Current through Register Vol. XLI, No. 35, August 30, 2024
Section 85-15-3 - Definitions As used in this exempt legislative rule, the following terms have the stated meanings unless the context of a specific use clearly indicates another meaning is intended.
3.1. "Executive Director" means the executive director of the West Virginia Workers' Compensation Commission pursuant to W. Va. Code § 23-1-1b.3.2. "Commission" means the West Virginia Workers' Compensation Commission as provided for by W. Va. Code § 23-1-1.3.3. "Injury" and derivative words have the meaning ascribed to the term "injury" by W. Va. Code § 23-4-1.3.4. "Injured worker" and "claimant" mean an employee entitled to workers' compensation benefits as the result of a work-related injury, as provided under W. Va. Code § 23-4-1.3.5. "Injured worker's employer" or "employer" means an employer of the injured worker who is a chargeable employer in the claim either through its experience or through its private carrier. 3.6 "Suitable gainful employment" means employment which restores the injured worker as closely as possible to his or her pre-injury level of earnings. If this is not possible, suitable gainful employment means other work for which the employee is, or may become, suited by training, experience, or education, but not limited by his or her previous level of earnings.3.7. "Physical rehabilitation services" means physician approved health care services, which will likely increase the injured worker's ability to return to suitable gainful employment. Physical rehabilitation services include but are not limited to work hardening and work conditioning programs or other Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable, approved physical rehabilitation program.3.8. "Physical rehabilitation services provider" means a provider of health care services, provided the provider is: a. A medicare certified rehabilitation agency;b. A certified outpatient rehabilitation facility;c. A duly licensed health care practitioner;d. A physical rehabilitation hospital;e. A duly licensed acute care hospital.3.9. "Physical rehabilitation hospital" means any of the following institutions or facilities: a. A duly licensed hospital that meets the requirements for rehabilitation hospitals as described in section 2803.2 of the medicare provider reimbursement manual, part 1, as amended, or any successor provision, as published by the United States health care financing administration; and that, for its in-patient services, obtains on or before December 31, 1994, and thereafter maintains accreditation from the Joint Commission on Accreditation of Health Care Organizations and, further, on or before July 1, 1995, obtains and thereafter maintains accreditation from the Commission on the Accreditation of Rehabilitation Facilities.b. A distinct rehabilitation unit in a duly licensed hospital which distinct part unit meets the requirements of section 2803.61 of the medicare provider reimbursement manual, part 1, as amended, or any successor provision, as published by the United States health care financing administration; or c. A facility operated by the West Virginia Division of rehabilitation services.3.10. "Work Conditioning" means an intensive, work-related, goal-oriented conditioning program designated specifically to restore systemic neuromusculoskeletal functions (eg strength, endurance, movement, flexibility, motor control) and cardiopulmonary functions. The objective of the work conditioning program is to restore physical capacity and function to enable the injured worker to return to work. Program will be two (2) to four (4) hours per day, five (5) days per week, and for a period not to exceed four (4) weeks in duration, however, the commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, on a case-by-case basis, may approve program extension.3.11. "Work Hardening" means a highly structured, goal-oriented, individualized progressive and supervised treatment program designed to return the client to work. Work hardening programs, which are often interdisciplinary in nature, use real or simulated work activities designed to restore physical, behavioral, and vocational functions. Work hardening addresses issues of productivity, safety, physical tolerances, and work behaviors. Programs duration will be four (4) to eight (8) hours per day, five (5) days per week, and for a period of not to exceed four (4) weeks in duration, however, the commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, on a case-by-case basis, may approve program extension.3.12. "Assistive devices" means physical aides, appliances or mechanical devices that will increase the injured worker's independence or provide assistance in performing an essential job task to facilitate a return to suitable gainful employment.3.13. "Vocational rehabilitation services" means professional services available to the injured worker under W. Va. Code § 23-4-9 which are reasonably necessary to enable him/her to return to suitable gainful employment as soon as practical. This may include, but is not limited to, coordination of medical services, vocational assessment, vocational evaluation, vocational counseling, vocational rehabilitation plan development, vocational rehabilitation plan monitoring, job development and job placement. Furthermore, "vocational rehabilitation service" means services covered by W. Va. Code § 23-4-9, which provide new skills or modified work to enable an injured worker to return to suitable gainful employment as soon as practical. Services may include, but are not limited to, Adult Basic Education, vocational-technical training, college training, on-the-job-training, travel expenses related to training, job modifications and placement tools.3.14. "Vocational rehabilitation service providers" means licensed professionals, public agencies, companies and corporations which provide injured workers vocational rehabilitation services as defined in section 3.13 of this rule.3.15. "Qualified rehabilitation professional" means a person who meets the criteria set forth in 85CSR 27, Qualified Rehabilitation Professional, which includes a person who is a certified case manager, certified rehabilitation counselor, certified disability management specialist, or certified rehabilitation registered nurse. a. "Certified rehabilitation counselor" means that earned designation as awarded by the Commissioner on Rehabilitation Counselor Certification.b. "Certified disability management specialist" means that earned designation as awarded by the Certification of Disability Management Specialists Commission.c. "Certified case manager" means that earned designation as awarded by the Commission for Case Manager Certification.d. "Certified rehabilitation registered nurse" means that earned designation as awarded by the Association of Rehabilitation Nurses.3.16. "Rehabilitation plan" means a plan or a modified plan for physical and/or vocational rehabilitation designed to facilitate the injured worker's return to work developed in accordance with this rule by a qualified rehabilitation professional and approved by the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable.3.17. "Vocational evaluation" means a systematic evaluation of the injured worker's skills, aptitudes, interests and functional ability through standardized testing and may include work samples. A vocational evaluation may be used when an injured worker has a limited work history, limited perceived interests, suspected cognitive impairment or when additional information is required regarding the injured worker's transferable skills for appropriate rehabilitation plan development.3.18. "Job analysis" means a systematic assessment of a specific job including essential functions, the physical and/or cognitive requirements, working conditions, work site structure/layout, tools and equipment used, required skills/abilities, and/or any other characteristic that may be pertinent to performing the job.3.19. "Job development" means the process of consultation with employers and the development of job opportunities in a comprehensive, professional manner. The intent is to establish continuing and mutually beneficial relationships with potential employers through selective placement, job modification, and adjustment counseling. Job development activities should provide clients with an opportunity to reach their employment potential.3.20. "Job placement services" means professional activities involved in assisting individuals to seek, obtain and maintain appropriate employment. It may include guidance in vocational decision making; a transferable skills analysis, training in job-seeking skills; supportive counseling; identifying job leads; negotiating with employers, supervisors and co-workers; and providing post-employment and follow-up services.3.21. "Job seeking skills training" means teaching the injured worker how to obtain employment. Topics to be included in job search skills training include but are not limited to development of a resume, how to use a resume, completing applications, utilizing the want ads, cold calling techniques, networking, interviewing, cover and thank you letters, appropriate attire/hygiene, and tracking and developing job leads.3.22. "Labor market survey" means an analysis of availability of jobs within a reasonable geographic region. The conclusions are based upon accumulation of data through employer contacts, review of help wanted listings, and use of published census wage and employment statistics. The survey is conducted considering employers within a reasonable distance of the injured worker's residence. The purpose is to determine if a proposed rehabilitation plan being considered has a reasonable likelihood of success.3.23. "On-the-job-training" means a structured program under which an individual, over a specific vocational preparation period of time, learns a trade, business or occupation that will ultimately result in gainful alternative re-employment that is consistent with the claimant's acquirable skills and residual physical capabilities. Each training program, and the employer providing the training must be approved on a case-by-case basis by the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable.3.24. "Adult Basic Education" means a training service to assist an individual in acquiring the academic skills necessary to compete in a job or educational setting. This service may include GED preparation and testing, computer skills enhancement, or developmental skills courses. Remedial instruction must be from an accredited academic, business or vocational school. Remedial services on a part time basis are permitted so long as the injured worker's participation in plan services, in conjunction with other approved vocational rehabilitation services, are equal to full time. Return to work plan documentation is required from the qualified rehabilitation professional regarding the injured worker's current academic standing, the academic goal and the specific plan steps necessary to reach that goal.3.25. "Vocational -Technical training"- means formal instruction to provide an individual specific mechanical or industrial skills or technical expertise to be applied to an occupation or trade. Vocational-technical schools or community colleges not already accredited by the North Central Association of Colleges and Schools Commissions on Institution of Higher Learning or approved by the State Dept. of Education must be individually approved by the Commission, Insurance Commissioner, self-insured employer or private carrier, whichever is applicable.3.26. "College training" means academic education to prepare an individual for an occupation of a professional or technical nature through a college or university accredited by the North Central Association of Colleges and Schools Commission on Institutions of Higher Learning.3.27. "Placement Tools" means tools and or equipment or other adaptive devices necessary to return an injured worker to employment or to enable participation in an approved program such as on the job training or formal training.3.28. "Transferable skills analysis" means a process by which jobs are identified that are consistent with the injured worker's capabilities, skills, and residual physical abilities.3.29. "Insurance commissioner" means the insurance commissioner of West Virginia as provided in section one, article two, chapter thirty-three of the West Virginia Code, or any designated third-party administrator of the Insurance Commissioner.3.30. "Private carrier" means any insurer, including the successor to the Commission, authorized by the insurance commissioner to provide workers' compensation insurance pursuant to chapters twenty-three and thirty-three of the West Virginia Code.