Liability for disability caused by unnecessary treatment
Under current law, an employer that is subject to the worker's compensation
law is liable for worker's compensation when an employee sustains an injury while
performing services growing out of and incidental to the employee's employment
(compensable injury). Worker's compensation for which an employer is liable
includes benefits for temporary or permanent disability arising out of a compensable
injury and the expense of reasonably required medical treatment to cure and relieve
the employee from the effects of the compensable injury. In addition, the Wisconsin
Supreme Court, in Spencer v. ILHR Department, 55 Wis. 2d 525 (1972), held that an
employer is liable not only for the consequences of the original compensable injury,
but also for the consequences, such as an increased period of temporary disability or
an increased permanent disability rating, of any medical treatment for the
compensable injury that the employee accepts in good faith even if the treatment on
further review turns out to be unnecessary.
This bill codifies the Spencer doctrine with respect to liability for disability
incurred as a result of unnecessary treatment undertaken in good faith that is
invasive and generally medically acceptable. The bill, however, repeals the Spencer
doctrine with respect to liability for disability incurred as a result of unnecessary
treatment undertaken in good faith that is either noninvasive or not medically
acceptable.
Maximum compensation amounts
Under current law, temporary and permanent disability benefits are subject to
maximum weekly compensation rates specified in statute. Specifically, the
maximum weekly compensation rate for temporary disability and for permanent
total disability is 100% of the state's average weekly earnings as of June 30 of the
previous year. This bill provides that, for injuries occurring before January 1, 2006,
the maximum weekly compensation rate for temporary disability and for permanent
total disability is 110% of the state's average weekly earnings as of June 30 of the
previous year. For injuries occurring on or after January 1, 2006, that maximum
weekly compensation rate reverts to 100% of the state's average weekly earnings as
under current law.
Currently, the maximum weekly compensation rate for permanent partial
disability is $184. This bill increases that maximum weekly compensation rate to
$212 for injuries occurring in 2002, $222 for injuries occurring in 2003, $232 for
injuries occurring in 2004, and $242 for injuries occurring in 2005.
Under current law, an injured employee who is receiving the maximum weekly
benefit in effect at the time of the injury for permanent total disability or continuous
temporary total disability resulting from an injury that occurred before January 1,
1976, is entitled to receive supplemental benefits in an amount that, when added to
the employee's regular benefits, equals $150. The bill makes an employee who is
injured prior to January 1, 1978, eligible for those supplemental benefits. The bill
also increases the supplemental benefit amount for a week of disability occurring
after January 1, 2002, to an amount that, when added to the employee's regular
benefits, equals $202.
Method of calculating compensation
Current law specifies the method by which an employee's average weekly
earnings are calculated for purposes of determining the employee's compensation
rate. Briefly, that method calls for multiplying the employee's average daily
earnings, not including overtime, by the number of days and fractional days
normally worked per week in the employment in which the employee was engaged
at the time of the injury. This bill clarifies that hours worked beyond the normal
full-time working day as established by the employer, whether compensated at the
employee's regular rate of pay or at an increased rate of pay, are not counted in
determining the employee's average daily earnings. The bill also provides an
alternate method of calculating an employee's average weekly earnings. Specifically,
under the bill, an employee's average weekly earnings are the greater of the
employee's daily earnings multiplied by the number of days and fractional days in
the normal full-time workweek as established by the employer or the employee's
hourly earnings multiplied by the hours in the normal full-time workweek as
established by the employer. In addition, the bill creates a presumption that the
normal full-time workweek is 24 hours for a flight attendant, 56 hours for a
firefighter, and not less than 40 hours for any other employee and provides that the
normal full-time workweek for an employee on a multi-week schedule with regular
hours alternating between weeks is the average number of hours worked per week,
that is, from Sunday to Saturday, under the schedule.
Under current law, the average weekly earnings of an employee who is working
part-time for the day are arrived at by multiplying the employee's hourly earnings
by the number of hours of the normal full-time working day for the employment
involved and then multiplying that result by the number of days and fractional days
normally worked per week in the employment. This method of calculating a
part-time employee's average weekly wage is commonly known as "wage expansion"
because it usually results in an average weekly wage that is based on a 40-hour week
rather than on the part-time hours actually worked. If, however, the part-time
employee is also receiving wages from another job at the time of the injury, the wages
from the other job are offset when computing the employee's actual wage loss.
Current law does not specify the amount from which the wages from the other job are
offset. This bill specifies that the wages from the employee's other job are offset
against the employee's expanded wage and not against the employee's actual
earnings from the part-time job in which the employee was engaged at the time of
the injury.
The wage expansion method of calculating a part-time employee's average
weekly earnings has been limited by the Wisconsin Supreme Court, in
Carr's Inc. V.
Industrial Commission, 234 Wis. 466 (1940), in the case of an employee who is a
member of a regularly-scheduled class of part-time employees. For those
employees, the average weekly earnings are based on the normal workweek of the
employee's class, subject to a minimum of 24 times the employee's normal hourly
earnings at the time of the injury. This bill provides that an employee is a member
of a regularly-scheduled class of part-time employees for purposes of calculating the
employee's average weekly earnings if the employee is a member of a class of
employees that does the same type of work at the same location, the minimum and
maximum weekly hours regularly scheduled by the employer for the members of the
class during the 13 weeks immediately preceding the injury vary by no more than
five hours, at least 10% of the employer's workforce doing the same type of work are
members of the class, and the class consists of more than one employee.
Vocational rehabilitation; offer of suitable employment
Under current law, an injured employee may be entitled to receive vocational
rehabilitation instruction from DWD under the federal Rehabilitation Act of 1973,
or, if the employee is eligible for that instruction, but DWD cannot provide that
instruction, from a private rehabilitation counselor. An injured employee must be
paid temporary disability benefits and the actual and necessary costs of travel and
maintenance while receiving vocational rehabilitation instruction, except that
current DWD administrative rules provide that an employer is not liable for those
benefits or costs if the employee is receiving vocational rehabilitation services from
a private vocational rehabilitation counselor and the employer makes an offer of
suitable employment to the employee.
The rules define "suitable employment" to mean a job that is within the
employee's permanent work restrictions, that the employee has the necessary
physical capacity, knowledge, transferable skills, and ability to perform, and that
pays not less than 85% of the employee's preinjury average weekly wage, except that
a job that pays 85% or more of the employee's preinjury average weekly wage does
not constitute suitable employment if the employee was working part-time at the
time of the injury and the employee's average weekly wage as calculated for purposes
of determining the employee's compensation rate exceeds the employee's actual
average weekly wage for the part-time employment or if the employee was on a
demonstrated career or vocational path at the time of the injury, the employee's
average weekly wage at the time of the injury does not reflect the employee's earning
potential in the demonstrated career or vocational path, and the permanent work
restrictions caused by the injury impede the employee's ability to pursue the
demonstrated career or vocational path.
This bill extends the offer of suitable employment rule to employees who are
receiving vocational rehabilitation instruction from DWD. Specifically, the bill
provides that if an employer makes an offer of suitable employment to an employee
who is receiving vocational rehabilitation instruction from DWD, the employer is not
liable for temporary disability benefits or for the costs of travel and maintenance
during the employee's rehabilitation. The bill differs from the administrative rule,
however, insofar as under the bill a job must pay not less than 90%, rather than 85%,
of the employee's preinjury average weekly wage in order to be considered suitable
employment
Statute of limitations
Under current law, an application for worker's compensation that is not filed
within 12 years from the date of the injury or from the date that worker's
compensation, other than treatment expenses, was last paid, whichever is later, is
barred (statute of limitations), except that in cases of occupational disease there is
no statute of limitations. In cases of occupational disease, benefits or treatment
expenses becoming due 12 years after the date of the injury or after the date that
worker's compensation was last paid, whichever is later, are paid not by the employer
or insurer, but rather by DWD from the work injury supplemental benefit fund. This
bill eliminates the 12-year statute of limitations for a traumatic injury resulting in
the loss or total impairment of a hand or any part of the rest of the arm proximal to,
that is, toward the trunk from, the hand or of a foot or any part of the rest of the leg
proximal to the foot, any loss of vision, any permanent brain injury, or any injury
causing the need for a total or partial knee or hip replacement. The bill also provides
that in those cases, benefits or treatment expenses becoming due 12 years after the
date of the injury or after the date that worker's compensation was last paid,
whichever is later, are paid from the work injury supplemental benefit fund.
Hearings and procedures
Under current law, DWD has jurisdiction to resolve disputes between health
care providers and insurers or self-insured employers over the necessity of
treatment provided for an injured employee. DWD may exercise that jurisdiction
when confirming a compromise or stipulation agreed to between the insurer or
self-insured employer and the employee, when making its findings following a
hearing on a contested case, or when exercising its jurisdiction under a necessity of
treatment dispute resolution process set forth in the statutes. Before determining
the necessity of treatment provided for an injured employee, DWD must obtain a
written opinion on the necessity of the treatment in dispute from an expert selected
by DWD. This bill requires DWD to obtain such an expert opinion only when DWD
is exercising its jurisdiction under the statutory necessity of treatment dispute
resolution process. In all other cases, obtaining such an expert opinion is optional
on the part of DWD.
Under current law, in a hearing on a contested case, the contents of certified
investigation reports made by industrial safety specialists employed by DWD are
prima facie evidence as to matter contained in those reports. This bill provides that
certified investigation reports made by industrial safety specialists employed,
contracted, or otherwise secured by DWD are prima facie evidence as to matter
contained in those reports.
Under current law, within 90 days after the final hearing in a contested case
DWD must make an order determining the rights of the parties, which order may
include an award of worker's compensation. Pending the final determination of a
case, DWD may also make interlocutory orders, which may be enforced in the same
manner as a final order. This bill permits DWD to 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 employee's injury.
Payment of benefits
Current DWD administrative rules require a party that has been ordered to pay
an award of worker's compensation following a contested case hearing or a default
to pay that compensation within 21 days after DWD mails a copy of the order to the
party's last-known address and a party that has been ordered to pay an award of
worker's compensation following a compromise or stipulation to pay that
compensation within ten days after DWD mails a copy of the order to the party's
last-known address. This bill requires a party that has been ordered to pay an award
of worker's compensation to pay that compensation within 21 days after DWD mails
a copy of the order to the party's last-known address, whether the award results from
a hearing, a default, or a compromise or stipulation.
Under current law, subject to certain exceptions, worker's compensation
exceeding $100 must be delivered directly to the claimant in person. This bill permits
an insurer or self-insured employer to deposit a worker's compensation payment
that is due a claimant directly into an account maintained by the claimant at a
financial institution, if the claimant so requests and the insurer or self-insured
employer so agrees. The claimant may revoke his or her request at any time by
providing appropriate written notice to the insurer or self-insured employer.
Current law requires worker's compensation for permanent disability to be
paid to an injured employee on a monthly basis. This bill requires worker's
compensation for permanent disability that results from an injury for which the
employer or insurer concedes liability and that is based on a minimum disability
rating promulgated by DWD by rule to begin within 30 days after the end of the
employee's healing period or within 30 days after the employer or insurer receives
a medical report that provides a permanent disability rating, whichever is later. The
bill also requires worker's compensation for permanent disability that results from
an injury for which the employer or insurer does not concede liability or that is based
on a permanent disability rating that is above a minimum permanent disability
rating promulgated by DWD by rule to begin within the later of those 30-day periods
unless the employer or insurer requests the employee to undergo an independent
medical examination, in which case that compensation must begin within 30 days
after the employer or insurer receives a report of the examination or within 90 days
after the date of the request, whichever is earlier. The bill also requires payments
for permanent disability to continue on a monthly basis and to accrue and be payable
between intermittent periods of temporary disability so long as the employer or
insurer knows the nature of the permanent disability.
Program administration
Under current DWD administrative rules, when an employee provides to the
employer or insurer a signed statement relating to a claim by the employee, the
employer or insurer must provide a copy of the statement to the employee. When an
employee's statement is taken by a recording device and not immediately reduced to
writing, a copy of the entire statement must be given to the employee or to his
attorney within a reasonable time after the employee files an application with DWD
for a hearing on the claim. If a hearing is held, the employer or insurer must also
make the actual recording of the statement available as an exhibit. Failure to comply
with this rule precludes the employer or insurer from using the statement in any
manner in connection with the claim. This bill codifies this rule in statute without
change, except that the bill requires the employee's written statement to be provided
in all cases to the employee within a reasonable time after the statement is made and
the employee's recorded statement to be provided, on the request of the employee or
the employee's attorney or other authorized agent, to the employee, attorney, or
agent within a reasonable time after the statement is taken.
Under current law, if an insurer or self-insured employer has evidence that a
worker's compensation claim is false or fraudulent and if the insurer or self-insurer
is satisfied that reporting the claim will not impede its ability to defend the claim,
the insurer or self-insured employer must report the claim to DWD. DWD may then
require the insurer or self-insured employer to investigate the claim and report the
results of the investigation to DWD. If based on the investigation, DWD has a
reasonable basis to believe that criminal insurance fraud has occurred, DWD must
refer the matter to the district attorney for prosecution. Current law also requires
DWD to submit an annual report to the governor and to the appropriate standing
committees of the legislature detailing for the previous year the number of reports
of false or fraudulent claims received, the number of referrals for prosecution made,
and the results of those referrals. This bill eliminates the requirement that DWD
annually report that information to the governor and to the appropriate standing
committees of the legislature.
Under current law, the Wisconsin compensation rating bureau (bureau), which
is a rate service organization licensed by the commissioner of insurance to establish
worker's compensation premium rates, must file certain information with DWD.
That information includes information collected by the bureau from insurers writing
worker's compensation insurance regarding employers insured for worker's
compensation. Current law prohibits the bureau from making public any
information reported to it by insurers except as required by law. Current law,
however, provides that subject to certain exceptions, the records of DWD relating to
the administration of workers compensation are subject to public inspection and
copying. This bill prohibits DWD from making public any information obtained from
the bureau except as authorized by the bureau.
Extension of expiring provisions
Under current law, a student of a public school or a private school who is
performing services for an employer as part of a school work training, work
experience, or work study program, who is not on the payroll of the employer or
otherwise receiving compensation on which a worker's compensation premium could
be assessed on the employer, and who is named as an employee of the school district
or private school by an endorsement on the school district's or private school's
worker's compensation policy is an employee of the school district or private school
for purposes of worker's compensation coverage. A student who is named as an
employee of a school district or private school for purposes of worker's compensation
coverage and who makes a claim for worker's compensation against the school
district or private school may not also make a claim for worker's compensation or
maintain an action in tort against the employer that provided the work training or
work experience from which the claim arose. Currently, these provisions do not apply
to injuries occurring after December 31, 2001. This bill eliminates that expiration
date, thereby applying these provision to a student who is injured after December
31, 2001.
Under current law, DWD has jurisdiction to determine the reasonableness of
the fees charged for health services provided to an injured employee. Current law
specifies the procedure that DWD must follow in analyzing a fee dispute submitted
to DWD before July 1, 2002. Specifically, DWD must compare the disputed fee to the
mean fee for the health service procedure for which the disputed fee was charged as
shown by a database of health service fees certified by DWD. If the disputed fee is
at or below the mean fee, plus 1.5 standard deviations from the mean fee, DWD must
determine that the fee is reasonable. If the disputed fee is above the mean fee, plus
1.5 standard deviations from the mean fee, DWD must determine that the fee is
unreasonable, unless the health services provider proves that a higher fee is
justified. This bill eliminates the July 1, 2002, expiration date for this procedure,
thereby applying this procedure to fee disputes submitted to DWD on or after July
1, 2002.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB505, s. 1
1Section
1. 15.227 (4) of the statutes is amended to read:
AB505,8,92
15.227
(4) Council on worker's compensation. There is created in the
3department of workforce development a council on worker's compensation appointed
4by the secretary of workforce development to consist of a
member or designated
5employee of the department of workforce development as chairperson, 5
6representatives of employers
, and 5 representatives of employees. The secretary of
7workforce development shall also appoint 3 representatives of insurers authorized
8to do worker's compensation insurance business in this state as nonvoting members
9of the council.
AB505, s. 2
10Section
2. 102.01 (2) (k) of the statutes is created to read:
AB505,8,1211
102.01
(2) (k) "Workweek" means a calendar week, starting on Sunday and
12ending on Saturday.
AB505, s. 3
13Section
3. 102.04 (2) of the statutes is amended to read:
AB505,9,8
1102.04
(2) Except with respect to a partner or member electing under s.
2102.075, members of partnerships or limited liability companies shall not be counted
3as employees. Except as provided in s. 102.07 (5) (a), a person under contract of hire
4for the performance of any service for any employer subject to this section
(1961)
5shall not constitute an is not the employer of any other person with respect to
such 6that service
, and
such that other person shall, with respect to
such that service, be
7deemed to be an employee only of
such
the employer for whom the service is being
8performed.
AB505, s. 4
9Section
4. 102.07 (7m) of the statutes is created to read:
AB505,9,1410
102.07
(7m) An employee, volunteer, or member of an emergency management
11unit is an employee for purposes of this chapter as provided in s. 166.03 (8) (d), and
12a member of a regional emergency response team who is acting under a contract
13under s. 166.215 (1) is an employee for purposes of this chapter as provided in s.
14166.215 (4).
AB505, s. 5
15Section
5. 102.07 (12m) of the statutes is amended to read:
AB505,9,2316
102.07
(12m) A student of a public school, as described in s. 115.01 (1), or a
17private school, as defined in s. 115.001 (3r), while he or she is engaged in performing
18services as part of a school work training, work experience or work study program,
19and who is not on the payroll of an employer that is providing the work training or
20work experience or who is not otherwise receiving compensation on which a worker's
21compensation carrier could assess premiums on that employer, is an employee of a
22school district or private school that elects under s. 102.077 to name the student as
23its employee.
This subsection does not apply after December 31, 2001.
AB505, s. 6
24Section
6. 102.077 (3) of the statutes is repealed.
AB505, s. 7
25Section
7. 102.11 (1) (intro.) of the statutes is amended to read:
AB505,11,2
1102.11
(1) (intro.) The average weekly earnings for temporary disability,
2permanent total disability
, or death benefits for injury in each calendar year on or
3after January 1, 1982, shall be not less than $30 nor more than the wage rate
which 4that results in a maximum compensation rate of
100% 110% of the state's average
5weekly earnings as determined under s. 108.05 as of June 30 of the previous year,
6except that the average weekly earnings for temporary disability, permanent total
7disability
, or death benefits for injuries occurring on or after January 1,
1998, and
8before January 1, 1999 2006, shall be not more than
$784.50, resulting in a
9maximum compensation rate of $523, and the average weekly earnings for
10temporary disability, permanent total disability or death benefits for injuries
11occurring on or after January 1, 1999, and before January 1, 2000, shall be not more
12than $807, resulting in a maximum compensation rate of $538 the wage rate that
13results in a maximum compensation rate of 100% of the state's average weekly
14earnings as determined under s. 108.05 as of June 30 of the previous year. The
15average weekly earnings for permanent partial disability shall be not less than $30
16and, for permanent partial disability for injuries occurring on or after January 1,
171998 2002, and before January 1,
1999 2003, not more than
$268.50 $318, resulting
18in a maximum compensation rate of $
179, and, $212, for permanent partial disability
19for injuries occurring on or after January 1,
1999
2003, and before January 1, 2004,
20not more than
$276 $333, resulting in a maximum compensation rate of
$184 $222,
21for permanent partial disability for injuries occurring on or after January 1, 2004,
22and before January 1, 2005, not more than $348, resulting in a maximum
23compensation rate of $232, and, for permanent partial disability for injuries
24occurring on or after January 1, 2005, and before January 1, 2006, not more than
1$363, resulting in a maximum compensation rate of $242. Between such limits the
2average weekly earnings shall be determined as follows:
AB505, s. 8
3Section
8. 102.11 (1) (a) of the statutes is renumbered 102.11 (1) (a) 1. and
4amended to read:
AB505,11,105
102.11
(1) (a) 1. Daily earnings shall mean the daily earnings of the employee
6at the time of the injury in the employment in which the employee was then engaged.
7In determining daily earnings under this
paragraph, overtime subdivision, any
8hours worked beyond the normal full-time working day as established by the
9employer, whether compensated at the employee's regular rate of pay or at an
10increased rate of pay, shall not be considered.
AB505,11,18
112. If at the time of the injury the employee is working on part time for the day,
12the employee's daily earnings shall be arrived at by dividing the amount received,
13or to be received by the employee for such part-time service for the day, by the
14number of hours and fractional hours of such part-time service, and multiplying the
15result by the number of hours of the normal full-time working day
established by the
16employer for the employment involved. The words "part time for the day" shall apply
17to Saturday half days and all other days upon which the employee works less than
18normal full-time working hours.
AB505,11,25
193. The average weekly earnings shall be arrived at by multiplying the
20employee's hourly earnings by the hours in the normal full-time workweek as
21established by the employer, or by multiplying the employee's daily earnings by the
22number of days and fractional days
normally worked per week in the normal
23full-time workweek as established by the employer, at the time of the injury in the
24business operation of the employer for the particular employment in which the
25employee was engaged at the time of the employee's injury
, whichever is greater.
AB505, s. 9
1Section
9. 102.11 (1) (a) 4. of the statutes is created to read:
AB505,12,82
102.11
(1) (a) 4. It is presumed, unless rebutted by reasonably clear and
3complete documentation, that the normal full-time workweek established by the
4employer is 24 hours for a flight attendant, 56 hours for a firefighter, and not less
5than 40 hours for any other employee. If the employer has established a multi-week
6schedule with regular hours alternating between weeks, the normal full-time
7workweek is the average number of hours worked per week under the multi-week
8schedule.
AB505, s. 10
9Section
10. 102.11 (1) (am) of the statutes is created to read:
AB505,12,1610
102.11
(1) (am) In the case of an employee who is a member of a
11regularly-scheduled class of part-time employees, average weekly earnings shall be
12arrived at by the method prescribed in par. (a), except that the number of hours of
13the normal working day and the number of hours and days of the normal workweek
14shall be the hours and days established by the employer for that class. An employee
15is a member of a regularly-scheduled class of part-time employees if all of the
16following conditions are met:
AB505,12,2317
1. The employee is a member of a class of employees that does the same type
18of work at the same location and, in the case of an employee in the service of the state,
19is employed in the same office, department, independent agency, authority,
20institution, association, society, or other body in state government or, if the
21department determines appropriate, in the same subunit of an office, department,
22independent agency, authority, institution, association, society, or other body in state
23government.
AB505,13,324
2. The minimum and maximum weekly hours regularly scheduled by the
25employer for the members of the class during the 13 weeks immediately preceding
1the date of the injury vary by no more than 5 hours. Subject to this requirement, the
2members of the class do not need to work the same days or the same shift to be
3considered members of a regularly-scheduled class of part-time employees.
AB505,13,54
3. At least 10% of the employer's workforce doing the same type of work are
5members of the class.
AB505,13,66
4. The class consists of more than one employee.
AB505, s. 11
7Section
11. 102.11 (1) (b) of the statutes is amended to read:
AB505,13,158
102.11
(1) (b) In case of seasonal employment, average weekly earnings shall
9be arrived at by the method prescribed in par. (a), except that the number of hours
10of the normal full-time working day and the number of days of the normal full-time
11working week workweek shall be
such the hours and
such the days in similar service
12in the same or similar nonseasonal employment. Seasonal employment shall mean
13employment
which that can be conducted only during certain times of the year, and
14in no event shall employment be considered seasonal if it extends during a period of
15more than fourteen weeks within a calendar year.
AB505, s. 12
16Section
12. 102.123 of the statutes is created to read:
AB505,14,6
17102.123 Statement of employee. If an employee provides to the employer or
18the employer's insurer a signed statement relating to a claim for compensation by
19the employee, the employer or insurer shall provide a copy of the statement to the
20employee within a reasonable time after the statement is made. If an employer or
21insurer uses a recording device to take a statement from an employee relating to a
22claim for compensation by the employee, the employer or insurer, on the request of
23the employee or the employee's attorney or other authorized agent, shall reduce the
24statement to writing and provide a written copy of the entire statement to the
25employee, attorney, or agent within a reasonable time after the statement is taken.
1The employer or insurer shall also make the actual recording of the statement
2available as an exhibit if a hearing on the claim is held. An employer or insurer that
3fails to provide an employee with a copy of the employee's statement as required by
4this section or that fails to make available as an exhibit the actual recording of a
5statement recorded by a recording device as required by this section may not use that
6statement in any manner in connection with the employee's claim for compensation.
AB505, s. 13
7Section
13. 102.125 (1) of the statutes is renumbered 102.125 and amended
8to read:
AB505,14,21
9102.125 Fraudulent claims reporting and investigation. If an insurer or
10self-insured employer has evidence that a claim is false or fraudulent in violation of
11s. 943.395 and if the insurer or self-insured employer is satisfied that reporting the
12claim to the department will not impede its ability to defend the claim, the insurer
13or self-insured employer shall report the claim to the department. The department
14may require an insurer or self-insured employer to investigate an allegedly false or
15fraudulent claim and may provide the insurer or self-insured employer with any
16records of the department relating to that claim. An insurer or self-insured
17employer that investigates a claim under this
subsection section shall report on the
18results of that investigation to the department. If based on the investigation the
19department has a reasonable basis to believe that a violation of s. 943.395 has
20occurred, the department shall refer the results of the investigation to the district
21attorney of the county in which the alleged violation occurred for prosecution.
AB505, s. 14
22Section
14. 102.125 (2) of the statutes is repealed.
AB505, s. 15
23Section
15. 102.16 (2) (d) of the statutes is amended to read:
AB505,15,1324
102.16
(2) (d)
For fee disputes that are submitted to the department before
25July 1, 2002, the The department shall analyze the information provided to the
1department under par. (c) according to the criteria provided in this paragraph to
2determine the reasonableness of the disputed fee. The department shall determine
3that a disputed fee is reasonable and order that the disputed fee be paid if that fee
4is at or below the mean fee for the health service procedure for which the disputed
5fee was charged, plus 1.5 standard deviations from that mean, as shown by data from
6a database that is certified by the department under par. (h). The department shall
7determine that a disputed fee is unreasonable and order that a reasonable fee be paid
8if the disputed fee is above the mean fee for the health service procedure for which
9the disputed fee was charged, plus 1.5 standard deviations from that mean, as shown
10by data from a database that is certified by the department under par. (h), unless the
11health service provider proves to the satisfaction of the department that a higher fee
12is justified because the service provided in the disputed case was more difficult or
13more complicated to provide than in the usual case.
AB505, s. 16
14Section
16. 102.16 (2m) (c) of the statutes is amended to read:
AB505,16,415
102.16
(2m) (c) Before determining
under this subsection the necessity of
16treatment provided for an injured employee who claims benefits under this chapter,
17the department shall obtain a written opinion on the necessity of the treatment in
18dispute from an expert selected by the department.
Before determining under sub.
19(1m) (b) or s. 102.18 (1) (bg) 2. the necessity of treatment provided for an injured
20employee who claims benefits under this chapter, the department may, but is not
21required to, obtain such an expert opinion. To qualify as an expert, a person must
22be licensed to practice the same health care profession as the individual health
23service provider whose treatment is under review and must either be performing
24services for an impartial health care services review organization or be a member of
25an independent panel of experts established by the department under par. (f). The
1department shall adopt the written opinion of the expert as the department's
2determination on the issues covered in the written opinion, unless the health service
3provider or the insurer or self-insured employer present clear and convincing
4written evidence that the expert's opinion is in error.
AB505, s. 17
5Section
17. 102.17 (1) (c) of the statutes is amended to read:
AB505,17,116
102.17
(1) (c)
Either Any party shall have the right to be present at any hearing,
7in person or by attorney
, or any other agent, and to present such testimony as may
8be pertinent to the controversy before the department. No person, firm
, or
9corporation
, other than an attorney at law
, duly who is licensed to practice law in the
10state, may appear on behalf of any party in interest before the department or any
11member or employee of the department assigned to conduct any hearing,
12investigation
, or inquiry relative to a claim for compensation or benefits under this
13chapter, unless the person is 18 years of age or older, does not have an arrest or
14conviction record, subject to ss. 111.321, 111.322 and 111.335, is otherwise qualified
, 15and has obtained from the department a license with authorization to appear in
16matters or proceedings before the department. Except as provided under pars. (cm)
17and (cr), the license shall be issued by the department under rules
to be adopted 18promulgated by the department.
There shall be maintained in the office of the
19department The department shall maintain in its office a current list of persons to
20whom licenses have been issued. Any license may be suspended or revoked by the
21department for fraud or serious misconduct on the part of an agent, any license may
22be denied, suspended, nonrenewed
, or otherwise withheld by the department for
23failure to pay court-ordered payments as provided in par. (cm) on the part of an
24agent
, and any license may be denied or revoked if the department of revenue
25certifies under s. 73.0301 that the applicant or licensee is liable for delinquent taxes.
1Before suspending or revoking the license of the agent on the grounds of fraud or
2misconduct, the department shall give notice in writing to the agent of the charges
3of fraud or misconduct
, and shall give the agent full opportunity to be heard in
4relation to
the same those charges. In denying, suspending, restricting, refusing to
5renew
, or otherwise withholding a license for failure to pay court-ordered payments
6as provided in par. (cm), the department shall follow the procedure provided in a
7memorandum of understanding entered into under s. 49.857. The license and
8certificate of authority shall, unless otherwise suspended or revoked, be in force from
9the date of issuance until the June 30 following the date of issuance and may be
10renewed by the department from time to time, but each renewed license shall expire
11on the June 30 following the issuance
thereof of the renewed license.
AB505, s. 18
12Section
18. 102.17 (1) (e) of the statutes is amended to read:
AB505,17,2113
102.17
(1) (e) The department may, with or without notice to
either any party,
14cause testimony to be taken,
or an inspection of the premises where the injury
15occurred to be made, or the time books and payrolls of the employer to be examined
16by any examiner, and may direct any employee claiming compensation to be
17examined by a physician, chiropractor, psychologist, dentist
, or podiatrist. The
18testimony so taken, and the results of any such inspection or examination, shall be
19reported to the department for its consideration upon final hearing. All ex parte
20testimony taken by the department shall be reduced to writing and
either any party
21shall have opportunity to rebut
such that testimony on final hearing.
AB505, s. 19
22Section
19. 102.17 (1) (h) of the statutes is amended to read:
AB505,18,223
102.17
(1) (h) The contents of certified reports of investigation, made by
24industrial safety specialists who are employed
, contracted, or otherwise secured by
25the department and available for cross-examination, served upon the parties 15
1days prior to hearing, shall constitute prima facie evidence as to matter contained
2therein in those reports.
AB505, s. 20
3Section
20. 102.17 (4) of the statutes is amended to read:
AB505,18,194
102.17
(4) The right of an employee, the employee's legal representative
or, or
5a dependent to proceed under this section shall not extend beyond 12 years from the
6date of the injury or death or from the date that compensation, other than treatment
7or burial expenses, was last paid, or would have been last payable if no advancement
8were made, whichever date is latest. In the case of occupational disease
, a traumatic
9injury resulting in the loss or total impairment of a hand or any part of the rest of
10the arm proximal to the hand or of a foot or any part of the rest of the leg proximal
11to the foot, any loss of vision, any permanent brain injury, or any injury causing the
12need for a total or partial knee or hip replacement, there shall be no statute of
13limitations, except that benefits or treatment expense becoming due after 12 years
14from the date of injury or death or last payment of compensation shall be paid from
15the work injury supplemental benefit fund under s. 102.65 and in the manner
16provided in s. 102.66. Payment of wages by the employer during disability or absence
17from work to obtain treatment shall be deemed payment of compensation for the
18purpose of this section if the employer knew of the employee's condition and its
19alleged relation to the employment.
AB505, s. 21
20Section
21. 102.18 (1) (b) of the statutes is amended to read:
AB505,19,1521
102.18
(1) (b) Within 90 days after the final hearing and close of the record, the
22department shall make and file its findings upon the ultimate facts involved in the
23controversy, and its order, which shall state its determination as to the rights of the
24parties. Pending the final determination of any controversy before it, the
25department may in its discretion after any hearing make interlocutory findings,
1orders
, and awards
, which may be enforced in the same manner as final awards. The
2department may include in
any interlocutory or final award or order an order
3directing the employer or insurer to pay for any future treatment that may be
4necessary to cure and relieve the employee from the effects of the injury. If the
5department finds that the employer or insurer has not paid any amount that the
6employer or insurer was directed to pay in any interlocutory order or award and that
7the nonpayment was not in good faith, the department may include in its final award
,
8as a penalty
for noncompliance with any such interlocutory order or award, if it finds
9that noncompliance was not in good faith, not exceeding 25% of each amount
which
10shall not have been that was not paid as directed
thereby. Where. When there is a
11finding that the employee is in fact suffering from an occupational disease caused by
12the employment of the employer against whom the application is filed, a final award
13dismissing
such the application upon the ground that the applicant has suffered no
14disability from
said the disease shall not bar any claim
he or she the employee may
15thereafter have for disability sustained after the date of the award.
AB505, s. 22
16Section
22. 102.18 (1) (e) of the statutes is created to read:
AB505,19,2317
102.18
(1) (e) Except as provided in s. 102.21, if the department orders a party
18to pay an award of compensation, the party shall pay the award no later than 21 days
19after the date on which the order is mailed to the last-known address of the party,
20unless a party files a petition for review under sub. (3). This paragraph applies to
21all awards of compensation ordered by the department, whether the award results
22from a hearing, the default of a party, or a compromise or stipulation confirmed by
23the department.
AB505, s. 23
24Section
23. 102.20 of the statutes is amended to read:
AB505,20,6
1102.20 Judgment on award. If
either any party presents a certified copy of
2the award to the circuit court for any county, the court shall, without notice, render
3judgment in accordance
therewith with the award. A judgment rendered under this
4section shall have the same effect as though rendered in an action tried and
5determined by the court, and shall, with like effect, be entered in the judgment and
6lien docket.
AB505, s. 24
7Section
24. 102.23 (1) (d) of the statutes is amended to read:
AB505,20,168
102.23
(1) (d) The commission shall make return to the court of all documents
9and papers on file in the matter,
and of all testimony
which that has been taken, and
10of the commission's order, findings
, and award. Such return of the commission when
11filed in the office of the clerk of the circuit court shall, with the papers
mentioned 12specified in s. 809.15
, constitute a judgment roll in the action; and it shall not be
13necessary to have a transcript approved. The action may thereupon be brought on
14for hearing before the court upon the record by
either
any party on 10 days' notice
15to the other; subject, however, to the provisions of law for a change of the place of trial
16or the calling in of another judge.
AB505, s. 25
17Section
25. 102.26 (3) (b) 3. of the statutes is created to read:
AB505,20,2518
102.26
(3) (b) 3. The claimant may request the insurer or self-insured employer
19to pay any compensation that is due the claimant by depositing the payment directly
20into an account maintained by the claimant at a financial institution. If the insurer
21or self-insured employer agrees to the request, the insurer or self-insured employer
22may deposit the payment by direct deposit, electronic funds transfer, or any other
23money transfer technique approved by the department. The claimant may revoke
24a request under this subdivision at any time by providing appropriate written notice
25to the insurer or self-insured employer.