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Introduction

Purpose

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The Workers’ Compensation Office of Judges conducts hearings, receives and weighs evidence and arguments and then issues written decisions in appeals (known as protests) from initial claim management decisions made by insurance carriers or by self-insured employers or their agents. Our goal is to resolve these protests in a fair, efficient, and timely manner. We are strictly neutral and do not assist, or take the side of, the injured worker, the employer, or the claims adjustor.

Overview

The Workers’ Compensation Office of Judges is a part of the Office of the Insurance Commissioner of West Virginia along with the Workers’ Compensation Board of Review.

All workers’ compensation claims are administered by either by a private insurance carrier or by a limited number of self-insured employers. All claims management decisions are made either by claims adjustors of the private insurance carrier or by similar employees of the self-insured employer. Any claims management decision by either the private carrier or a self-insured employer may be contested and appealed.

All appeals (called ‘protests’) from claim management decisions of the private carrier or self-insured employer are resolved by the Office of Judges. The Office of Judges establishes a deadline for the filing of evidence (called a Time Frame). After all parties have been allowed an opportunity to submit evidence and argument to the Office of Judges, a written decision is issued by an Administrative Law Judge (ALJ).

Any decision of an ALJ may then be appealed to the Workers’ Compensation Board of Review. No new evidence can be submitted to the Board of Review, which reviews the decision of the ALJ and either upholds (affirms) or changes (reverses or modifies) that decision.

Any party may then ask the W.Va. Supreme Court of Appeals to review the decision of the Board of Review. A review is not automatic, but is granted only at the discretion of the Court.