W. Va. Workers’ Comp Board of Managers Gives Approval to New Rules, Resolutions

April 1, 2004

Executive Director Gregory Burton said four measures approved this week by West Virginia’s Workers’ Compensation Board of Managers represent important building blocks for the Commission’s future success.

The measures include rules governing the medical management of claims and vocational and physical rehabilitation, as well as resolutions regarding the Workers’ Compensation Commission’s new Employer Violator System and pending litigation against coal companies.

“Building a new Commission is not an easy task,” Burton said. “It’s a journey of many steps, and the steps we took today were important ones.”

The comprehensive, 117-page medical management of claims rule establishes reasonable and standardized parameters for appropriate treatments for injured workers, the expected periods of time to reach maximum medical improvement, and ranges of permanent partial disability awards for common injuries and diseases.

The Workers’ Compensation Commission reportedly pays about $225 million each year in medical payments for injured workers. It pays an additional $120 million annually in PPD awards. “This rule is intended to give structure and discipline to both those areas,” said General Counsel T.J. Obrokta Jr.

The Commission uses Presley Reed guidelines in helping to make decisions on appropriate medical care. Medical providers now must provide clear documentation to support additional treatment beyond the guidelines for injured workers. After receiving input from various stakeholders, the Commission changed the standard for continued medical reimbursement from “clear and convincing” evidence to “a preponderance of the evidence.”

Also under the new rule:

*Medical providers must now submit invoices for payment within six months of the date of service. They used to be allowed up to two years. This will help the Commission keep better track of expenses and better manage the claim.
*A nine-page guideline outlines comprehensive treatment for carpal tunnel syndrome.
*Treatment guidelines are provided on multidisciplinary pain management and the interventional management of chronic pain.
*A 14-page section which significantly overhauls the Commission’s approach to occupational pneumoconiosis (OP) claims.

The vocational and physical rehabilitation rule increases from $10,000 to $20,000 the maximum allowed expenditure for vocational rehabilitation for any one injured employee; allows employers to contract with preferred providers for rehabilitation services; and limits the duration wage that replacement benefits are paid to rehab participants.

Last year, the Commission spent about $26 million for rehabilitation services. Roughly $20.2 million of that total went to qualified rehabilitation professionals in fiscal 2003. Under the new rule, the services of QRPs will be charged against the $20,000 cap – a significant change from prior practice. QRP charges were not included in the former $10,000 cap.

“Again, in response to feedback we received from the public, we agreed to ‘grandfather’ expenditures in rehab plans that took place on or before July 1, 2003, so they do not fall under the $20,000 cap,” Burton noted.

QRPs charge roughly $65 per hour to develop a rehab plan, submit the plan to the Commission for approval, and then implement the plan. “With this new rule, we will be able to monitor those charges, as a matter of law and as a matter of fiscal responsibility,” Obrokta said.

The new Employer Violator System, which becomes operational in April, allows the Commission to reportedly be more proactive in enforcing premium collections and prevent companies that don’t pay their premiums from simply closing shop and then reopening under a new name.

“Any individual with an interest of 10 percent or more in a defaulted company, or who serves as an officer or director of that company, will be blocked from receiving a new business license, and can have an existing license revoked, by any state agency,” Burton explained.

The EVS was developed in conjunction with a previous rule that went into effect March 1 regarding the revocation of business licenses for employers that go into default. Lists of these companies as well as their officers, directors and stakeholders with an interest of 10 percent or greater will be available to the public on the Commission’s Web site.

Employers who do not file their quarterly premiums on time are in delinquency for the first 60 days following the due date. Default occurs when an employer fails to cure its delinquency within those 60 days. A defaulted employer loses its civil immunity, exposing the employer to potential lawsuits from its injured workers.

A separate resolution authorized the Commission to proceed with seven pending lawsuits in Kanawha and McDowell counties, and to continue a contract with the Charleston law firm of DiTrapano, Barrett & DiPiero to represent the Commission in those cases.

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