West Virginia Code 33-16H-3 – Judicial review; enforcement
(a) An individual or issuer may seek judicial review of a final decision rendered by an independent review organization by filing a petition in the circuit court within sixty days after receipt of notice of such decision.
Terms Used In West Virginia Code 33-16H-3
- External review: means a review of a final adverse determination by an independent review organization. See West Virginia Code 33-16H-1
- Independent review organization: means an entity approved by the commissioner to conduct external reviews of final adverse determinations. See West Virginia Code 33-16H-1
- issuer: means an entity required to be licensed under this chapter that contracts, or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including an accident and sickness insurance company, a health maintenance corporation, a health care corporation, a health or hospital service corporation, and a fraternal benefit society. See West Virginia Code 33-16H-1
- State: when applied to a part of the United States and not restricted by the context, includes the District of Columbia and the several territories, and the words "United States" also include the said district and territories. See West Virginia Code 2-2-10
- Venue: The geographical location in which a case is tried.
(1) Venue for a petition filed pursuant to this section is the county in which the individual resides or, if the individual is a non-resident, the county in which he or she works or, if he or she does not work in this state, the county in which his or her employer is located, or if none of these counties are applicable, in Kanawha County.
(2) The issuer shall provide benefits pursuant to the final external review decision, including by making payment on a disputed claim, unless or until there is a judicial decision otherwise.
(3) If the issuer files a petition pursuant to this section and the individual substantially prevails, the issuer shall be responsible for the reasonable attorney's fees of the individual.
(b) A decision issued by an independent review organization pursuant to this article may be enforced in the same manner as an order of the commissioner.
(c) This article does not create any new cause of action or eliminate any presently existing cause of action.