West Virginia Adjuster Response Deadlines Action
Time to Rule
Response
None
A letter can be sent to the claimant enclosing a WC-1 and advising the claimant that they have 6 months to complete the WC-1. No continued follow-up thereafter.
Completed WC-1 for injury or occupational disease (other than OP)
15 working days beginning with the date that the form is received by your office
You should investigate the claim. If the investigation cannot be completed timely you should issue a tolling letter that states specifically what information you are awaiting for to make the decision. You should issue a subsequent tolling letter every 30 days. A decision needs to be made within 90 days, if possible.
Completed WC-1
5 days from receipt
First Report of Injury must be filed with EDI
Completed WC-1 for injury or occupational pneumoconiosis
90 days from receipt
Can toll for up to 30 additional days
Medical Treatment Issues
15 working days from receipt
Must issue an approval or denial. All orders need protest language included.
Occupational Pneumoconiosis Board Examinations
60 days
Examinations and evaluations shall be scheduled and noticed within 60 days after issuance of a non-medical decision directing referral to the Board.
Independent Medical Examinations
Every 120 days the claimant is out of work and receiving temporary total disability
The examination by occur within 120 days (20 days before the expiration of the 120 day period) and must reoccur every 120 days that the claimant remains out of work and receiving temporary total disability benefits
Permanent Partial Disability Evaluation Requests
30 days to make referral
Schedule with a provider
Permanent Partial Disability Awards
Payment to be made within 15 working days of award order
Commence payment. Payments can be paid in lump sum, or installments (monthly by the 3rd of each month, weekly, or bi-weekly)
Reopening Applications
30 calendar days
Must be ruled upon from receipt of the application. Can be tolled but must issue letter
Receipt of Order from Office of Judges, Board of Review, or Supreme Court
30 days from order
Must be acted upon, cannot be tolled. Not applicable when there is a petition to stay filed by counsel. You must issue an acknowledgement letter.
OIC complaints
15 working days to respond
Can be done in-house or by defense counsel
Failure to Timely Act filed with the Office of Judges
15 days to request a hearing 30 days to respond
Send to defense counsel immediately
First Report of Injury by Employer
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HARRISBURG
SCRANTON
PHILADELPHIA
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WHEELING
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CHARLESTON
WILMINGTON
(304)341-0500
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