AB501: Bill Text

AB501,20,16 102.13 (2) (b) A physician, chiropractor, podiatrist, psychologist, dentist, physician assistant, advanced practice nurse prescriber, hospital, or health service provider shall furnish a legible, certified duplicate of the written material requested under par. (a) in paper format upon payment of the actual costs of preparing the certified duplicate, not to exceed the greater of 45 cents per page or $7.50 per request, plus the actual costs of postage, or shall furnish a legible, certified duplicate of that material in electronic format upon payment of $26 per request. Any person who refuses to provide certified duplicates of written material in the person's custody that is requested under par. (a) shall be liable for reasonable and necessary costs and, notwithstanding s. 814.04 (1), reasonable attorney fees incurred in enforcing the requester's right to the duplicates under par. (a).

AB501,21 Section 21. 102.13 (2) (c) of the statutes is amended to read:

AB501,21,7 102.13 (2) (c) Except as provided in this paragraph, if an injured employee has a period of temporary disability that exceeds 3 weeks or a permanent disability, if the injured employee has undergone surgery to treat his or her injury, other than surgery to correct a hernia, or if the injured employee sustained an eye injury requiring medical treatment on 3 or more occasions off the employer's premises, the department may by rule require the insurer or self-insured employer to submit to the department a final report of the employee's treating practitioner. The department may not require an insurer or self-insured employer to submit to the department a final report of an employee's treating practitioner when the insurer or self-insured employer denies the employee's claim for compensation in its entirety and the employee does not contest that denial. A treating practitioner may charge a reasonable fee for the completion of the final report, but may not require prepayment of that fee. An insurer or self-insured employer that disputes the reasonableness of a fee charged for the completion of a treatment practitioner's final report may submit that dispute to the department for resolution under s. 102.16 (2).

AB501,22 Section 22. 102.16 (2) (d) of the statutes is amended to read:

AB501,21,24 102.16 (2) (d) The department shall analyze the information provided to the department under par. (c) according to the criteria provided in this paragraph to determine the reasonableness of the disputed fee. Except as provided in 2011 Wisconsin Act 183, section 30 (2) (b), the department, subject to par. (dm), shall determine that a disputed fee is reasonable and order that the disputed fee be paid if that fee is at or below the mean fee for the health service procedure for which the disputed fee was charged, plus 1.2 standard deviations from that mean, as shown by data from a database that is certified by the department under par. (h). Except as provided in 2011 Wisconsin Act 183, section 30 (2) (b), the department , subject to par. (dm), shall determine that a disputed fee is unreasonable and order that a reasonable fee be paid if the disputed fee is above the mean fee for the health service procedure for which the disputed fee was charged, plus 1.2 standard deviations from that mean, as shown by data from a database that is certified by the department under par. (h), unless the health service provider proves to the satisfaction of the department that a higher fee is justified because the service provided in the disputed case was more difficult or more complicated to provide than in the usual case.

AB501,23 Section 23. 102.16 (2) (dm) of the statutes is created to read:

AB501,22,3 102.16 (2) (dm) Notwithstanding par. (d) and 2011 Wisconsin Act 183, section 30 (2) (b), if an employer or insurer and a health care provider have agreed by contract to a fee for a health service procedure, all of the following apply:

AB501,22,6 1. If a disputed fee charged for that procedure is at or below the agreed-to fee in effect on the day on which the procedure was provided, the department shall determine that the disputed fee is reasonable and order that the disputed fee be paid.

AB501,22,10 2. If a disputed fee charged for that procedure is above the agreed-to fee in effect on the day on which the procedure was provided, the department shall determine that the disputed fee is unreasonable and order that the agreed-to fee be paid.

AB501,24 Section 24. 102.17 (1) (a) 3. of the statutes, as affected by 2015 Wisconsin Act 55, is amended to read:

AB501,22,17 102.17 (1) (a) 3. If a party in interest claims that the employer or insurer has acted with malice or bad faith as described in s. 102.18 (1) (b) 3. or (bp), that party shall provide written notice stating with reasonable specificity the basis for the claim to the employer, the insurer, the department, and the division before the division schedules a hearing on the claim of malice or bad faith.

AB501,25 Section 25. 102.17 (4) of the statutes is amended to read:

AB501,23,16 102.17 (4) Except as provided in this subsection and s. 102.555 (12) (b), in the case of occupational disease, the right of an employee, the employee's legal representative, or a dependent to proceed under this section shall not extend beyond 12 years after the date of the injury or death or after the date that compensation, other than for treatment or burial expenses, was last paid, or would have been last payable if no advancement were made, whichever date is latest, and in the case of traumatic injury, that right shall not extend beyond 2 years after that date. In the case of occupational disease; a traumatic injury resulting in the loss or total impairment of a hand or any part of the rest of the arm proximal to the hand or of a foot or any part of the rest of the leg proximal to the foot, any loss of vision, or any permanent brain injury; or a traumatic injury causing the need for an artificial spinal disc or a total or partial knee or hip replacement, there shall be no statute of limitations, except that benefits or treatment expense for an occupational disease becoming due 12 years after the date of injury or death or last payment of compensation, other than for treatment or burial expenses, shall be paid from the work injury supplemental benefit fund under s. 102.65 and in the manner provided in s. 102.66 and benefits or treatment expense for such a traumatic injury becoming due 12 years after that date shall be paid from that fund and in that manner if the date of injury or death or last payment of compensation, other than for treatment or burial expenses, is before April 1, 2006. Payment of wages by the employer during disability or absence from work to obtain treatment shall be considered payment of compensation for the purpose of this section if the employer knew of the employee's condition and its alleged relation to the employment.

AB501,26 Section 26. 102.18 (1) (b) of the statutes, as affected by 2015 Wisconsin Act 55, is renumbered 102.18 (1) (b) 1. and amended to read:

AB501,23,24 102.18 (1) (b) 1. Within 90 days after the final hearing and close of the record, the division shall make and file its findings upon the ultimate facts involved in the controversy, and its order, which shall state the division's determination as to the rights of the parties. Pending the final determination of any controversy before it, the division, after any hearing, may, in its discretion, make interlocutory findings, orders, and awards, which may be enforced in the same manner as final awards.

AB501,24,5 2. The division may include in any interlocutory or final award or order an order directing the employer or insurer to pay for any future treatment that may be necessary to cure and relieve the employee from the effects of the injury or to pay for a future course of instruction or other rehabilitation training services provided under a rehabilitation training program developed under s. 102.16 (1) or (1m).

AB501,24,10 3. If the division finds that the employer or insurer has not paid any amount that the employer or insurer was directed to pay in any interlocutory order or award and that the nonpayment was not in good faith, the division may include in its final award a penalty not exceeding 25 percent of each amount that was not paid as directed.

AB501,24,15 4. When there is a finding that the employee is in fact suffering from an occupational disease caused by the employment of the employer against whom the application is filed, a final award dismissing the application upon the ground that the applicant has suffered no disability from the disease shall not bar any claim the employee may have for disability sustained after the date of the award.

AB501,27 Section 27. 102.18 (3) of the statutes, as affected by 2015 Wisconsin Act 55, is amended to read:

AB501,25,11 102.18 (3) A party in interest may petition the commission for review of an examiner's decision awarding or denying compensation if the department, the division, or the commission receives the petition within 21 days after the department or the division mailed a copy of the examiner's findings and order to the last-known addresses of the parties in interest. The commission shall dismiss a petition that is not timely filed within those 21 days unless the petitioner shows probable good cause that the petition was filed late for a reason for failure to timely file that was beyond the petitioner's control. If no petition is filed within those 21 days after the date on which a copy of the findings or order of the examiner is mailed to the last-known addresses of the parties in interest, the findings or order shall be considered final unless set aside, reversed, or modified by the examiner within that time. If the findings or order are set aside by the examiner, the status shall be the same as prior to the setting aside of the findings or order. If the findings or order are reversed or modified by the examiner, the time for filing a petition commences on the date on which notice of the reversal or modification is mailed to the last-known addresses of the parties in interest. The commission shall either affirm, reverse, set aside, or modify the findings or order, in whole or in part, or direct the taking of additional evidence. The commission's action shall be based on a review of the evidence submitted.

AB501,28 Section 28. 102.18 (4) (b) of the statutes is amended to read:

AB501,25,15 102.18 (4) (b) Within 28 days after the date of a decision of the commission is mailed to the last-known address of each party in interest, the commission may, on its own motion, set aside the decision for further consideration.

AB501,29 Section 29. 102.18 (7) of the statutes is created to read:

AB501,26,2 102.18 (7) In cases in which the division makes a final award of compensation based on a finding that the injured employee has incurred a permanent partial disability, the division shall order the injured employee to submit to a reexamination under s. 102.13 (1) (a) once every 3 years after the date of the award or order upon the written request of the employer or insurer. After such a reexamination, a party in interest may file an application requesting the division to review its findings on the issue of the level of the employee's disability. After that review, the division may make new findings on that issue and order a new award based on the level of the employee's disability as it may then appear. This subsection shall not affect the application of the limitation in s. 102.17 (4).

AB501,30 Section 30. 102.21 of the statutes, as affected by 2015 Wisconsin Act 55, is amended to read:

AB501,26,18 102.21 Payment of awards by municipalities. Whenever When an award is made under this chapter or s. 66.191, 1981 stats., against any municipality local governmental unit, the person in whose favor the award is made shall file a certified copy of the award with the municipal clerk of the local governmental unit. Unless an appeal is taken, within 20 days after that filing, the municipal clerk shall draw an order on the municipal treasurer of the local governmental unit for the payment of the award. If upon appeal the award is affirmed in whole or in part, the municipal clerk shall draw an order for payment of the award within 10 days after a certified copy of the judgment affirming the award is filed with that clerk. If the award or judgment provides for more than one payment, the municipal clerk shall draw orders for payment as the payments become due. No statute relating to the filing of claims against, or the auditing, allowing, and payment of claims by, a municipality local governmental unit applies to the payment of an award or judgment under this section.

AB501,31 Section 31. 102.23 (1) (a) of the statutes, as affected by 2015 Wisconsin Act 55, is renumbered 102.23 (1) (a) 1. and amended to read:

AB501,27,2 102.23 (1) (a) 1. The findings of fact made by the commission acting within its powers shall, in the absence of fraud, be conclusive. The order or award granting or denying compensation, either interlocutory or final, whether judgment has been rendered on the order or award or not, is subject to review only as provided in this section and not under ch. 227 or s. 801.02. The commission shall identify in the order or award the persons that must be made parties to an action for review of the order or award.

AB501,27,18 2. Within 30 days after the date of an order or award made by the commission either originally or after the filing of a petition for review with the department, the division, or the commission under s. 102.18, any party aggrieved by the order or award may commence an action in circuit court for review of the order or award by serving a complaint as provided in par. (b) and filing the summons and complaint with the clerk of the circuit court commence, in circuit court, an action against the commission for the review of the order or award, in which action the adverse party shall also be made a defendant. The summons and complaint shall name the party commencing the action as the plaintiff and shall name as defendants the commission and all persons identified by the commission under subd. 1. If the circuit court determines that any other person is necessary for the proper resolution of the action, the circuit court may join that person as a party to the action, unless joinder of the person would unduly delay the resolution of the action. If the circuit court is satisfied that a party in interest has been prejudiced because of an exceptional delay in the receipt of a copy of any finding or order, the circuit court may extend the time in within which an action may be commenced by an additional 30 days.

AB501,27,22 3. The proceedings shall be in the circuit court of the county where the plaintiff resides, except that if the plaintiff is a state agency, the proceedings shall be in the circuit court of the county where the defendant resides. The proceedings may be brought in any circuit court if all parties stipulate and that court agrees.

AB501,32 Section 32. 102.23 (1) (c) of the statutes is amended to read:

AB501,28,6 102.23 (1) (c) Except as provided in par. (cm), the The commission shall serve its answer within 20 days after the service of the complaint, and, within the like time, the adverse party. Except as provided in par. (cm), any other defendant may serve an answer to the complaint within 20 days after the service of the complaint, which answer may, by way of counterclaim or cross complaint, ask for the review of the order or award referred to in the complaint, with the same effect as if the party defendant had commenced a separate action for the review thereof of the order or award.

AB501,33 Section 33. 102.23 (1) (cm) of the statutes is amended to read:

AB501,28,10 102.23 (1) (cm) If an adverse party to the proceeding a defendant in an action brought under par. (a) is an insurance company, the insurance company may serve an answer to the complaint within 45 days after the service of the complaint.

AB501,34 Section 34. 102.28 (2) (a) of the statutes is amended to read:

AB501,28,21 102.28 (2) (a) Duty to insure payment for compensation. Unless exempted by the department under par. (b) or (bm) or sub. (3), every employer, as described in s. 102.04 (1), shall insure payment for that compensation under this chapter in an insurer authorized to do business in this state. A joint venture may elect to be an employer under this chapter and obtain insurance for payment of compensation. If a joint venture that is subject to this chapter only because the joint venture elected to be an employer under this chapter is dissolved and cancels or terminates its contract for the insurance of compensation under this chapter, that joint venture is deemed to have effected withdrawal, which shall be effective on the day after the contract is canceled or terminated.

AB501,35 Section 35. 102.28 (2) (b) (title) of the statutes is amended to read:

AB501,28,23 102.28 (2) (b) (title) Exemption from duty to insure; employers generally.

AB501,36 Section 36. 102.28 (2) (bm) of the statutes is created to read:

AB501,29,10 102.28 (2) (bm) Exemption from duty to insure; governmental employers. 1. Subject to subds. 2. to 4., if the state or a local governmental unit that has independent taxing authority is not partially insured or fully insured for its liability for the payment of compensation under this chapter, or to the extent that the state or a local governmental unit that has independent taxing authority is not partially insured for that liability under one or more contracts issued with the consent of the department under s. 102.31 (1) (b), and if the state or local governmental unit agrees to report faithfully all compensable injuries and to comply with this chapter and all rules of the department, the state or local governmental unit may elect to self-insure that liability without further order of the department.

AB501,29,17 2. Notwithstanding the absence of an order of exemption from the duty to insure under par. (a), the state or a local governmental unit that elects to self-insure as provided in subd. 1. is exempt from that duty. Notwithstanding that exemption, if the state or a local governmental unit that elects to self-insure as provided in subd. 1. desires partial insurance or divided insurance, the state or local governmental unit shall obtain the consent of the department under s. 102.31 (1) (b) to the issuance of a contract providing such insurance.

AB501,29,24 3. a. A local governmental unit that elects to self-insure its liability for the payment of compensation under this chapter shall notify the department of that election in writing before commencing to self-insure that liability and shall notify the department of its intent to continue to self-insure that liability every 3 years after that initial notice. A local government unit that wishes to withdraw that election shall notify the department of that withdrawal not less than 30 days before the effective date of that withdrawal.

AB501,30,7 b. A notice under subd. 3. a. shall be accompanied by a resolution adopted by the governing body of the local governmental unit and signed by the elected or appointed chief executive of the local governmental unit stating that the governing body intends and agrees to self-insure the liability of the local governmental unit for the payment of compensation under this chapter and that the local government unit agrees to report faithfully all compensable injuries and to comply with this chapter and all rules of the department.

AB501,30,15 4. An election to self-insure under subd. 1. is subject to revocation under par. (c) 2. Once such an election is revoked, the employer whose election is revoked may not elect to self-insure its liability for the payment of compensation under this chapter unless at least 3 calendar years have elapsed since the revocation and the department finds that the employer's financial condition is adequate to pay its employees' claims for compensation, that the employer has not received an excessive number of claims for compensation, and that the employer has faithfully discharged its obligations under this chapter and the rules of the department.

AB501,37 Section 37. 102.28 (2) (c) (title) of the statutes is amended to read:

AB501,30,17 102.28 (2) (c) (title) Revocation of exemption or election.

AB501,38 Section 38. 102.28 (2) (c) of the statutes is renumbered 102.28 (2) (c) 1. and amended to read:

AB501,31,2 102.28 (2) (c) 1. The department, after seeking the advice of the self-insurers council, may revoke an exemption granted to an employer under par. (b), upon giving the employer 10 days' written notice, if the department finds that the employer's financial condition is inadequate to pay its employees' claims for compensation, that the employer has received an excessive number of claims for compensation , or that the employer has failed to discharge faithfully its obligations according to the agreement contained in the application for exemption. The employer may, within

AB501,31,14 3. Within 10 days after receipt of the a notice of revocation, under subd. 1. or 2., the employer may request in writing a review of the revocation by the secretary or the secretary's designee and the secretary or the secretary's designee shall review the revocation within 30 days after receipt of the request for review. If the employer is aggrieved by the determination of the secretary or the secretary's designee, the employer may, within 10 days after receipt of notice of that determination, request a hearing under s. 102.17. If the secretary or the secretary's designee determines that the employer's exemption or election should be revoked, the employer shall obtain insurance coverage as required under par. (a) immediately upon receipt of notice of that determination and, notwithstanding the pendency of proceedings under ss. 102.17 to 102.25, shall keep that coverage in force until another exemption under par. (b) is granted or another election under par. (bm) is made.

AB501,39 Section 39. 102.28 (2) (c) 2. of the statutes is created to read:

AB501,31,21 102.28 (2) (c) 2. The department may revoke an election made by an employer under par. (bm), upon giving the employer 10 days' written notice, if the department finds that the employer's financial condition is inadequate to pay its employees' claims for compensation, that the employer has received an excessive number of claims for compensation, or that the employer has failed to discharge faithfully its obligations under this chapter and the rules of the department.

AB501,40 Section 40. 102.28 (2) (d) of the statutes is amended to read:

AB501,32,3 102.28 (2) (d) Effect of insuring with unauthorized insurer. An employer who procures an exemption under par. (b) and thereafter If an employer that is exempted under par. (b) or (bm) from the duty to insure under par. (a) enters into any agreement for excess insurance coverage with an insurer not authorized to do business in this state, the employer shall report that agreement to the department immediately. The placing of such coverage shall not by itself be grounds for revocation of the exemption.

AB501,41 Section 41. 102.28 (7) (a) of the statutes is amended to read:

AB501,32,19 102.28 (7) (a) If an employer who is currently or was formerly exempted by written order of the department under sub. (2) (b) is unable to pay an award, judgment is rendered in accordance with s. 102.20 against that employer, and execution is levied and returned unsatisfied in whole or in part, payments for the employer's liability shall be made from the fund established under sub. (8). If a currently or formerly exempted employer files for bankruptcy and not less than 60 days after that filing the department has reason to believe that compensation payments due are not being paid, the department in its discretion may make payment for the employer's liability from the fund established under sub. (8). The secretary of administration shall proceed to recover such those payments from the employer or the employer's receiver or trustee in bankruptcy, and may commence an action or proceeding or file a claim therefor for those payments. The attorney general shall appear on behalf of the secretary of administration in any such action or proceeding. All moneys recovered in any such action or proceeding shall be paid into the fund established under sub. (8).

AB501,42 Section 42. 102.28 (7) (b) of the statutes is renumbered 102.28 (7) (b) 1. and amended to read:

AB501,33,9 102.28 (7) (b) 1. Each employer exempted by written order of the department under sub. (2) (b) shall pay into the fund established by sub. (8) a sum equal to that assessed against each of the other such exempt employers upon the issuance of an initial order. The order an initial assessment based on orders of the department as provided in subd. 2. An order of the department requiring exempt employers to pay into that fund shall provide for a sum an amount that is sufficient to secure estimated payments of the an insolvent exempt employer due for the period up to the date of the order and for one year following the date of the order and to pay the estimated cost of insurance carrier or insurance service organization services under par. (c). Payments ordered to be made to the fund shall be paid to the department within 30 days after the date of the order. If additional moneys are required, further assessments shall be made based on orders of the department with as provided under subd. 2.

AB501,33,18 2. An initial or further assessment under subd. 1. shall be prorated on the basis of the gross payroll for this state of the exempt employer, as reported to the department for the previous calendar year for unemployment insurance purposes under ch. 108. If the or, if an exempt employer is not covered under ch. 108, then the department shall determine on the basis of the comparable gross payroll for the exempt employer as determined by the department. If payment of any assessment made under this subsection subd. 1. is not made within 30 days of after the date of the order of the department, the attorney general may appear on behalf of the state to collect the assessment.

AB501,43 Section 43. 102.28 (7) (bm) of the statutes is created to read:

AB501,33,20 102.28 (7) (bm) The department may not do any of the following:

AB501,33,23 1. Require an employer that elects under sub. (2) (bm) to self-insure its liability for the payment of compensation under this chapter to pay into the fund established under sub. (8).

AB501,34,2 2. Make any payments from the fund established under sub. (8) for the liability under this chapter of an employer that elects under sub. (2) (bm) to self-insure its liability for the payment of compensation under this chapter, whether currently or formerly exempt from the duty to insure under sub. (2) (a).

AB501,44 Section 44. 102.29 (1) (b) 2. of the statutes is amended to read:

AB501,34,11 102.29 (1) (b) 2. Out of the balance remaining after the deduction and payment specified in subd. 1., the employer, the insurance carrier, or, if applicable, the uninsured employers fund or the work injury supplemental benefit fund shall be reimbursed for all payments made by the employer, insurance carrier, or department, or which the employer, insurance carrier, or department may be obligated to make in the future, under this chapter, except that the employer, insurance carrier, or department shall not be reimbursed for any payments made or to be made under s. 102.18 (1) (b) 3. or (bp), 102.22, 102.35 (3), 102.57, or 102.60.

AB501,45 Section 45. 102.31 (2) (b) 2. of the statutes is amended to read:

AB501,34,18 102.31 (2) (b) 2. Regardless of whether the notices required under par. (a) have been given, a cancellation or termination is effective upon the effective date of replacement insurance coverage obtained by the employer or , of an order under s. 102.28 (2) (b) exempting the employer from carrying the duty to carry insurance under s. 102.28 (2) (a), or of an election by an employer under s. 102.28 (2) (bm) to self-insure its liability for the payment of compensation under this chapter.

AB501,46 Section 46. 102.315 (2) of the statutes is amended to read:

AB501,35,2 102.315 (2) Employee leasing company liable. An employee leasing company is liable under s. 102.03 for all compensation payable under this chapter to a leased employee, including any payments required under s. 102.16 (3), 102.18 (1) (b) 3. or (bp), 102.22 (1), 102.35 (3), 102.57, or 102.60. Except as permitted under s. 102.29, an employee leasing company may not seek or receive reimbursement from another employer for any payments made as a result of that liability. An employee leasing company is not liable under s. 102.03 for any compensation payable under this chapter to an employee of a client who is not a leased employee.

AB501,47 Section 47. 102.42 (2) (a) of the statutes is renumbered 102.42 (2) (a) 1. and amended to read:

AB501,35,13 102.42 (2) (a) 1. When the employer has notice of an injury and its relationship to an employee who is covered under a health benefit plan, as defined in s. 609.01 (1g), provided by the employer and of the relationship of the injury to the employment, the employer shall offer to the injured employee his or her the employee's choice of any physician, chiropractor, psychologist, dentist, physician assistant, advanced practice nurse prescriber, or podiatrist licensed to practice and practicing in this or any other state for treatment of the injury. By mutual agreement, the employee may have the choice of any qualified practitioner not licensed in this state as provided under the health care plan.

AB501,35,20 3. In case of emergency, the employer may arrange for treatment without tendering a choice. After the emergency has passed the an employee who is covered under a health benefit plan provided by the employer shall be given his or her choice of attending practitioner as provided under the health benefit plan at the earliest opportunity. The employee has the right to a 2nd choice of attending practitioner on notice to the employer or its insurance carrier. Any further choice shall be by mutual agreement. Partners

AB501,35,23 4. In this paragraph, partners and clinics are considered to be one practitioner. Treatment, and treatment by a practitioner on referral from another practitioner is considered to be treatment by one practitioner.

AB501,48 Section 48. 102.42 (2) (a) 2. of the statutes is created to read:

AB501,36,8 102.42 (2) (a) 2. When the employer has notice of an injury to an employee who is not covered under a health benefit plan provided by the employer and of the relationship of the injury to the employment, the employer shall offer to the injured employee the employer's choice of any practitioner specified in subd. 1. for treatment of the injury in accordance with the employee's treatment plan. This subdivision permits an employer to choose a particular practitioner for treatment of an injury, but does not permit an employer to choose the type of treatment to be provided or the type of practitioner to provide that treatment.

AB501,49 Section 49. 102.42 (3) of the statutes is amended to read:

AB501,36,15 102.42 (3) Practitioner choice unrestricted. If the employer fails to tender treatment as provided in sub. (1) or choice of an attending practitioner as provided in sub. (2), the employee's right to choose the attending practitioner is not restricted subs. (1) and (2), the employee may choose an attending practitioner without restriction and the employer is liable for the reasonable and necessary expense thereof of any treatment provided by that attending practitioner.

AB501,50 Section 50. 102.425 (3) (am) of the statutes is created to read:

AB501,37,4 102.425 (3) (am) 1. Subject to subds. 2. and 3., if a prescription drug dispensed under sub. (2) (a) for outpatient use by an injured employee is a repackaged prescription drug, the liability of an employer or insurer for the cost of the repackaged prescription drug is limited to the average wholesale price, as determined under par. (a) 1., of the prescription drug set by the original manufacturer of the prescription drug, plus any dispensing fee that may be payable under par. (a) 2. and any taxes that may be applicable under par. (a) 3., except that if the national drug code number of the prescription drug as packaged by the original manufacturer of the prescription drug cannot be determined from the billing statement under par. (c), that liability is limited to the average wholesale price, as determined under par. (a) 1., of the lowest-priced drug product equivalent, plus any dispensing fee under par. (a) 2. and any taxes under par. (a) 3. that would be payable for the drug product equivalent.

AB501,37,6 2. An employer or insurer is not liable for the cost of a repackaged prescription drug dispensed from a retail, mail-order, or institutional pharmacy.

AB501,37,8 3. Subdivisions 1. and 2. do not apply to a repackaged prescription drug dispensed from a retail, mail-order, or institutional pharmacy.

AB501,51 Section 51. 102.425 (3) (b) of the statutes is amended to read:

AB501,37,13 102.425 (3) (b) In addition to the liability under par. (a) or (am), whichever is applicable, an employer or insurer is also liable for reimbursement to an injured employee for all out-of-pocket expenses incurred by the injured employee in obtaining the prescription drug dispensed.

AB501,52 Section 52. 102.425 (4) (a) of the statutes is amended to read:

AB501,37,19 102.425 (4) (a) Except as provided in par. (b), a pharmacist or practitioner who dispenses a prescription drug under sub. (2) to an injured employee may not collect, or bring an action to collect, from the injured employee any charge that is in excess of the liability of the injured employee under sub. (2) (c) 2. or the liability of the employer or insurer under sub. (3) (a) or (am), whichever is applicable.

AB501,53 Section 53. 102.425 (4) (b) of the statutes is amended to read:

AB501,38,7 102.425 (4) (b) If an employer or insurer denies or disputes liability for the cost of a drug prescribed to an injured employee under sub. (2), the pharmacist or practitioner who dispensed the drug may collect, or bring an action to collect, from the injured employee the cost of the prescription drug dispensed, subject to the limitations specified in sub. (3) (a) or (am), whichever is applicable. If an employer or insurer concedes liability for the cost of a drug prescribed to an injured employee under sub. (2), but disputes the reasonableness of the amount charged for the prescription drug, the employer or insurer shall provide notice under sub. (4m) (b) to the pharmacist or practitioner that the reasonableness of the amount charged is in dispute and the pharmacist or practitioner who dispensed the drug may not collect, or bring an action to collect, from the injured employee the cost of the prescription drug dispensed after receiving that notice.

AB501,54 Section 54. 102.425 (4m) (b) of the statutes, as affected by 2015 Wisconsin Act 55, is amended to read:

AB501,38,19 102.425 (4m) (b) An employer or insurer that disputes the reasonableness of the amount charged for a prescription drug dispensed under sub. (2) for outpatient use by an injured employee or the department or division under sub. (4) (b) or s. 102.16 (1m) (c) or 102.18 (1) (bg) 3. shall provide, within 30 days after receiving a completed bill for the prescription drug, reasonable written notice to the pharmacist or practitioner that the charge is being disputed. After receiving reasonable written notice under this paragraph or under sub. (4) (b) or s. 102.16 (1m) (c) or 102.18 (1) (bg) 1. 3. that a prescription drug charge is being disputed, a pharmacist or practitioner may not collect the disputed charge from, or bring an action for collection of the disputed charge against, the employee who received the prescription drug.

AB501,55 Section 55. 102.43 (5) (c) of the statutes is amended to read: