W. Va. Code R. § 93-1-3

Current through Register Vol. XLI, No. 50, December 13, 2024
Section 93-1-3 - Definitions
3.1. Claim Administrator

Where used within this rule, "claim administrator" shall mean the entity with legal authority to administer workers' compensation claims, make awards, and take any other administrative actions as authorized in Chapter Twenty-three of the W. Va. Code. In some places in the code, the term "issuing entity" is used. For purposes of this rule, "claim administrator" and "issuing entity" mean the same thing.

"Claim administrator" includes the Offices of the Insurance Commissioner, any self-administering employer who has been granted self-insured status, any authorized Third Party Administrator, or any private insurance carrier authorized to issue workers' compensation coverage in West Virginia.

3.2. Party

"Party" shall mean the injured worker (claimant), claimant's dependants, the employer, and, with respect to claims involving funds created in 23-2C-1 et seq. of the W. Va. Code, the Offices of Insurance Commissioner. Private carriers, insurance agents, and third party administrators are not parties to the litigation.

3.3. Expedited Hearing

"Expedited hearing", as contemplated by W. Va. Code § 23-4-1c(a)(3), shall mean the final resolution of the issue. The term "hearing" is used in the sense of an opportunity for a party to offer evidence or argument and have his or her cause considered (heard), rather than used in the sense of a formalized appearance before a judge.

3.4. Most Compelling of Good Cause

"Most compelling of good cause", shall mean some extraordinary circumstance and contemplates a more compelling reason than the ordinary "good cause" required elsewhere in the Rule. A reason that might be sufficient for "good cause" may well not be sufficient for "most compelling of good cause".

3.5. Closing Argument and Case Summation

"Closing argument" or "case summation" shall mean a written discussion of the facts and controlling law of the case. Such written summary may be submitted at any time up to ten days after the expiration of the time frame. An argument that is filed later than ten days after the expiration of the time frame may be considered at the discretion of the ALJ. Such summary does not constitute argument in lieu of evidence as defined in subsection 3.6, below, for purposes of section ten [93-1-10 et seq.]

3.6. Argument in Lieu of Evidence

"Argument in lieu of evidence" shall mean a written statement explaining why the claim administrator's ruling is incorrect on its face. Such statement may be submitted instead of submitting new evidence when the party believes that additional evidence is not necessary. Such statement avoids having the claim administrator's ruling automatically affirmed for failure to prosecute under section ten [93-1-10 et seq.]. Such statement must be filed during the protesting party's time frame.

3.7. Record

The "record" upon which a protest is decided shall mean evidence timely submitted by a party to the Office of Judges and evidence taken at hearings conducted by the Office of Judges. For protests acknowledged before April 2, 2007, any documents compelled under the former version of this Rule will remain a part of the record.

W. Va. Code R. § 93-1-3