053-5 Wyo. Code R. § 5-2

Current through April 27, 2019
Section 5-2 - Determination Procedure

The following procedures apply to all determinations by the Division, including coverage/compensability determinations, all benefits claim applications, and all medical bill reviews.

(a) The Division will review the matter within 15 days from the date any completed employer or employee injury report or claim is filed and will issue either a final determination or request for additional information.

(b) At the earliest possible date within 45 days following the request for additional information, the Division will make its final determination as to whether the injury, or death resulting from injury, is compensable and within the jurisdiction of the Act or whether and in what amount a claim or bill is allowed.

(c) Upon mutual consent of the worker, the employer, and the Division, the time limit for the determination by the Division may be extended. Otherwise, upon failure of the Division to make a decision within the time allowed by the Act, at the request of any affected party the matter shall be referred by the Division for hearing.

(d) The final determination shall be mailed to all affected parties at their last known addresses, and, when required by law, shall include a statement of reasons, and a notice of right to request a hearing and right to counsel. An affected party shall immediately notify the Division, in writing, of any change of address or physical residence.

(e) Objection. Any affected party may object to the Division's final determination by filing a written request for hearing with the Division within 15 days following the mailing of the determination. W.S. § 27-14-601. A timely written request for hearing is prerequisite to review by the appropriate hearing authority.

053-5 Wyo. Code R. § 5-2