HB 4636 - "The Big Bill" 

In the March 20 issue of InSights, we briefly described a few bills from the recently completed session of the West Virginia Legislature. This weeks' edition will focus on House Bill 4636, referred to by many as "The Big Bill" because of the multiple ways it will affect workers' compensation in our state.

Provisions of HB 4636 which are effective immediately include:

  • Requirement changes for employer notice posters: This poster must now include the name of the policyholder’s staff person who should be contacted regarding claim questions.
  • Establishing parties to a claim: the claimant or the claimant's dependents, if applicable; the employer; and the West Virginia Offices of the Insurance Commissioner (OIC), if applicable.
  • Claims process mailing: No later than the date of the initial decision in a claim, the carrier is required to send the claimant a brochure, approved by the OIC, outlining the claims process.
  • Decision and protest mailings: All claims decisions and protests are to be sent to all parties to the claim.
  • Changing decisions with additional evidence: The ability to enter a corrected decision when additional evidence is later acquired in now only applicable "with respect to any order or decision denying benefits."
  • Protest time extension: Injured workers now have 60 days after receipt to protest a decision. This was extended from the previous 30-day time frame.
  • Employer protests: The employer may protest
    1. Decisions incorporating findings of the Occupational Pneumoconiosis Board;
    2. Decisions made by the OIC acting as the administrator of claims involving funds created under 23-2C-1 et seq.; or
    3. Permanent Partial Disability (PPD) decisions of 15 percent or less based on a treating physician's rating.
  • Third-party administrator (TPA) contract provisions: For private carriers and self-insurers that enter into a contract with a TPA, the TPA must be licensed in accordance with OIC guidelines. The TPA no longer must have an office in West Virginia.


Provisions of HB 4636 which have later effective dates include:

  • 7/1/2008:
    1. State-mandated surcharges: Surcharges, regardless of the carrier, are capped at 9 percent for debt reduction and 5.5 percent for the administrative operations of the OIC.
    2. For policies issued after this date: The deficit reduction surcharge is set at 9 percent of premium collected plus the total of all premium discounts based on deductible provisions.
    3. For applications for benefits filed on or after this date: Provisions previously described as the Claims Dispute Resolution Process are only applicable when (1) a decision to deny is protested and (2) the only controversy is whether the claim is a new claim or the reopening of a previous claim.
  • 1/1/2009:
    1. Premium audit compliance termination time reduced: Termination for refusal to comply with a premium audit will be changed to 10 days with written notice. Currently, this stands at 15 days.

It is important to remember that these changes not only affect us, but also any other carrier that decides to enter the West Virginia market. The above provisions are not an exhaustive list; for more information, please contact your agent or call us at 866.45BRICK.