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

The focused settlement initiative has considerably contributed to the increase in claim closures
as indicated above. This has produced significant savings and overall reduction in the reserves. The
OIC has a settlement team in place that holds weekly meetings on the larger settlements. The TPA
presents the claim(s) and the proposed settlement range, dollar authority is given at the meetings. The
settlement team consists of: OIC’s General Counsel, Insurance Program Manager of Claims Services,
WC System Specialist II from Claims Services, and multiple attorneys from the Attorney General’s
office.
The old fund consists of claims with a date of injury or date of last exposure prior to July 1,
2005; this remains the responsibility of the State of West Virginia. The Insurance Commissioner was
required to assume responsibility for administering and managing the old fund from BrickStreet
Mutual Insurance, the statutorily mandated Third Party Administrator of the old fund from July 1,
2005 to December 31, 2007. It should be noted there are new occupational disease claims that are
submitted to Claims Services for entry and establishment of the claim, these applications have a date of
last exposure prior to July 1, 2005. In addition, new claims are filed for Federal Black Lung (FBL),
the date of last exposure for these claims, must be prior to January 1, 2006. Under the enactment of
1556, Health Care Bill, we have seen an increase in the filing of FBL claims.
In addition, this Division performs a number of regulatory duties. The Occupational
Pneumoconiosis (OP) Board and the Permanent Total Disability Review Board (PTDRB) dockets are
maintained in this Division. We have one full-time designated occupational pneumoconiosis (OP)
employee that handles the OP applications. This individual prepares the files and maintains the docket
for the OP Board and prepares the files for hearings before the Office of Judges. In FY 2010, there
were 561 examinations scheduled before the Occupational Pneumoconiosis Board, and 180 fatal
reviews. The PTDRB docket has been overseen in this Division since October 2008. In FY 2010, the
PTDRB reviewed a total of 138 applications; including initial, remands and final reviews. In addition,
the board reviewed 39 for employability standards as set out in Senate Bill 2013. Applications are
received for the old fund, new carriers and self-insured employees.
Regulatory Boards FY 2010 FY 2009
OP Board Examinations 561 602
OP Board Fatal Reviews 180 124
PTDRB Reviews (Initial, Remands, Finals) 138 123
PTDRB Vocational Reviews 39 48
Also, the Division reviews applications for access to the Workers’ Compensation Claims Index.
The Claims Index is legislatively mandated uniform system of gathering workers’ compensation claim
information in order to make it available to the workers’ compensation industry. The index contains
basic demographic data to assist insurers in obtaining information from other insurers regarding
previously filed workers’ compensation claims by a particular claimant. Applications are approved or
denied by a WC System Specialist II within this Division.
This Division remains committed to providing oversight of the old fund claims to assure
statutory compliance, quality claims processing and cost efficient management.
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