West Virginia Medical Direction of Care
85-20-6. The Role of the Treating Physician.
6.1. Each injured worker selects a treating physician of record who will treat the injured worker and be responsible for coordinating all subsequent health care. The treating physician of record may be a medical doctor, osteopath, podiatrist, or chiropractor. Any treating physician who is limited in number of treatments by another provision of this Rule shall, upon exhaustion of that limit, only seek reimbursement as a treating physician for services provided in intervals consistent with those of other treating physicians. The injured worker should not seek care from more than one provider without contacting the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, requesting the designation of a different attending physician, and having that request approved. Injured workers whose employer's or the employer's private carrier's managed care plans have been approved by the Commission or Insurance Commissioner, whichever is applicable, or who are covered by a managed care plan adopted by the Commission shall chose a treating physician offered under the applicable plan.
6.7. Injured workers must request authorization from the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, to change the treating physician of record in their claim.
This rule does not apply in the following cases:
a. Care transferred after initial emergency or first aid treatment if done so within 30 days of the date of injury;
b. Care transferred to a specialist by the original treating physician; or
c. Care where an unforeseen emergency develops which requires special facilities and skills are not available to the treating physician or hospital.
For additional information, please access this Internet Site - http://www.wvinsurance.gov/Portals/0/pdf/pol_leg/rules/wc/c-wc-rule-20.pdf?ver=2007-10-12-143028-000 .
Managed Health Care Plan (MHCP) Benefits
- Medical Direction into the MHCP for the life of the claim
- Certification in all 55 countries
- Limited exceptions for non-network access
- Access to contracted PPO discounts only allowed within the MHCP
- Transfer of Select Cases into MHCP
Please note: Only open claims greater than 60 days can be considered for use within a MHCP.
For additional information regarding Gallagher Bassett's West Virginia Managed Health Care Plan offering, please contact your Gallagher Bassett Account Executive.
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The information provided throughout this Web site is provided from a general insurance/risk management perspective and is NOT legal advice. Gallagher Bassett Services, Inc. (GB) does not provide legal advice as it is not qualified to do so. GB recommends that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to the information provided above as such implications are highly dependent on the unique facts and circumstances applicable to an individual situation.