2001 WISCONSIN ACT 65
An Act to repeal 628.097 (1) (title) and 628.097 (2); to renumber 601.41 (3), 628.097 (1) (a) and 628.097 (1) (b); to renumber and amend 628.46 (2m); to amend 227.21 (2) (a), 227.21 (2) (b), 600.03 (19) (b) 1., 612.33 (2) (a), 612.33 (2) (b), 618.43 (7), 628.09 (1), 628.09 (4), 628.09 (5), 628.097 (title), 632.05 (2), 632.68 (2) (e), 632.68 (4) (c), 632.835 (2) (b), 655.27 (5) (a) 1., 655.27 (5) (a) 2. and 655.455; and to create 601.41 (3) (b), 604.04 (8), 618.39 (3), 628.46 (2m) (b) and 632.835 (2) (bg) of the statutes; relating to: miscellaneous changes to the insurance laws related to the confidentiality of personal information obtained in the course of administering a state insurance fund, the statute of limitations for bringing an action against the patients compensation fund and providing notice of mediation to that fund, the applicability of a timeliness requirement for the payment of insurance claims for chiropractic services, an exception from a requirement to obtain consent to incorporate certain publications by reference in administrative rules, the type of property for which the loss amount is the insurance limits, the renewal date for viatical settlement brokers' licenses, eliminating the requirement to keep a separate account for surplus lines taxes, issuance of temporary licenses for intermediaries, specifying by rule the amount of stop-loss reinsurance that a town mutual must obtain, standards related to assisting unauthorized insurers, providing notice of the right to independent review, and defining extraordinary dividends for life insurers; and granting rule-making authority.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
65,1
Section
1. 227.21 (2) (a) of the statutes is amended to read:
227.21 (2) (a) To Except as provided in s. 601.41 (3) (b), to avoid unnecessary expense, an agency may, with the consent of the revisor and the attorney general, adopt standards established by technical societies and organizations of recognized national standing by incorporating the standards in its rules by reference to the specific issue or issues of the publication in which they appear, without reproducing the standards in full.
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2. 227.21 (2) (b) of the statutes is amended to read:
227.21 (2) (b) The revisor and the attorney general shall consent to incorporation by reference only in a rule of limited public interest and in a case where the incorporated standards are readily available in published form. Each rule containing an incorporation by reference shall state how the material incorporated may be obtained and, except as provided in s. 601.41 (3) (b), that the standards are on file at the offices of the agency, the secretary of state, and the revisor.
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Section
3. 600.03 (19) (b) 1. of the statutes is amended to read:
600.03 (19) (b) 1. With respect to a life insurer, the total net gain from operations income of the insurer for the calendar year preceding the date of the dividend or distribution, minus realized capital gains for that calendar year.
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4. 601.41 (3) of the statutes is renumbered 601.41 (3) (a).
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5. 601.41 (3) (b) of the statutes is created to read:
601.41 (3) (b) The commissioner may, without the consent of the revisor or the attorney general as required under s. 227.21 (2), adopt standards of the National Association of Insurance Commissioners by incorporating by reference in rules promulgated by the commissioner any materials published, adopted, or approved by the National Association of Insurance Commissioners, without reproducing the standards in full. The standards referred to in this paragraph do not include any model act or model regulation proposed or adopted by the National Association of Insurance Commissioners. Any materials of the National Association of Insurance Commissioners that are incorporated by reference in rules promulgated by the commissioner shall be obtainable from, and are only required to be kept on file at, the office, which shall be stated in any rule containing such an incorporation by reference. Nothing in this paragraph prohibits the commissioner from adopting standards of the National Association of Insurance Commissioners through incorporation by reference in rules in the manner provided under s. 227.21 (2).
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Section
6. 604.04 (8) of the statutes is created to read:
604.04 (8) Nondisclosure of personal information. The manager may refuse to disclose, and may prevent any other person from disclosing, any personally identifiable information, as defined in s. 19.62 (5), that is obtained by the manager in the course of administering a fund under chs. 605 to 607.
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7. 612.33 (2) (a) of the statutes is amended to read:
612.33 (2) (a) Windstorm and hail insurance. If a town mutual provides coverage against windstorm or hail, or other perils involving a similar potential for catastrophic losses, which are designated by the commissioner by rule, it shall obtain reinsurance for each such risk or else stop-loss reinsurance with an insurer authorized to do such business in this state, to an extent reasonably adequate to cover the risk of catastrophic losses or in an amount specified by the commissioner by rule. The commissioner may prescribe detailed requirements for such reinsurance by rule or by order.
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Section
8. 612.33 (2) (b) of the statutes is amended to read:
612.33 (2) (b) Nonproperty insurance. To the extent that a town mutual provides insurance under s. 612.31 (3), it shall obtain reinsurance of at least a 90% proportional share of each risk with an insurer authorized to do such business in this state. The commissioner may permit a town mutual to retain a larger percentage if he or she finds that the interests of the members will not be endangered thereby, or may require it to reinsure a larger percentage if he or she finds that the interests of the members make it advisable. The commissioner may by rule require other reinsurance.
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Section
9. 618.39 (3) of the statutes is created to read:
618.39 (3) Standards by rule. (a) The office may by rule promulgate standards for any of the following:
1. Establishing that a person should know that the result of insurance business is or might be the illegal placement of insurance with an unauthorized insurer or the subsequent servicing of an insurance policy illegally placed with an unauthorized insurer.
2. Imposing requirements under s. 601.42 or 628.04 or sanctions or remedial measures under sub. (2) or s. 601.64, or any other applicable penalty or remedial provision of chs. 600 to 646, for a violation of this section.
(b) Notwithstanding par. (a) 1., it is not necessary for the office to promulgate a rule under par. (a) 1. to establish that a person violated sub. (1).
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Section
10. 618.43 (7) of the statutes is amended to read:
618.43 (7) Taxes as trust funds. All premium taxes collected under this section by an agent or broker or by an insurer are the property of this state. They shall be kept in a separate account and may not be commingled with funds belonging to anyone else, to be held in trust for the state.
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Section
11. 628.09 (1) of the statutes is amended to read:
628.09 (1) Issuance of license. Except as provided in s. 628.095 or 628.097, the commissioner may issue a temporary license as an intermediary for a period of not more than 3 12 months to the personal representative of a deceased or mentally disabled intermediary, or to a person designated by an intermediary who is otherwise disabled or has entered active duty in the U.S. armed forces, in order to give time for more favorable sale of the goodwill of a business owned by the intermediary, for the recovery or return of the intermediary, or for the orderly training and licensing of new personnel for the intermediary's business. This subsection does not apply to life insurance agents.
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Section
12. 628.09 (4) of the statutes is amended to read:
628.09 (4) Duration of license. The commissioner may by order revoke a temporary license if the interests of insureds or the public are endangered. Except as provided in s. 628.097, a A temporary license may
not be extended beyond the initial period specified under sub. (1), for additional periods of not more than 3 months each, with the total period not to exceed 12 months in the aggregate. A temporary license may not continue after the owner or the personal representative disposes of the business.
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13. 628.09 (5) of the statutes is amended to read:
628.09 (5) Fees. The fees for a temporary license are the same as for a permanent license. No additional fee may be charged for extensions under sub. (4), nor for the issuance of a subsequent license under s. 628.04 if that license is issued while the temporary license remains in effect.
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14. 628.097 (title) of the statutes is amended to read:
628.097 (title) Refusal to issue license; failure to pay support or to comply with subpoena or warrant; tax delinquency.
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15. 628.097 (1) (title) of the statutes is repealed.
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16. 628.097 (1) (a) of the statutes is renumbered 628.097 (1m).
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17. 628.097 (1) (b) of the statutes is renumbered 628.097 (2m).
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18. 628.097 (2) of the statutes is repealed.
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Section
19. 628.46 (2m) of the statutes, as created by
2001 Wisconsin Act 16, is renumbered 628.46 (2m) (a) and amended to read:
628.46 (2m) (a) Notwithstanding subs. (1) and (2) and except as provided in par. (b), a claim for payment for chiropractic services is overdue if not paid within 30 days after the insurer receives clinical documentation from the chiropractor that the services were provided unless, within those 30 days, the insurer provides to the insured and to the chiropractor the written statement under s. 632.875 (2).
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Section
20. 628.46 (2m) (b) of the statutes is created to read:
628.46 (2m) (b) Paragraph (a) does not apply to any of the following:
1. Worker's compensation insurance.
2. Any line of property and casualty insurance except disability insurance. In this subdivision, "disability insurance" does not include uninsured motorist coverage, underinsured motorist coverage, or medical payment coverage.
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21. 632.05 (2) of the statutes is amended to read:
632.05 (2) Whenever any policy insures real property which that is owned and occupied by the insured primarily as a dwelling and the property is wholly destroyed, without criminal fault on the part of the insured or the insured's assigns, the amount of the loss shall be taken conclusively to be the policy limits of the policy insuring the property.
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Section
22. 632.68 (2) (e) of the statutes is amended to read:
632.68 (2) (e) Except as provided in sub. (3), a license issued under this subsection shall be renewed annually on the anniversary date July 1 upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing the licensee's social security number, unless the licensee does not have a social security number, or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license. If the licensee is a natural person who does not have a social security number, the license shall be renewed annually on the anniversary date July 1 upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing to the commissioner a statement made or subscribed under oath or affirmation, on a form prescribed by the department of workforce development, that the licensee does not have a social security number.
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Section
23. 632.68 (4) (c) of the statutes is amended to read:
632.68 (4) (c) Except as provided in sub. (5), a license issued under this subsection shall be renewed annually on the anniversary date July 1 upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing the licensee's social security number, unless the licensee does not have a social security number, or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license. If the licensee is a natural person who does not have a social security number, the license shall be renewed annually, except as provided in sub. (5), on the anniversary date July 1 upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing to the commissioner a statement made or subscribed under oath or affirmation, on a form prescribed by the department of workforce development, that the licensee does not have a social security number.
632.835 (2) (b) Whenever If an adverse determination or an experimental treatment determination is made, the insurer involved in the determination shall provide notice to the insured of the insured's right to obtain the independent review required under this section, how to request the review, and the time within which the review must be requested. The notice shall include a current listing of independent review organizations certified under sub. (4). An independent review under this section may be conducted only by an independent review organization certified under sub. (4) and selected by the insured.
65,23d
Section 23d. 632.835 (2) (bg) of the statutes is created to read:
632.835 (2) (bg) Notwithstanding par. (b), an insurer is not required to provide the notice under par. (b) to an insured until the insurer sends notice of the disposition of the internal grievance if all of the following apply:
1. The health benefit plan issued by the insurer contains a description of the independent review procedure under this section, including an explanation of the insured's rights under par. (d), how to request the review, the time within which the review must be requested, and how to obtain a current listing of independent review organizations certified under sub. (4).
2. The insurer includes on its explanation of benefits form a statement that the insured may have a right to an independent review after the internal grievance process and that an insured may be entitled to expedited independent review with respect to an urgent matter. The statement shall also include a reference to the section of the policy or certificate that contains the description of the independent review procedure as required under subd. 1. The statement shall provide a toll-free telephone number and website, if appropriate, where consumers may obtain additional information regarding internal grievance and independent review processes.
3. For any adverse determination or experimental treatment determination for which an explanation of benefits is not provided to the insured, the insurer provides a notice that the insured may have a right to an independent review after the internal grievance process and that an insured may be entitled to expedited, independent review with respect to an urgent matter. The notice shall also include a reference to the section of the policy or certificate that contains the description of the independent review procedure as required under subd. 1. The notice shall provide a toll-free telephone number and website, if appropriate, where consumers may obtain additional information regarding internal grievance and independent review processes.
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Section
24. 655.27 (5) (a) 1. of the statutes is amended to read:
