West Virginia Code of State Rules Agency 102 - Workers' Compensation Board Of Review
1. Overview of the Agency
The Workers’ Compensation Board of Review is a specialized administrative body within West Virginia that handles disputes and appeals related to workers’ compensation claims. Its primary function is to ensure that injured workers receive fair benefits and that employers’ obligations under the workers’ compensation system are applied correctly.
The Board operates as an appellate authority, reviewing decisions made by lower-level workers’ compensation offices or claims examiners. Its purpose is to provide a structured process for resolving disagreements over claims, ensuring due process and consistency in decisions.
2. Composition of the Board
The Board consists of a panel of appointed members, usually experienced in matters of workers’ compensation, labor, or administrative law.
Members serve for specified terms as defined by the agency rules.
The Board may have a Chairperson who oversees procedural matters and schedules hearings.
Quorum requirements are specified to ensure that decisions are made by a valid number of members.
3. Jurisdiction
The Board of Review has authority over:
Appeals from decisions made by Workers’ Compensation Division examiners regarding:
Compensation benefits
Denial or reduction of benefits
Determination of disability ratings
Disputes over medical treatment covered under workers’ compensation.
Interpretation of agency rules relating to workers’ compensation benefits.
Any procedural or administrative decisions made within the workers’ compensation system that a party contests.
The Board does not make initial determinations of claims; it only reviews appeals after initial decisions have been made.
4. Filing an Appeal
Appeals must be submitted within a specific time frame from the date of the lower-level decision.
The appeal must include:
Identification of the parties involved (employee and employer or insurer)
A copy of the decision being appealed
The grounds or reasons for contesting the decision
The Board may reject appeals that are untimely or incomplete.
5. Procedures of the Board
Initial Review:
Once an appeal is filed, the Board reviews the record of the lower-level decision, including all evidence, medical records, and documentation provided by both parties.
Hearings:
The Board may schedule a formal hearing where parties can present oral arguments, submit additional evidence, and call witnesses.
Hearings are typically recorded and follow procedural rules established by the agency.
Deliberation and Decision:
After reviewing the record and hearing arguments, the Board deliberates.
Decisions are made based on the evidence in the record and the agency’s rules, not external laws.
Written Decision:
The Board issues a written decision stating:
Whether the appeal is granted or denied
The reasoning for the decision
Any modifications to the original workers’ compensation award or denial
Copies are sent to all parties involved.
6. Powers of the Board
The Board can affirm, modify, or reverse decisions made by the lower-level claims examiners.
It can order additional evidence or medical examinations if necessary.
The Board can provide clarification on procedural or evidentiary questions in workers’ compensation claims.
7. Rights of Parties
Both the injured worker and the employer/insurer have the right to:
Present evidence
Be represented by counsel
Request a hearing
Receive a written decision with reasons
Parties must comply with all procedural rules to ensure their appeal is considered valid.
8. Record Keeping
The Board maintains records of all appeals, hearings, and decisions.
Decisions serve as precedents within the agency for similar disputes, ensuring consistency in interpretation of workers’ compensation rules.
9. Limitations
The Board cannot create new compensation rules or obligations beyond those defined by the agency.
Its role is strictly appellate and interpretative; it cannot directly award compensation without an appeal.
10. Summary
In essence, Agency 102 – Workers’ Compensation Board of Review acts as an internal appellate body within West Virginia’s workers’ compensation system. It ensures fairness, proper application of agency rules, and resolution of disputes through structured procedures, hearings, and written decisions. Its authority is confined to reviewing and modifying decisions of lower-level examiners, maintaining procedural integrity, and upholding the agency’s internal rules.
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