E.L. Lambert, Chairperson Shop Committee

Effective July 1, 2004 dramatic changes will go into effect that will affect YOU, YOUR JOB, YOUR FAMILY, if you may have a workers' compensation claim.

Elimination of "Rule of Liberality" Regarding Consideration of Evidence: Despite nearly eighty years of following this rule, the legislature has created an evidentiary standard more like that in a civil lawsuit. No longer will evidence supporting a claimant's position be given greater weight if contrary evidence is submitted. This will encourage GM to spend even more money fighting claims.

Presley-Reed: Previously temporary total disability (the weekly amount you are paid when off on disability) was determined by your treating physician, and benefits paid when off on disability) was determined by your treating physician, and benefits were paid until such time as you are returned to work, released to return to work, or had reached your maximum degree of medical improvement whichever occurred first. Now, BM will be utilizing a publication known as the Presley-Reed databank. This publication is a compendium of national averages for anticipated periods of disability for various types of injuries and will be utilized in determining probable return to work dates. When these projections are exceeded. Your physician, who is already overburdened with paperwork anyway, most probably will not respond. The failure to respond in a timely manner will cause benefits to be suspended or stopped and will require a petition to reopen or litigation. In the meantime your benefits cease.

TTD Cut In Half: Previously you could draw weekly wages for 208 weeks. However, with the passage of SB 2013 you can only draw for 104 weeks.

Self-Insured: Previously a self-insured employer (which GM is) you would file your workers comp. claim with WV comp. An impartial group would make a determination on compensability, re-openings, TTD benefits, authorization for medical procedure and treatments, change of doctor etc., etc., etc. If any benefits or requests were denied you had a right to a hearing before an Administrative Law Judge (ARJ). Effective July 1, all claims must be filed with GM and they make all aforesaid decisions. If your claim is denied or any request denied you still have a right to appeal to an ARJ. However, you will need to retain an attorney to do so.

Blood Testing: If you sustain an injury, GM, if they have a reasonable and good faith objective suspicion of you being intoxicated or under the influence of drugs they can request a blood test. Currently, there have been no decisions on whether you can be forced to do so, however, refusal would probably add weight to GM's position to deny your claim.

Billing Period Reduction: Previously you or your physician could submit a bill within two years from the date of service. Effective 7/1/04 this period will be reduced to 6 months. GM denies your claim and you appeal, however, in the meantime your physician wants paid. Until your claim is resolved, you're responsible for payments.

Appeal Process: These are just a few of the changes that will be taking effect. You have a right to appeal any decision made by GM and the right to have an attorney of your choice. If your appeal is denied by the Administrative Law Judge you may appeal to the Board of Review. Eventually your claim could be decided by the WV Supreme Court. This court is made up of five Judges, currently, three of the Judges, in most cases support the worker, the other two generally support the employer.