Hale v. Office of Ins. Comm'r (Signed Opinion)Annotate this Case
Employee injured his back while working for Employer. Employee ultimately received a permanent partial disability award for his back injury. Employee then sought a psychiatric consultation, which resulted in Employee being assessed with major depressive disorder. The claims administrator denied Employee's request to add depression as a compensable injury of his workers' compensation claim, and the Workers' Compensation Office of Judges and Workers' Compensation Board of Review (BOR) affirmed. At issue on appeal was whether a claimant must get prior authorization from a claims administrator before seeking an initial psychiatric consultation. The Supreme Court reversed, holding (1) W. Va. S.C.R. 85-20-12.5(a), which states that an initial psychiatric evaluation must be authorized by a claims administrator, is an invalid administrative regulation; (2) W. Va. C.S.R. 85-12-12.4 sets forth a three-step process that must be followed when a claimant is seeking to add a psychiatric disorder as a compensable injury in his or her workers' compensation claim; and (3) in the instant case, Employee did not receive the process that he was entitled to under section 85-12-12.4. Remanded.