Current through Register Vol. XLI, No. 41, October 11, 2024
Section 85-1-10 - Time Standards10.1. Injiuy and occupational disease claims. -- The responsible party shall rule on claims based upon injuries and occupational diseases other than occupational pneumoconiosis that are properly executed and filed on prescribed forms with the responsible party within fifteen (15) working days from the receipt of all required information by the responsible party. The responsible party shall consider all information and proof properly submitted in connection with each claim. Whenever a claim has not been adequately or properly developed for consideration, the responsible party may require the production of additional evidence. The fifteen (15) working days to rule on the claim shall be tolled during this evidence gathering process.10.2. Occupational Pneumoconiosis claims. " The responsible party shall enter nonmedical decisions in occupational pneumoconiosis claims vdthin ninety (90) days from the date the responsible party receives properly executed, prescribed forms. The responsible party shall consider all information and proof properly submitted in connection with each claim. Whenever the responsible party is of the opinion that a claim has not been adequately or properly developed for consideration, it may require the production of additional evidence. The ninety (90) days shall be tolled for no more than thirty (30) additional days during this evidence gathering process.10.3. Medical treatment, medications, appHances, devices and supplies. -- The responsible party shall act upon an injured worker's request for authorization of medical treatment, medications, appliances, devices and supplies within fifteen (15) working days from the date the request was received by the responsible party.10.4. Medical evaluations. 10.4.a. The responsible party shall refer claimants to physicians for examinations and evaluations as required by W. Va. Code § 23-4-7a within twenty (20) days of the end of the one hundred twenty (120) day period of temporary total disability: Provided, That if the period of expected temporary total disability exceeds one himdred twenty (120) days, the responsible party shall make the referral within twenty (20) days of the end of the expected period of disability.10.4.b. Examinations and evaluations to be performed by the Occupational Pneumoconiosis Board shall be scheduled and notice of the scheduling shall be transmitted to the parties within sixty (60) days after issuance of a non-medical decision directing referral to the Board.10.5. Permanent disability decisions. 10.5.a. The responsible party shall act on a permanent disability evaluation report received from a physician to whom the responsible party referred a claimant in a claim for injuries and occupational diseases other than occupational pneumoconiosis within thirty (30) working days of receipt by the responsible party of the report.10.5.b. The responsible party shall make a referral of a claimant to a physician for examination and evaluation in response to a request by or on behalf of the claimant for consideration of a permanent disability award in a claim for injuries and occupational diseases other than occupational pneumoconiosis within thirty (30) working days from the date the request was received by the responsible party.10.5.c. Permanent partial disability awards may be paid, at the discretion of the responsible party, either by lump sum or in installments consistent with applicable law. Payment of permanent partial awards shall commence within fifteen (15) working days of the decision granting the award.10.5.d. Findings of the Occupational Pneumoconiosis Board shall be transmitted to the parties within thirty (30) working days after the date of examination by the Board.10.6. Application for reopening. Applications for reopening of claims for temporary or permanent disability benefits shall be ruled upon by the responsible party within thirty (30) days from the date of receipt of the application by the responsible party. The responsible party shall consider all information and proof properly submitted in coimection with the application. Whenever a claim has not been adequately or properly developed for consideration, the responsible party may require the production of additional evidence. The thirty (30) days to rule on the claim shall be tolled during this evidence gathering process.
10.7. Orders. A responsible party shall comply with all orders of the Office of Judges and the Board of Review and all mandates of the West Virginia Supreme Court of Appeals within thirty (30) days after the date of receipt, unless the responsible party is required to act sooner under the terms of the order or mandate or the order or mandate is subject to a lawftiUy ordered stay.