COMMITTEE SUBSTITUTE
FOR
H. B. 3180
(By Delegates Webster, Hrutkay, Brown, Miley,
Kessler, Burdiss, Guthrie and Fleischauer)
(Originating in the Committee on the Judiciary)
(February 23, 2007)
A BILL to amend and reenact §23-5-9 of the Code of West Virginia,
1931, as amended, relating to the granting of workers'
compensation benefits on review or appeal; requiring the
prompt implementation of any benefit award of workers'
compensation granted by an administrative law judge's
decision, unless stayed by the administrative law judge or the
Board of Review; establishing appropriate standards of review
for any stay request; and referencing the proper mechanism for
handling any overpayment which may result if a favorable
decision granting benefits is subsequently reversed.
Be it enacted by the Legislature of West Virginia:
That §23-5-9 of the Code of West Virginia, 1931, as amended,
be amended and reenacted as follows:
ARTICLE 5. REVIEW.
§23-5-9. Hearings on objections to commission or self-insured
employer decisions; mediation; remand.
a) Objections to a decision of the Workers' Compensation Commission, the successor to the commission, other Insurance
Commissioner, private insurance carriers and carrier or self-
insured employers employer, whichever is applicable, made pursuant
to the provisions of section one of this article shall be filed
with the office of judges. Upon receipt of an objection, the
office of judges shall notify the commission, the successor to the
commission, other Insurance Commissioner, private insurance
carriers and carrier or self-insured employers employer, whichever
is applicable, and all other parties of the filing of the
objection. The office of judges shall establish by rule
promulgated in accordance with the provisions of subsection (e),
section eight of this article an adjudicatory process that enables
parties to present evidence in support of their positions and
provides an expeditious resolution of the objection. The employer,
the claimant, and the commission, the successor to the commission,
other Insurance Commissioner, private insurance carriers and
carrier self-insured employers employer, whichever is are
applicable, shall be notified of any hearing at least ten days in
advance. The office of judges shall review and amend, or modify,
as necessary its procedural rules by the first day of July, two
thousand seven.
(b) The office of judges shall establish a program for
mediation to be conducted in accordance with the requirements of
rule twenty-five of the West Virginia trial court rules. The
parties may agree that the result of the mediation is binding. A
case may be referred to mediation by the administrative law judge on his or her own motion, on motion of a party or by agreement of
the parties. Upon issuance of an order for mediation, the office
of judges shall assign a mediator from a list of qualified
mediators maintained by the West Virginia State Bar.
c) The office of judges shall keep full and complete records
of all proceedings concerning a disputed claim. Subject to the
rules of practice and procedure promulgated pursuant to section
eight of this article, the record upon which the matter shall be
decided shall include any evidence submitted by a party to the
office of judges and evidence taken at hearings conducted by the
office of judges. and any documents in the claim files which relate
to the subject matter of the objection. The record may include
evidence or documents submitted in electronic form or other
appropriate medium in accordance with the rules of practice and
procedure. The office of judges is not bound by the usual common
law or statutory rules of evidence.
(d) All hearings shall be conducted as determined by the chief
administrative law judge pursuant to the rules of practice and
procedure promulgated pursuant to section eight of this article.
Upon consideration of the designated record, the chief
administrative law judge or other authorized adjudicator within the
office of judges shall, based on the determination of the facts of
the case and applicable law, render a decision affirming, reversing
or modifying the action protested. The decision shall contain
findings of fact and conclusions of law and shall be mailed to all
parties.
(e) The rule authorized by subsection (a) of this section
shall be promulgated on or before the first day of October, two
thousand three. Until the rule is promulgated, any rules
previously promulgated shall remain in full force and effect.
(f) (e) The office of judges may remand a claim to the
commission, the successor to the commission, other Insurance
Commissioner, private insurance carriers and carrier or self-
insured employers employer, whichever is applicable, for further
development of the facts or administrative matters as, in the
opinion of the administrative law judge, may be necessary for a
full and complete disposition of the case. The administrative law
judge shall establish a time within which the commission, the
successor to the commission, other Insurance Commissioner, private
insurance carriers and carrier or self-insured employers employer,
whichever is applicable, must report back to the administrative law
judge.
(g) (f) The decision of the workers' compensation office of
judges regarding any objections to a decision of the workers'
compensation commission, the successor to the commission, other
Insurance Commissioner private insurance carriers and carrier or
self-insured employers employer, whichever is applicable, is final
and benefits shall be paid or denied in accordance with the
decision, unless an order staying the payment of benefits is
specifically entered by the appeal board created in section eleven
of this article or by the administrative law judge who granted the
benefits. Before any order granting such a stay may be granted, the judge or board of review must determine that the party seeking
the stay has a reasonable likelihood of success on appeal, that
payment of the benefits while the matter remains on appeal would
place an undue hardship on the party seeking the stay, and an undue
hardship will not be placed upon the claimant if the payment of
benefits were delayed, pending final outcome of the appeal. No
stay with respect to any medical treatment or rehabilitation
authorized by the office of judges may be granted. If the decision
is subsequently appealed and reversed in accordance with the
procedures set forth in this article, and any overpayment of
benefits occurs as a result of such reversal, any such overpayment
may be recovered pursuant to the provisions of subsection d,
section one-d, article four chapter twenty-three of this code.