Administrative Code

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Virginia Administrative Code
Title 16. Labor And Employment
Agency 30. Virginia Workers' Compensation Commission
Chapter 60. Procedural Regulations Governing the Administration of Medical Costs Peer Review by the Regional Peer Review Committees under the Virginia Workers' Compensation Act

16VAC30-60-130. Decision.

A. After deliberation, the peer review committee will vote on the recommended disposition, in the following manner:

1. The vote of the majority of the members present shall be adopted;

2. In the case of a tie vote, the review will be terminated and the decision deemed to be favorable to the defending party; and

3. Dissenting members may record their objections in writing.

B. If the decision is favorable to the physician, the peer review committee shall approve the payment of fees.

C. If the decision is unfavorable to the physician, the peer review committee shall set the physician's fee at a reasonable amount as described by the standard set out in § 65.2-605 of the Code of Virginia and, if the fee has already been paid by the party requesting review, require repayment by the physician of the excess amount.

D. Within 30 days of the informal hearing, the peer review committee shall prepare a statement, in writing, of the factual basis for its decision. Notice of the defending party's right of appeal shall be included in this statement. A copy of this statement shall be forwarded by the Secretary of the Statewide Coordinating Committee by certified mail, return receipt requested, to the defending party, the party requesting review, and the commission. The peer review committee file compiled under 16VAC30-60-110 of this chapter shall be forwarded to the commission

Statutory Authority

§ 65.2-1305 of the Code of Virginia.

Historical Notes

Derived from VR405-02-01 § 3.2, eff. Jan. 9, 1981; July 16, 1993.

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