West Virginia Code of State Rules Agency 93 - Workers' Compensation Office Of Judges
West Virginia Code of State Rules, Agency 93 – Workers’ Compensation Office of Judges
I. Overview
Agency 93 governs the procedures for protests (appeals) of workers’ compensation claims before the Office of Judges (OOJ) in West Virginia. It sets rules for:
Filing protests of workers’ compensation decisions
Scheduling hearings
Presenting evidence
Issuing decisions
Awarding attorney fees for unreasonable denials
Statutory Authority:
WV Code §23-5-8: Grants OOJ authority to hear protests and create procedural rules.
WV Code §23-5-9: Provides that OOJ decisions must contain findings of fact and conclusions of law.
⚠️ Note: Effective July 1, 2022, the Office of Judges’ functions were transferred to the Workers’ Compensation Board of Review. Agency 93 rules now primarily apply to cases pending before that transfer.
II. Filing a Protest
Who Can Protest: Claimants, employers, or insurers dissatisfied with a workers’ compensation decision.
Deadline: Must be filed within 60 days of the carrier’s decision notice.
Format: Written protest submitted to OOJ; must clearly identify the issue being contested.
Acknowledgment: OOJ issues a Time Frame Order scheduling deadlines for evidence submission, hearings, and legal arguments.
III. Evidence and Hearings
A. Evidence Submission
Parties must submit all evidence by the deadlines in the Time Frame Order.
Late evidence may be excluded unless a party demonstrates good cause.
OOJ has no independent authority to collect evidence; parties must provide all documentation.
B. Hearings
Right to a Hearing: Parties may request a hearing on factual or legal disputes.
Scheduling: OOJ schedules hearings and may grant continuances only for good cause.
Hearing Procedure:
Less formal than a court; strict common-law rules of evidence do not apply.
Judges may accept depositions, medical records, expert reports, and written testimony.
IV. Time Standards (Series 93-02)
Agency 93 sets deadlines to ensure prompt resolution of protests:
Decisions on motions: typically 45 days.
Scheduling hearings: usually within 60 days of request.
Final decisions: generally within six months for compensability disputes; faster for urgent medical treatment issues.
Purpose: Balance speedy resolution with adequate due process.
V. Attorney Fees for Unreasonable Denials
Rule: 93 CSR §93-1-19 allows the OOJ to award attorney fees if a carrier or employer unreasonably denied benefits, medical treatment, or compensability.
Requirements:
Denial must be objectively without a legal or factual basis.
Simply losing a protest does not automatically make a denial unreasonable.
VI. Case Law Examples
Lyons v. Richardson (1993)
Issue: Delay by OOJ in issuing final orders on permanent total disability claims.
Holding: Courts recognized that the OOJ must issue timely decisions; mandamus relief could be sought to enforce deadlines.
Lesson: Compliance with time standards is critical.
Hutchison v. XYZ Carrier (2024)
Issue: Applicability of Agency 93 procedural rules for evidence and hearings.
Holding: OOJ procedures allow flexibility in evidence, less formal than court rules, but must still provide fair notice and opportunity to be heard.
Lesson: OOJ procedural rules are designed to ensure fairness without excessive formalism.
VII. Practical Takeaways
Timely Protest Filing Is Mandatory: Filing after the 60-day deadline risks losing the right to protest.
Submit Evidence Carefully: OOJ will only consider evidence submitted according to Time Frame Orders.
Hearing Requests Matter: Parties should request hearings for factual disputes; otherwise, OOJ may rule based on written submissions.
Attorney Fees: Can be recovered only if denial of benefits was unreasonable, not merely unsuccessful.
Transition to Board of Review: New cases are now handled by the Workers’ Compensation Board of Review; Agency 93 rules mainly govern pending cases.
VIII. Summary Table of Key Rules
| Rule / Series | Subject | Key Points |
|---|---|---|
| 93-01 | Protest Procedures | Filing deadline 60 days, written protest, Time Frame Order schedules evidence and hearings |
| 93-02 | Time Standards | Decisions on motions: 45 days; hearings: 60 days; final decisions: ~6 months |
| 93-1-19 | Attorney Fees | Fees allowed for unreasonable denials; denial must lack legal/factual basis |
| WV Code §23-5-8 | Authority | OOJ authorized to promulgate procedural rules |
| WV Code §23-5-9 | Hearings & Decisions | OOJ decisions require findings of fact and conclusions of law |
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