Member Article

In Emergency Order 20-EO-03, entered March 23, 2020, Insurance Commissioner Dodrill ordered that normal time standards for claims handling applicable to workers' compensation insurers and other regulated entities as set forth in title 85, series 1, section 10, of the West Virginia Code of State Rules are suspended until further notice. This is provided that workers' compensation insurers and other regulated entities shall continue to adjust workers' compensation claims as expeditiously as possible during the insurance emergency and shall utilize all possible methods of adjusting claims remotely, such as telephone, email, facsimile, and mobile applications, all the while striving to meet normal time standards for the adjustment and resolution of claims whenever possible. Workers' compensation insurers and other regulated entities shall prioritize claims adjustment and resolution strategies during this insurance emergency to ensure high-priority claims are addressed before lower priority claims.

Commissioner Dodrill ordered workers' compensation insurers and other regulated entities shall not terminate or suspend a claimant's temporary total disability benefits for failure to undergo examinations or needed treatment during this insurance emergency. The Commissioner recognizes many medical or healthcare providers have closed offices, deferred or suspended all non-emergent procedures and treatment during the state of emergency. Claimants may have difficulty in continuing ongoing care or treatment, obtaining an examination, may be quarantined, or staying in their homes.

Importantly, Commissioner Dodrill ordered workers' compensation insurers and other regulated entities to review Executive Order 7-20 issued by Governor Jim Justice on March 19, 2020, and evaluate their telehealth and telemedicine programs to ensure utilization to the fullest extent possible. The use of telehealth or telemedicine can potentially reduce barriers for treatment as virtual office visits have been identified as a way of safely treating certain patients while containing or limiting the spread of infection in hospitals, clinics, and medical offices.

On March 24, 2020, Commissioner Dodrill entered Emergency Order 20-EO-04 allowing Emergency Insurance Adjusters to be utilized to adjust claims. Commissioner Dodrill ordered any insurance company licensed to do business in West Virginia may submit to the Commissioner an application requesting appointment and authorization of one or more emergency insurance adjusters for the purpose of adjusting claims in West Virginia during the pendency of the current COVID-19 insurance emergency. An emergency insurance adjuster license is valid only for so long as the Commissioner specifies, but not to exceed a period of 120 days unless extended for a period of an additional 90 days. An emergency insurance adjuster license is valid only for the COVID-19 insurance emergency. During the time an individual is licensed as an emergency insurance adjuster, he or she has the same power, authority and responsibility as other licensed insurance adjusters in the state. An emergency insurance adjuster licensing application can be found on the Commissioner’s website. The completed application can be submitted via email to [email protected]. A link to the application can also be found under the red “COVID-19” tab on the Commissioner’s website. Due to remote working restrictions, the Commissioner will not accept applications via facsimile or U.S. mail at this time.

Please contact our COVID-19 Task Force and Workers' Compensation practice group if you have any questions.