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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 36 Chapter 13 Determining Disability, Incapacity, and Blindness

13.11 CLIENT’S RIGHTS IN THE DETERMINATION PROCESS 13.11.1 CLIENT’S RIGHT TO AN ADDITIONAL MEDICAL REPORT If the client requests a second medical examination, either during the application, reevaluation or Hearing process, such examination must be provided and paid for by the Department of Human Services (DOHS). If the client does not secure the additional medical report within 90 days, the application is processed using the medical reports that were originally obtained. In the following instances an individual in an active assistance group (AG) is entitled to an additional medical report at the Department's expense after the Medical Review Team (MRT) makes a negative decision about continuing medical eligibility: • If only one medical report was used in making the MRT decision; or • If a new medical report, in addition to previous reports, is used in making the negative decision, and it is the new one that causes ineligibility. The Worker must notify the client of the availability of this service and the impending case closure or removal of the client from the case. An DFA-NL-C or appropriate letter from the eligibility system is used for client notification. 13.11.2 PROCEDURE AFTER THE CLIENT’S DECISION TO REQUEST AN ADDITIONAL MEDICAL REPORT The Worker’s action after the client makes a decision to request an additional medical report at DOHS’s expense depends upon the client’s request. The possibilities are as follows: • If the client does not request the additional medical report or does not make a timely (13 days) response to the notification, the Worker closes the AG or removes the client from the AG. • If the client requests the additional medical report and responds within the time limit of the DFA-NL-C or the eligibility system notice, the Worker does not take any action until notified by the MRT that a second decision has been made. If action is required, follow these procedures: