WV WORKERS’ COMPENSATION LEGAL PROCESS FLOW CHART ADJUSTER MUST COMPLY WITH APPELLATE ORDERS WITHIN 30 DAYS OF RECEIPT UNLESS STAY IS GRANTED
If No Protest is Filed, the Order is Final.
Adjuster Enters Protestable Order Granting/Denying Benefits
Claimant or Employer Files Protest with the WV Office of Judges within 60 days. If Good Cause is Shown, OOJ may allow filing of protest outside of 60 day deadline.
00J Complies with BOR Order and Addresses Issues to be Resolved. Additional evidentiary development may be allowed.
If Remanded by the Board of Review back to the Office of Judges, the Litigation Process Begins Anew
OOJ Acknowledges Protest and Enters Time Frame Order Setting Forth Deadlines for the Submission of Evidence
Obtain Counsel to Represent Interest of Employer
OOJ Issues Decision after Expiration of Time Frame. A Party may File and Appeal with the WV Board of Review within 30 days of Receipt of the OOJ Decision.
If No Party Appeals, the 00J Decision is Final.
If a Party Appeals, the Board of Review Sets for a Briefing Schedule for Submission of Briefs.
WV Board of Review issues an Order Affirming or Reversing the 00J Decision. The BOR may also Remand the Claim back to the 00J for further evidentiary development and investigation.
A Party may file a Petition for Review the WV Supreme Court of Appeals within 30 days of Receipt of the BOR Order. The Respondent has 30 days to file its Response to the Petition for Review.
A Motion to Stay Must be filed with the BOR or OOJ within 10 days of the OOJ Decision or accompany the BOR Appeal. Stays can only be granted in TTD and PPD litigated issues.
The WV Supreme Court Accepts/Refuses the Petition for Appeal.
If No Party Appeals, the BOR Order is Final
If SC Rejects the Petition, the Board of Review Order is Final.
If SC Petition is Accepted, the SC Sets forth a Briefing Schedule for Submission of Briefs.
WV Supreme Court Issues a Decision. This Order is FINAL.
WHEELING, WV
CHARLESTON, WV
1144 MARKET STREET SUITE 300 WHEELING, WV 26003
UNITED CENTER, SUITE 750 500 VIRGINIA STREET EAST CHARLESTON, WV 25301
NATHAN D. HUGHES
JEFFREY B. BRANNON
NHUGHES@C-WLAW.COM (304) 232-3600
JBRANNON@C-WLAW.COM (304) 341-0500
Pennsylvania • New Jersey • West Virginia PITTSBURGH
HARRISBURG
SCRANTON
PHILADELPHIA
MT. LAUREL, NJ
650 WASHINGTON ROAD SUITE 700 PITTSBURGH, PA 15228
1011 MUMMA ROAD SUITE 201 LEMOYNE, PA 17043
409 LACKAWANNA AVENUE SUITE 402 SCRANTON, PA 18503
450 SENTRY PARKWAY SUITE 200 BLUE BELL, PA 19422
155 GAITHER DRIVE SUITE B MT. LAUREL, NJ 08054
WALTER E. WERNER, III
DENNIS P. CULLEN
JOSEPH M. CAPUTO
JOHN F. HAYES
GREGORY C. DICARLO
WWERNER@C-WLAW.COM (412) 563-2500
DCULLEN@C-WLAW.COM (717) 975-9600
JCAPUTO@C-WLAW.COM (570) 347-0600
JHAYES@C-WLAW.COM (610) 567-0700
GDICARLO@C-WLAW.COM (856) 761-3800
WWW.C-WLAW.COM
MEDICAL TREATMENT FLOW CHART Receipt of Request for Medical Treatment, Durable Medical Equipment or Supplies
Medical Treatment Requests MUST be Acted Upon within 15 days of RECEIPT
Directly Related to Compensable Diagnoses?
Yes - The Request is Related to the Compensable Work Place Injury or Disease
Does the Request fall within 85 C.S.R. § 20?
Issue Order Granting/Denying Medical Request. If Denied State Basis for Denial in Order (i.e., Treatment Unrelated to Compensable Injury)
Authorization of the Treatment is Discretionary. Consider whether Authorizing the request will assist in Claimant's Recovery and Return to Work
Yes - The Request falls within Rule 20. Note that NOT ALL Requests Require
No - The Request falls Outside of Rule 20
No - The Request is NOT Related to the Compensable Work Place Injury or Disease
Yes - Issue Order Granting/Denying Medical Request. If Denied, State Basis for Denial in Order (i.e., Treatment Unrelated to Compensable Injury)
Does the Request fall within? (1) Pressley Reed Guidelines (2) ODG (3) Medical Position Papers
No - The Request falls Outside of Pressley
Issue Order Granting/Denying Medical Request. If Denied, State Basis for Denial in Order (i.e., Treatment Unrelated to Compensable Injury)
Possible IME
Reed, ODG & Medical Position Papers and Request is still QUESTIONABLE
Request is Still Questionable?
Possible Physician Advisor Review
WHEELING, WV
CHARLESTON, WV
1144 MARKET STREET SUITE 300 WHEELING, WV 26003
UNITED CENTER, SUITE 750 500 VIRGINIA STREET EAST CHARLESTON, WV 25301
NATHAN D. HUGHES
JEFFREY B. BRANNON
NHUGHES@C-WLAW.COM (304) 232-3600
JBRANNON@C-WLAW.COM (304) 341-0500
Pennsylvania • New Jersey • West Virginia PITTSBURGH
HARRISBURG
SCRANTON
PHILADELPHIA
MT. LAUREL, NJ
650 WASHINGTON ROAD SUITE 700 PITTSBURGH, PA 15228
1011 MUMMA ROAD SUITE 201 LEMOYNE, PA 17043
409 LACKAWANNA AVENUE SUITE 402 SCRANTON, PA 18503
450 SENTRY PARKWAY SUITE 200 BLUE BELL, PA 19422
155 GAITHER DRIVE SUITE B MT. LAUREL, NJ 08054
WALTER E. WERNER, III
DENNIS P. CULLEN
JOSEPH M. CAPUTO
JOHN F. HAYES
GREGORY C. DICARLO
WWERNER@C-WLAW.COM (412) 563-2500
DCULLEN@C-WLAW.COM (717) 975-9600
JCAPUTO@C-WLAW.COM (570) 347-0600
JHAYES@C-WLAW.COM (610) 567-0700
GDICARLO@C-WLAW.COM (856) 761-3800
WWW.C-WLAW.COM