Remand for Qualified Psychiatric Evidence under Rule 21(d) in Workers’ Compensation Claims

Introduction

This commentary examines the Supreme Court of Appeals of West Virginia’s decision in E.B. v. Alliance Coal, LLC, decided April 25, 2025. The case arose from a coal miner’s 2020 on‐the‐job injury and subsequent compensable physical and psychological diagnoses. The key parties are E.B., the injured miner and petitioner, and Alliance Coal, LLC, the employer and respondent. The principal legal issue was whether the lower courts erred by refusing to vacate a Board of Review (“BOR”) decision that denied additional psychiatric diagnoses and related benefits, and whether the petitioner had shown “good cause” under West Virginia Code § 23-5-12a(d) (Rule 21(d)) to remand for further evidence from a duly qualified psychiatrist.

Summary of the Judgment

The Supreme Court granted relief to E.B., vacating the Intermediate Court of Appeals’ (“ICA”) June 7, 2023 memorandum decision and remanding the claim to the BOR. The Court held that the petitioner established good cause for remand under Rule 21(d) so he could obtain a psychiatric evaluation from a properly qualified psychiatrist. The majority emphasized the remedial purpose of the Workers’ Compensation Act—to secure prompt and necessary medical treatment—and concluded that, because it was unclear whether E.B.’s existing reports came from a fully qualified psychiatrist, remand was warranted. The decision was issued as a memorandum decision under limited‐circumstances provisions, with a dissent from Justices Armstead and Bunn, who would have affirmed the BOR on the ground that the petitioner’s evidence failed the specific documentation requirements of W. Va. Code R. 85-20-12.4.

Analysis

Precedents Cited

Ney v. Workmen’s Compensation Commissioner, 171 W. Va. 13, 297 S.E.2d 212 (1982): Establishes the fundamental purpose of workers’ compensation to cover the cost of medical treatment and rehabilitation for work‐related injuries.
Hale v. West Virginia Office of Insurance Commissioner, 228 W. Va. 781, 724 S.E.2d 752 (2012): Sets forth the three‐step process under W. Va. Code R. 85-20-12.4 for adding a psychiatric diagnosis as compensable.
Duff v. Kanawha County Commission, 250 W. Va. 510, 905 S.E.2d 528 (2024): Clarifies de novo review for questions of law and deference to Board of Review findings of fact.

Legal Reasoning

The majority applied Rule 21(d) (W. Va. Code § 23-5-12a(d)), which allows the ICA or Supreme Court to remand a case to the BOR for “new, additional, or further evidence” upon a showing of good cause. It recognized that the rule’s purpose aligns with statutes demanding quick and efficient delivery of benefits (W. Va. Code §§ 23-4-1, 23-1-1(b), 23-5-13a). Because the record did not clearly demonstrate that E.B.’s treating psychiatrist was a fully credentialed psychiatrist—as required by W. Va. Code R. 85-20-12.4—the petition presented an adequate basis for remand. The majority stressed that remanding served both the statutory policy favoring prompt medical treatment and the petitioner’s right to a complete evidentiary record. The dissent countered that the BOR properly denied the additional diagnoses due to failure to follow the rule’s specific evidentiary requirements (inclusion of a mental status exam, causal relationship analysis, and full Exhibit C compliance) and that no further remand was necessary.

Impact

This decision underscores the willingness of West Virginia’s highest court to interpret remand provisions liberally when an injured worker’s access to necessary medical evidence may be impeded. Future claimants may cite E.B. for the proposition that remand under Rule 21(d) is available whenever there is uncertainty about the adequacy or qualifications of the expert evidence. Employers and carriers will need to ensure that psychiatric evaluations strictly comply with R. 85-20-12.4, both in form (Exhibit C, mental status exams, causation analysis) and in substance (performed by a duly qualified psychiatrist), to avoid remand or reversal. Moreover, the decision reinforces the remedial thrust of the Workers’ Compensation Act, potentially tipping marginal claims in favor of injured workers when procedural ambiguities arise.

Complex Concepts Simplified

Rule 21(d) / W. Va. Code § 23-5-12a(d): A procedural provision that allows appellate courts to send a workers’ compensation case back to the Board of Review for more evidence, if good cause is shown.
Temporary Total Disability: Benefits paid when an injured worker cannot return to any form of employment for a limited period due to injury.
Exhibit C Compliance: Under W. Va. Code R. 85-20-12.3–.4, psychiatric evaluations must follow a precise outline (mental status exam, diagnostic criteria, causation explanation) to be accepted.
Good Cause: A flexible standard requiring a reasonable basis—such as questions about an expert’s credentials or incomplete reports—to justify further fact‐finding.

Conclusion

E.B. v. Alliance Coal, LLC marks a significant affirmation of injured workers’ rights to develop psychiatric evidence in workers’ compensation claims. By vacating the ICA’s decision and ordering remand, the Supreme Court of Appeals emphasized that procedural irregularities—especially uncertainty over an evaluator’s qualifications—must not block an injured worker from obtaining full medical benefits. The ruling clarifies appellate authority under Rule 21(d) to secure additional expert evidence, reinforces the strict compliance requirements of W. Va. Code R. 85-20-12.4, and strengthens the overarching policy of swift and effective compensation for workplace injuries.