West Virginia Offices of the Insurance Commissioner 2009 Annual ...

Legal Division
The Legal Division of the Offices of the West Virginia Insurance Commissioner (OIC) performs many
functions including providing legal counsel to the Insurance Commissioner and other agency staff
members, drafting and implementing legislation, administrative rules and informational letters,
investigating agents and companies pursuant to complaints of alleged fraud or other code/rule
violations, responding to general legal questions and Freedom of Information Act requests, litigation,
hearings and coordination of receivership activities.
As of January 1, 2006, a host of new regulatory duties were transferred to the OIC from the former
Workers’ Compensation Commission, and the Legal Division performs several functions relative to
those duties including recovery of pre December 1, 2005 workers’ compensation premium taxes and
fines, collection of fines assessed against uninsured employers and injunction cases filed against
uninsured employers. In addition, the OIC is responsible for the administration of several funds
associated with the workers' compensation system, including the Uninsured Employers' Fund
("UEF" - for claims filed after 1-1-06 against uninsured employers) and the Workers' Compensation
Old Fund (all claims with dates of injury or dates of last exposure before 7-1-05). Legal Division staff
advises and works directly with the third party administrators of the UEF and the Old Fund on the
proper administration, litigation and settlement of these claims.
Some of the major activities of the Legal Division are discussed in more depth below.
LEGISLATION
The following is a brief synopsis of the significant legislation enacted during the 2009 regular session
of the West Virginia Legislature. This information is not to be construed as inclusive of all legislation
which may affect the insurance industry or insurance consumer, nor should it be construed as a
comprehensive explanation of the bills addressed. Rather, the information provided is intended to
highlight the bills significantly affecting the insurance community at large.
BILLS
Senate Bill 278 - Creating felony offense for willful failure to provide certain drug benefits.
(Effective July 10, 2009)
This bill amends W. Va. Code §33-15E-15 to clarify the criminal provisions in the discount
medical/prescription plan act enacted in 2008. In the original legislation, determination of whether the
crime of failing to provide promised benefits to plan members was a misdemeanor or a felony was
based on the “value of the benefits denied” to the member. The bill amends this language to tie the
misdemeanor/felony distinction to the amount of fees paid by the member. Now, if a person collects a
fee for purported membership in a discount medical plan or discount prescription drug plan and
knowingly and willfully fails to provide the promised benefits, he or she is guilty of a felony if the fees
collected total $1,000 or more and a misdemeanor if less than $1,000.
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