Offices of the Insurance Commissioner
Allan L. McVey
Insurance Commissioner
Explanation of Forms to Use

Subpoenas and Subpoenas Duces Tecum

If you need to subpoena a witness, or a witness with records, to appear at one of our scheduled hearings, we provide a subpoena form that you may use and serve upon the witness by regular U.S. mail. To receive the form, you need to call us at (304) 558-5230.

Request for Award of Claimant's Attorney Fees and Expenses for "Unreasonable Denial"

W. Va. Code § 23-2C-21(c) provides that the Board of Review may order any private insurance carrier or self-insured employer, to pay reasonable attorney fees and costs to claimants when the Board of Review determines a denial of compensability, a denial of an award of TTD, or a denial of an authorization for medical benefits was unreasonable. A request for attorney fees can only be filed AFTER the initial claim adjustor’s decision has been reversed by the Board of Review, Intermediate Court of Appeals or Supreme Court of Appeals and the applicable appeal period has run without an appeal being filed. This form must be filed within ninety (90) days of the final decision reversing the claim denial. Use the "Unreasonable Denial Form".


Request for Award of Claimant's Attorney Fees and Expenses

W. Va. Code § 23-5-16(c) provides that an attorney’s fee for successful recovery of denied medical benefits may be charged or received by an attorney, and paid by the private carrier or self-insured employer for a claimant or dependent.  Following the successful resolution of the denial in favor of the claimant, a fee petition shall be submitted by the claimant’s attorney within thirty days following a decision in which the claimant prevails and the order becomes final.  The Board of Review, Intermediate Court of Appeals or Supreme Court of Appeals shall enter an order within thirty days of receipt of claimant’s fee petition awarding reasonable attorney fees not to exceed $125.00 per hour and reasonable costs of the claimant to be paid by the private carriers or self-insured employers, whichever is applicable, which shall be paid as directed.  In no event may an award of the claimant’s attorney fees exceed $500.00 per litigated medical issue, not to exceed $2,500.00 in a claim.  Use the "Petition for Award of Claimants Attorney Fees" form.


Court Reporter Fees 

The Insurance Commissioner may pay reasonable and customary court reporter fees for a deposition that is presented as evidence in workers’ compensation litigation before the Board of Review. The Insurance Commissioner may also pay a reasonable and customary fee for those instances when a deposition is canceled without prior notice to the court reporter. Use the "Court Reporter Invoice" or "Verification of Court Reporter's Appearance at Canceled Deposition" form, whichever is applicable.


Filing Documents with the Board of Review

The "Document Submission Form" is to be used when filing any litigation document (i.e., general correspondence, copies of subpoenas, etc. do not need to be accompanied by this form) with the Board of Review. The purpose of this form is to ensure that certain basic information needed to properly index the documents is provided. Please continue to use a cover letter in addition to this form.


Filing Physical Evidence with the Board of Review

Physical evidence consists of video tapes, audio tapes, photos, dust samples, x-rays, etc. The purpose of this form is to ensure that certain basic information needed to properly index the documents is provided. Please continue to use a cover letter in addition to this form. Do not submit CD's containing medical records.  The medical records you want the Board of Review to consider should be printed and submitted with the "Document Submission Form".


Psychiatric or Psychological Reports

W. Va. Code §23-1-13(f) allows a psychiatric or psychological report of a claimant to be withheld from that claimant if, and only if, the “… treating or evaluating psychiatrist or clinical doctoral level psychologist certifies that exposure to the contents of the full report is likely to cause serious harm to the claimant or is likely to cause the claimant to pose a serious threat of harm to a third party.” (emphasis added). In order to assist the Board of Review in indexing this kind of certified report in an appropriate location (one which will not be available to the claimant) it is necessary that the "Psychiatric or Psychological Report Certification" form be completed by the party submitting the report into evidence and attached to the report to be withheld from the claimant. Please be aware that W. Va. Code §23-1-13(f) also requires that a summary of the report, which may be provided to the claimant, be compiled by the psychiatrist or psychologist. It further requires the claimant’s attorney to agree to provide the claimant with only the summary before the full report shall be provided to the attorney.

This form should be used only when the psychiatrist or psychologist certifies the report is to be withheld from the claimant for the reasons stated in the statute. Merely stamping the report "confidential" is insufficient. All psychiatric or psychological reports not certified in accordance with the statute will be indexed in such a manner as to be available to the claimant.


Filing an Appeal for a Board of Review Decision

W. Va. Code § 23-4-1c(a)(3) provides a process by which claimants may seek the help of the Board of Review when any private insurance carrier or self-insured employer fails to timely rule or act upon any request or motion in a workers’ compensation claim. Many common actions in workers compensation claims (e.g.: rule on claim; supply copy of file; arrange for doctor’s examination; act upon doctor’s request; etc.) have legally established time limits for insurance carriers or self-insured employers to act. This process does not apply to claims administered by the Office of the Insurance Commissioner through its third party administrator. 

To start this process and file a complaint, please complete the "Failure of a Carrier to Timely Rule or Act" form and submit to:

Board of Review
P.O. Box 2628
Charleston, WV 25329-2628

 Or, call the Board of Review at 304-558-5230.