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Workers' Compensation

Contact Information
Telephone:
  304-558-5230
Fax:
   304-558-1322
Correspondence:
  PO Box 2628
  Charleston, West Virginia 25329-2628
Physical Address:
  1207 Quarrier St., Suite 304
  Charleston, West Virginia 25301

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Board of Review

Board Members Rita Hedrick-Helmick, James D. Gray and Nick Casey welcome you to the Offices of the Insurance Commissioners' Board of Review WebPage. Our site is to help direct you during your appeal process.

About The Board

On February 1, 2004, the Board of Review began exercising exclusive jurisdiction over all appeals from the Worker’s Compensation Office of Judges.

The Workers Compensation Board of Review consists of three members who are appointed by the governor from names submitted by the “Workers’ Compensation Board of Review Nominating Committee”. By law, no more than two Board members may be from the same political party. Initially, one member of the Board was appointed for a period of two years, one member was appointed for four years, and the third member was appointed for a period of six years. Hereafter, the members will be appointed for a term of six years.

Prior to July 1, 2005, all claims were filed with the Workers Compensation Commission, and all initial rulings were made by the Commission. After July 1, 2005, claims are filed with a claims administrator who processes the claim. If any party is in disagreement with an order from the claims administrator, a protest may be filed. The claim is then presented to the Office of Judges for litigation processes. After all proceedings are finalized and all evidence has been submitted, the Administrative Law Judge prepares a final order setting forth Findings of Fact and Conclusions of Law. At this stage, should a party disagree, an appeal may be filed to this Board.

When the claim gets to the Workers’ Compensation Board of Review, the matter is heard strictly as an appellate case. Parties cannot submit new evidence to the Board of Review. Thus, the hearings before the Board are confined to the evidence presented before the Office of Judges. It is important for claimants, employers, and attorneys practicing before the Board to understand that new evidence cannot be introduced to the Board. The Board must decide the case on evidence which was presented to the Administrative Law Judge. Instead of affirming, reversing or modifying the decision of the Administrative Law Judge, the Board may, upon motion of any party or upon it’s own motion, remand the case to the claims administrator or the Office of Judges for the taking of such new, additional or further evidence as in the opinion of the Board may be necessary for a full and complete development of the facts of the case.

There are guidelines that the Board must follow when reviewing a case. These are set out in Chapter 23 of the West Virginia Code and are as follows:

[The Board of Review] shall, reverse, vacate or modify the order or decision of the administrative law judge if the substantial rights of the petitioner or petitioners have been prejudiced because the administrative law judge’s findings are:
1) In violation of statutory provisions; or
2) In excess of the statutory authority or jurisdiction of the administrative law judge; or
3) Made upon unlawful procedures; or
4) Affected by other error of law; or
5) Clearly wrong in view of the reliable, probative and substantial evidence on the whole record; or
6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

In Conley v. Workers’ Compensation Division, 199 W.Va.196, 203, 483 S.E.2d 542, 549 (1997), the Supreme Court of Appeals further advised the Board as follows:

The legislature has seen the need to craft bright lines between rulings by the Office of Judges and review of those rulings by the Appeal Board. The legislature has determined by its enactment of West Virginia Code § 23-5-12(b) that the Appeal Board, in essence, must accord deference to decisions by the Office of Judges. The legislature has not instructed the Appeal Board to adopt every decision by the Office of Judges. However, the legislature has made clear the standard by which the Appeal Board may reverse a decision by the Office of Judges. The legislature has made it mandatory that the Appeal Board apply the standard of review set out in West Virginia Code § 23-5-12(b). This Court has the authority and constitutional duty to uphold this legislative mandate.

Therefore, the Court held that when the Board reviews a ruling from the Office of Judges, it must do so under the standard of review set out in West Virginia Code § 23-5-12(b), and that failure to do so constitutes reversible error.

The Board of Review receives the entire record from the Office of Judges and reads all filed documents, including the Administrative Law Judge’s decisions. The Board judges each case on its own merits and applies statutory and case law to each appeal.

The Board sets a time and place for the hearing of oral arguments that have been requested by the parties. Oral arguments are welcome, but they are optional by the respective attorneys or individuals without attorneys. Prior to the parties presenting their cases during oral argument proceedings, the entire record of each docketed case, along with the briefs filed in each case are reviewed by the Board. The Board privately deliberates and renders its rulings.

Should any party to these proceedings not be satisfied with the Board’s decision, the case may be appealed to the West Virginia Supreme Court of Appeals.

In summary, any employer, employee, claimant, dependent or the Insurance Commission is accorded the right to appeal any final order of the Office of Judges to the West Virginia Workers’ Compensation Board of Review. The Board then reviews the case on its merits. It cannot take new evidence, but it does review the entire record and must then make a decision based on the evidence before it. The Board will not reverse the Administrative Law Judge unless the Judge's decision is in violation of statutory provisions or unless the Judge is clearly wrong in light of the reliable, probative and substantial evidence on the whole record, or has misinterpreted the law, exceeded his/her authority, made a procedural error or has exceeded the extent of his/her discretion. After review, the Board will either affirm the order of the Office of Judges, remand the claim to the Office of Judges or the Administrator for further proceedings, or reverse, vacate or modify the order of the Office of Judges.

If the Workers’ Compensation Board of Review can be of assistance to you, please contact us at P.O. Box 2628, Charleston, WV 25329, or you may reach us by telephone at 558-5230. The goal of the Board is to continue its service to the State of West Virginia.