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

Workers’ Compensation Office of Judges
The primary responsibility of the Office of Judges is to process protests from initial workers’
compensation claim management decisions made by insurers or their agents. Jurisdiction of the Office
of Judges commenced on July 1, 1991. Early in the history of the office, the sole responsibility was to
perform judicial review of actions of the Administrative Agency, the Workers’ Compensation
Division. Since privatization of the workers’ compensation market in 2005, the Office of Judges
reviews claim management decisions from Private Insurance Carriers and Self Insured Employers, as
well as claim management decisions from the Third Party Administrator’s, which administer the
legacy claims of the former Workers’ Compensation Commission. Our goal is to resolve these protests
in a fair, efficient, and timely manner.
The Office of Judges currently employs sixty-three employees, including nineteen
Administrative Law Judges. The operation is housed in three primary locations: Charleston, Beckley
and Fairmont. Additionally, evidentiary hearings are conducted in seven venues across the State,
including Charleston, Beckley, Fairmont, Parkersburg, Wheeling, Elkins and Martinsburg.
The issues in litigation traditionally arise under Chapter 23 of the West Virginia Code, as well
as a plethora of Workers’ Compensation Rules found in Title 85 of the Code of State Regulations. The
Office of Judges is governed by procedural rules found in 93 CSR 1, Litigation of Protests, and 93
CSR 2, Time Standard Rules. Pursuant to rule, the Office of Judges establishes a deadline for the
filing of evidence by the parties. The Office of Judges conducts hearings, receives and weighs
evidence, as well as receives argument by the parties. At the end of the evidentiary time frame, a
written decision is issued by an Administrative Law Judge.
In addition to traditional workers’ compensation appeals, the Office of Judges also conducts
hearings or review of other legal matters, including the following:
Failure to Timely Act or Rule on a Claim Request: W.Va. Code § 23-4-1c(a)(3)
provides a process by which claimants may seek review by the Office of Judges when a
self-insured employer, or any private insurance carrier, fails to timely rule or act upon
any request or motion in a workers’ compensation claim.
Award of Attorney Fees for Unreasonable Denial of Benefits by the Insurance Carrier:
W.Va. Code §23-2C-21(c) provides that the Office of Judges may order a self-insured
employer, or any private insurance carrier, to pay reasonable attorney fees and expenses
to claimants when the Office of Judges determines that the original denial of a claim or
treatment request was unreasonable.
Workers’ Compensation Default List: An employer in default of payment of workers’
compensation premiums may be liable to the Offices of the Insurance Commissioner
(“OIC”) for all medical and indemnity payments, administrative expenses, attorney fees
and interest. The employer will remain on the default list until all payments are current
and can be fined up to $10,000.00. The Office of Judges has been designated as the
entity to review final decisions by the OIC regarding placement of an Employer on the
Workers’ Compensation Default List. Review by the Office of Judges must be
conducted in accordance with the West Virginia Administrative Procedures Act.
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