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Is New Virginia Rule 14 Work Comp Fee Schedule?

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The New Virginia Rule 14 – Fee Schedule Soon?

The new State of Virginia Rule 14 is now closed for comments.   A copy of the Proposed Rule 14 can be found here.  (PDF File).

Adobe PDF Virginia rule 14 Logo
Wikimedia Commons – Adobe

According to the Virginia Workers Compensation Commission, a public hearing on Virginia Rule 14 was held on October 13, 2015.   The slides from the Rule 14 presentation can be found here.  Unfortunately, the deadline for comments was October 15, 2015.

I have always been a proponent of full state fee schedules.   Virginia has community rates, but not a true statewide fee schedule.   A 10 community rate basis is part of the new rule.   Check out the new regions in Virginia map below – (c) MC Innovations

As a side note, the Virginia Workers Compensation Commission’s webpage on medical charges is as follows:

Outside view of Virginia rule 14 capitol
Wikimedia Commons – Analogue Kid

The Act also provides the standard that is to be used in calculating reimbursement.Va. Code §65.2-605 states that the employer’s liability for medical charges is limited to “such charges as prevail in the same community for similar treatment[.]” The term “community” is defined by reference to Commission Rule 14. There is no fee schedule in Virginia. Charge schedules agreed to by the carrier and provider will be enforced.

If a dispute arises as to reimbursement for a medical charge, the health care provider may invoke one or more of the following remedies:

Adjudication Requirements

  • Appropriate where there has been no payment or where provider is dissatisfied with level of reimbursement
  • Initial decision issued by a deputy commissioner after reviewing evidence
  • Right of review by the Commission
  • Appeals to Virginia Court of Appeals and Supreme Court of Virginia
  • Initiated by filing a request along with supporting evidence to the Commission

The result of no fee schedule will be further analyzed tomorrow along with a study from WCRI.  Rarely do all the planets align in the WC world.  This is one instance.  Check back in tomorrow.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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