What dispute deadlines should providers track in West Virginia?

Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within standard policy billing deadlines (typically 1 to 3 years); Clean Claim Payment Window: 40 calendar days from receipt of clean claim (W. Va. Code § 33-15-4b). Verify the trigger date, current agency notices, and any extension before acting.

Which agencies administer these rules in West Virginia?

The guide identifies West Virginia Offices of the Insurance Commissioner (WVOIC). The correct agency depends on the plan and claim jurisdiction.

Auto Accident, PIP & Medical Billing State Guides

West Virginia Auto Accident, PIP & Medical Billing Laws

West Virginia operates an At-Fault automobile insurance framework under Chapter 33 and Chapter 55 of the West Virginia Code. Motor vehicle liability is governed by modified comparative fault with a 51% bar under W. Va. Code § 55-7-13a. MedPay subrogation is restricted by statute and common law Made-Whole rules under W. Va. Code § 33-6-36, and healthcare providers enforce statutory medical liens under W. Va. Code § 38-5-1 et seq.

Accountability & Review

Reviewed by Millennova Legal Operational Integrity Team, Senior Audit and Arbitration Analysts

Last Reviewed

2026-03-01

Plain-language overview

At-Fault / Traditional Tort (Modified Comparative Fault & West Virginia Healthcare Lien Statutes)

West Virginia is a traditional tort jurisdiction that does not mandate Personal Injury Protection (PIP) insurance. Medical expenses incurred from motor vehicle collisions are covered through optional first-party Medical Payments (MedPay) coverage, private health insurance, or third-party automobile liability insurance. Under W. Va. Code § 55-7-13a, an injured claimant may recover damages if their comparative fault was less than the combined fault of all other persons contributing to the injury. Under W. Va. Code § 33-6-36 and Murriel-Don Coal Co. v. Aspen Ins. UK Ltd., auto insurers have restricted subrogation rights and cannot recover until the insured is made whole. Healthcare providers secure unpaid accounts through statutory provider liens.

PIP and MedPay coverage

Optional Med Pay Coverage

MedPay is optional in West Virginia (commonly written in limits of $1,000 to $10,000+ per person), providing no-fault reimbursement for reasonable medical, surgical, dental, hospital, and ambulance expenses resulting from an automobile collision

Statutory Subrogation Restrictions

Under W. Va. Code § 33-6-36, subrogation for medical payments benefits in motor vehicle policies is restricted, and under West Virginia common law, subrogation is barred until the injured insured is fully compensated for all economic and non-economic losses

Assignment Of Benefits

Healthcare providers routinely obtain patient assignments of MedPay benefits for direct claims submission to automobile insurers

Medical fee schedule and reimbursement rules

Name

Reasonable and Customary Fee Standard

Rules

West Virginia does not enforce a statutory fee schedule table for motor vehicle accident medical bills outside of workers' compensation. Providers bill standard reasonable and customary charges prevailing in the local medical community for comparable care.

Cpt Basis

CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims

Preauthorization and utilization review

Requirement

Preauthorization is not required by statute for emergency trauma stabilization or initial acute management. Elective surgical interventions and prolonged physical therapy regimens are evaluated under insurer medical necessity guidelines.

Carrier Examinations

Under standard auto policy terms, insurers may request medical records or independent physician reviews to evaluate causal relationship to the motor vehicle collision.

Appeals and dispute resolution

Prompt Payment Statute

Under W. Va. Code § 33-15-4b, insurers must pay clean claims within 40 calendar days of receipt. Overdue clean claims accrue statutory interest from the date the claim became overdue.

Medical Provider Lien Statutes

Under West Virginia law (W. Va. Code § 38-5-1 et seq. and § 38-8-1 et seq.), hospitals and healthcare providers can assert statutory liens against personal injury tort claims, settlements, and judgments for the reasonable value of medical services rendered. Notice must be filed with the county commission clerk and served on the liability insurer prior to distribution of proceeds.

Dispute Forum

West Virginia Circuit Court (county circuit court) for civil recovery actions.

Claim and dispute deadlines

Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.

Event	Timeframe
Accident Notice	Notice to insurer as soon as reasonably practicable
MedPay Claim Submission	Submission within standard policy billing deadlines (typically 1 to 3 years)
Clean Claim Payment Window	40 calendar days from receipt of clean claim (W. Va. Code § 33-15-4b)
County Commission Lien Filing	Must be filed with county commission clerk prior to settlement payment
Statute of Limitations	2 years from accident date for personal injury tort claims (W. Va. Code § 55-2-12); 10 years for written contracts

Documentation checklist

West Virginia MedPay Claim Application Form
Executed Assignment of Benefits (AOB) and medical records authorization
Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS codes and ICD-10 diagnostic coding
Contemporaneous medical records, emergency intake documentation, operative reports, and imaging findings
Filed Notice of Medical Lien with county commission clerk recording stamp
Insurer Explanation of Benefits (EOB) or written explanation of claim determination

Responsible agencies

West Virginia Offices of the Insurance Commissioner (WVOIC)Statewide Regulation of Auto Insurers, Rate Filings & Consumer Inquiries

Primary legal and regulatory sources

West Virginia Code Chapter 33, Article 6, Section 36 (Subrogation in Motor Vehicle Insurance Policies)West Virginia Legislature · 2024
West Virginia Code Chapter 55, Article 7, Section 13a (Comparative Fault)West Virginia Legislature · 2024

This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.

Common questions

What rules govern auto accident, pip & medical billing state guides in West Virginia?: West Virginia operates an At-Fault automobile insurance framework under Chapter 33 and Chapter 55 of the West Virginia Code. Motor vehicle liability is governed by modified comparative fault with a 51% bar under W. Va. Code § 55-7-13a. MedPay subrogation is restricted by statute and common law Made-Whole rules under W. Va. Code § 33-6-36, and healthcare providers enforce statutory medical liens under W. Va. Code § 38-5-1 et seq.
What dispute deadlines should providers track in West Virginia?: Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within standard policy billing deadlines (typically 1 to 3 years); Clean Claim Payment Window: 40 calendar days from receipt of clean claim (W. Va. Code § 33-15-4b). Verify the trigger date, current agency notices, and any extension before acting.
Which agencies administer these rules in West Virginia?: The guide identifies West Virginia Offices of the Insurance Commissioner (WVOIC). The correct agency depends on the plan and claim jurisdiction.