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