, social security number, date of injury (or last exposure), employer's name and address, and insurer's name;

B. The policy number, claim number, and case number, if known;

C. The nature of the action requested of the insurer;

D. The date the action was requested of the insurer;

E. The address to which the request was mailed or delivered.

The Office of Judges will provide a form for the submission of the required information.

18.3. Notice to Employer

Upon receipt of a properly completed statement, or form, the Office of Judges will immediately transmit a copy of the statement, or form, to the employer. The notice shall order the employer to make a ruling, or take required action, within the time limits provided by the applicable statute or regulation.

The notice shall also set a deadline for submission of any statements or evidence that either employer or claimant wishes to submit for consideration by the Office of Judges.

18.4. Findings of Office of Judges

Following the deadline for submission of statements or evidence, the Office of Judges will review the matter and report findings of fact and conclusions of law to the Offices of the Insurance Commissioner. The Offices of the Insurance Commissioner may take such administrative action as it determines to be justified.

W. Va. Code R. § 93-1-18