West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-97 - External Review of Adverse Health Insurance Determinations
Section 114-97-9 - Binding Nature of External Review Decision; Judicial Review of IRO Decisions
Current through Register Vol. XLI, No. 38, September 20, 2024
9.1. An issuer or covered person adversely affected by a final decision rendered by an IRO in accordance with this rule is entitled to judicial review thereof, but nothing in this rule shall be deemed to prevent other means of redress or relief provided by law. The Commissioner may enforce a final decision of an IRO in the same manner and to the same extent as an order issued by him or her.
9.2. Judicial Proceedings.
9.3. The review conducted by the court shall be upon the record made before the IRO, except that in cases of alleged irregularities in procedure before the IRO, not shown in the record, testimony thereon maybe taken before the court.
9.4. The court may affirm the decision of the IRO or remand the case to the IRO for further proceedings; it shall reverse, vacate or modify the order or decision of the IRO if the substantial rights of the petitioner has been prejudiced because the findings, inferences, conclusions, decision or order are:
9.5. A covered person may not file a subsequent request for external review involving the same adverse determination or final adverse determination for which the covered person has already received an external review decision pursuant to this rule.