AB686: Bill Text

AB686, s. 8 Section 8. 102.16 (2) (c) of the statutes is amended to read:

AB686,6,5 102.16 (2) (c) After a fee dispute is submitted to the department, the insurer or self-insured employer self-insurer that is a party to the dispute shall provide to the department information on that fee and information on fees charged by other health service providers for comparable services. The insurer or self-insured employer self-insurer shall obtain the information on comparable fees from a database that is certified by the department under par. (h). Except as provided in par. (e) 1., if the insurer or self-insured employer self-insurer does not provide the information required under this paragraph, the department shall determine that the disputed fee is reasonable and order that it be paid. If the insurer or self-insured employer self-insurer provides the information required under this paragraph, the department shall use that information to determine the reasonableness of the disputed fee.

AB686, s. 9 Section 9. 102.16 (2) (e) 1. of the statutes is amended to read:

AB686,6,14 102.16 (2) (e) 1. Subject to subd. 2., if an insurer or self-insured employer self-insurer that disputes the reasonableness of a fee charged by a health service provider cannot provide information on fees charged by other health service providers for comparable services because the database to which the insurer or self-insured employer self-insurer subscribes is not able to provide accurate information for the health service procedure at issue, the department may use any other information that the department considers to be reliable and relevant to the disputed fee to determine the reasonableness of the disputed fee.

AB686, s. 10 Section 10. 102.16 (2) (f) of the statutes is amended to read:

AB686,6,23 102.16 (2) (f) Within 30 days after a determination under this subsection, the department may set aside, reverse, or modify the determination for any reason that the department considers sufficient. Within 60 days after a determination under this subsection, the department may set aside, reverse, or modify the determination on grounds of mistake. A health service provider, insurer, or self-insured employer self-insurer that is aggrieved by a determination of the department under this subsection may seek judicial review of that determination in the same manner that compensation claims are reviewed under s. 102.23.

AB686, s. 11 Section 11. 102.16 (2m) (a) of the statutes is amended to read:

AB686,7,14 102.16 (2m) (a) Except as provided in this paragraph, the department has jurisdiction under this subsection, sub. (1m) (b), and s. 102.17 to resolve a dispute between a health service provider and an insurer or self-insured employer self-insurer over the necessity of treatment provided for an injured employee who claims benefits under this chapter. A health service provider may not submit a dispute over necessity of treatment to the department under this subsection before all treatment by the health service provider of the employee's injury has ended if the amount in controversy, whether based on a single charge or a combination of charges for one or more days of service, is less than $25. After all treatment by a health service provider of an employee's injury has ended, the health service provider may submit any dispute over necessity of treatment to the department, regardless of the amount in controversy. The department shall deny payment for any treatment that the department determines under this subsection, sub. (1m) (b), or s. 102.18 (1) (b) to be unnecessary.

AB686, s. 12 Section 12. 102.16 (2m) (am) of the statutes is amended to read:

AB686,8,5 102.16 (2m) (am) A health service provider and an insurer or self-insured employer self-insurer that are parties to a dispute under this subsection over the necessity of treatment are bound by the department's determination under this subsection on the necessity of that treatment, unless that determination is set aside on judicial review as provided in par. (e). A health service provider and an insurer or self-insured employer self-insurer that are parties to a dispute under sub. (1m) (b) over the necessity of treatment are bound by the department's determination under sub. (1m) (b) on the necessity of that treatment, unless that determination is set aside or modified by the department under sub. (1). An insurer or self-insured employer self-insurer that is a party to a dispute under s. 102.17 over the necessity of treatment and a health service provider are bound by the department's determination under s. 102.18 (1) (b) on the necessity of that treatment, unless that determination is set aside, reversed or modified by the department under s. 102.18 (3) or by the commission under s. 102.18 (3) or (4) or is set aside on judicial review under s. 102.23.

AB686, s. 13 Section 13. 102.16 (2m) (b) of the statutes is amended to read:

AB686,8,15 102.16 (2m) (b) An insurer or self-insured employer self-insurer that disputes the necessity of treatment provided by a health service provider or the department under sub. (1m) (b) or s. 102.18 (1) (bg) 2. shall provide reasonable notice to the health service provider that the necessity of that treatment is being disputed. After receiving reasonable notice under this paragraph or under sub. (1m) (b) or s. 102.18 (1) (bg) 2. that the necessity of treatment is being disputed, a health service provider may not collect a fee for that disputed treatment from, or bring an action for collection of the fee for that disputed treatment against, the employee who received the treatment.

AB686, s. 14 Section 14. 102.16 (2m) (c) of the statutes is amended to read:

AB686,9,6 102.16 (2m) (c) Before determining under this subsection the necessity of treatment provided for an injured employee who claims benefits under this chapter, the department shall obtain a written opinion on the necessity of the treatment in dispute from an expert selected by the department. Before determining under sub. (1m) (b) or s. 102.18 (1) (bg) 2. the necessity of treatment provided for an injured employee who claims benefits under this chapter, the department may, but is not required to, obtain such an expert opinion. To qualify as an expert, a person must be licensed to practice the same health care profession as the individual health service provider whose treatment is under review and must either be performing services for an impartial health care services review organization or be a member of an independent panel of experts established by the department under par. (f). The department shall adopt the written opinion of the expert as the department's determination on the issues covered in the written opinion, unless the health service provider or the insurer or self-insured employer present self-insurer presents clear and convincing written evidence that the expert's opinion is in error.

AB686, s. 15 Section 15. 102.16 (2m) (d) of the statutes is amended to read:

AB686,9,17 102.16 (2m) (d) The department may charge a party to a dispute over the necessity of treatment provided for an injured employee who claims benefits under this chapter for the full cost of obtaining the written opinion of the expert under par. (c). The department shall charge the insurer or self-insured employer self-insurer for the full cost of obtaining the written opinion of the expert for the first dispute that a particular individual health service provider is involved in, unless the department determines that the individual health service provider's position in the dispute is frivolous or based on fraudulent representations. In a subsequent dispute involving the same individual health service provider, the department shall charge the losing party to the dispute for the full cost of obtaining the written opinion of the expert.

AB686, s. 16 Section 16. 102.16 (2m) (e) of the statutes is amended to read:

AB686,9,24 102.16 (2m) (e) Within 30 days after a determination under this subsection, the department may set aside, reverse, or modify the determination for any reason that the department considers sufficient. Within 60 days after a determination under this subsection, the department may set aside, reverse, or modify the determination on grounds of mistake. A health service provider, insurer, or self-insured employer self-insurer that is aggrieved by a determination of the department under this subsection may seek judicial review of that determination in the same manner that compensation claims are reviewed under s. 102.23.

AB686, s. 17 Section 17. 102.17 (1) (g) of the statutes is amended to read:

AB686,10,16 102.17 (1) (g) Whenever the testimony presented at any hearing indicates a dispute or creates a doubt as to the extent or cause of disability or death, the department may direct that the injured employee be examined, that an autopsy be performed, or that an opinion be obtained without examination or autopsy, by or from an impartial, competent physician, chiropractor, dentist, psychologist or podiatrist designated by the department who is not under contract with or regularly employed by a compensation insurance carrier or self-insured employer self-insurer. The expense of the examination, autopsy, or opinion shall be paid by the employer or, if the employee claims compensation under s. 102.81, from the uninsured employers fund. The report of the examination, autopsy, or opinion shall be transmitted in writing to the department and a copy of the report shall be furnished by the department to each party, who shall have an opportunity to rebut such report on further hearing.

AB686, s. 18 Section 18. 102.18 (1) (bg) 1. of the statutes is amended to read:

AB686,10,25 102.18 (1) (bg) 1. If the department finds under par. (b) that an insurer or self-insured employer self-insurer is liable under this chapter for any health services provided to an injured employee by a health service provider, but that the reasonableness of the fee charged by the health service provider is in dispute, the department may include in its order under par. (b) a determination as to the reasonableness of the fee or the department may notify, or direct the insurer or self-insured employer self-insurer to notify, the health service provider under s. 102.16 (2) (b) that the reasonableness of the fee is in dispute.

AB686, s. 19 Section 19. 102.18 (1) (bw) of the statutes is amended to read:

AB686,11,8 102.18 (1) (bw) If an insurer, a self-insured employer self-insurer or, if applicable, the uninsured employers fund pays compensation to an employee in excess of its liability and another insurer is liable for all or part of the excess payment, the department may order the insurer or self-insured employer self-insurer that is liable to reimburse the insurer or self-insured employer self-insurer that made the excess payment or, if applicable, the uninsured employers fund.

AB686, s. 20 Section 20. 102.26 (3) (b) 3. of the statutes is amended to read:

AB686,11,18 102.26 (3) (b) 3. The claimant may request the insurer or self-insured employer self-insurer to pay any compensation that is due the claimant by depositing the payment directly into an account maintained by the claimant at a financial institution. If the insurer or self-insured employer self-insurer agrees to the request, the insurer or self-insured employer self-insurer may deposit the payment by direct deposit, electronic funds transfer, or any other money transfer technique approved by the department. The claimant may revoke a request under this subdivision at any time by providing appropriate written notice to the insurer or self-insured employer self-insurer.

AB686, s. 21 Section 21. 102.28 (2) (b) of the statutes is amended to read:

AB686,12,11 102.28 (2) (b) Exemption from duty to insure. The department may grant a written order of exemption to an employer who, or group of employers engaged in the logging industry, that shows its financial ability to pay the amount of compensation, agrees to report faithfully all compensable injuries, and agrees to comply with this chapter and the rules of the department. The department may condition the granting of an exemption upon the employer's applicant's furnishing of satisfactory security to guarantee payment of all claims under compensation. The department may require that bonds or other personal guarantees be enforceable against sureties in the same manner as an award may be enforced. The department may from time to time require proof of financial ability of the employer or group of employers to pay compensation. Any exemption shall be void if the application for it contains a financial statement which that is false in any material respect. An employer who or an employer that is a member of a group of employers that files an application containing a false financial statement remains subject to par. (a). The department may promulgate rules establishing an amount to be charged to an initial applicant for exemption under this paragraph and an annual amount to be charged to employers and groups of employers that have been exempted under this paragraph.

AB686, s. 22 Section 22. 102.28 (2) (bm) of the statutes is created to read:

AB686,12,19 102.28 (2) (bm) Exemption from duty to insure; logging industry groups. Two or more employers engaged in the logging industry may enter into an agreement to pool their liabilities under this chapter for purposes of obtaining an exemption under par. (b). If the department grants an exemption under par. (b) to a group of 2 or more employers engaged in the logging industry, each employer that is a member of the group shall be exempt under par. (b) and may operate as a self-insurer under this chapter.

AB686, s. 23 Section 23. 102.28 (2) (c) of the statutes is amended to read:

AB686,13,17 102.28 (2) (c) Revocation of exemption. The department, after seeking the advice of the self-insurers council, may revoke an exemption granted to an employer or group of employers under par. (b), upon giving the employer or group of employers 10 days' written notice, if the department finds that the employer's financial condition of the employer or group of employers is inadequate to pay its employees' claims for compensation, that the employer or group of employers has received an excessive number of claims for compensation, or that the employer or group of employers has failed to discharge faithfully its obligations according to the agreement contained in the application for exemption. The employer or group of employers may, within 10 days after receipt of the notice of revocation, 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 or group of employers is aggrieved by the determination of the secretary or the secretary's designee, the employer or group of employers 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 of the employer or group of employers should be revoked, the employer, or each employer that is a member of the group of employers, 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.

AB686, s. 24 Section 24. 102.28 (2) (d) of the statutes is amended to read:

AB686,13,24 102.28 (2) (d) Effect of insuring with unauthorized insurer. An employer who or group of employers that procures an exemption under par. (b) and thereafter enters into any agreement for excess insurance coverage with an insurer not authorized to do business in this state shall report that agreement to the department immediately. The placing of such coverage shall not by itself be grounds for revocation of the exemption.

AB686, s. 25 Section 25. 102.28 (7) (a) of the statutes is amended to read:

AB686,14,17 102.28 (7) (a) If an employer who or group of employers that 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 or group of employers, and execution is levied and returned unsatisfied in whole or in part, payments for the employer's liability of the employer or group of employers shall be made from the fund established under sub. (8). If a currently or formerly exempted employer or group of employers 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 of the employer or group of employers from the fund established under sub. (8). The secretary of administration shall proceed to recover such those payments from the employer, the group of employers, or the employer's receiver or trustee in bankruptcy of the employer or group of employers, 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).

AB686, s. 26 Section 26. 102.28 (7) (b) of the statutes is amended to read:

AB686,15,13 102.28 (7) (b) Each employer or group of employers 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 and groups of employers upon the issuance of an initial order. The order shall provide for a sum sufficient to secure estimated payments of the insolvent exempt employer or group of employers 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. If additional moneys are required, further assessments shall be made based on orders of the department with assessment prorated on the basis of the gross payroll for this state of the exempt employer, or of each employer that is a member of the group of employers, reported to the department for the previous calendar year for unemployment insurance purposes under ch. 108. If the exempt employer, or an employer that is a member of a group of employers, is not covered under ch. 108, then the department shall determine the comparable gross payroll for the exempt employer or for each employer that is a member of the group of employers. If payment of any assessment made under this subsection is not made within 30 days of after the order of the department, the attorney general may appear on behalf of the state to collect the assessment.

AB686, s. 27 Section 27. 102.33 (2) (b) (intro.) of the statutes is amended to read:

AB686,16,2 102.33 (2) (b) (intro.) Notwithstanding par. (a), a record maintained by the department that reveals the identity of an employee who claims worker's compensation benefits, the nature of the employee's claimed injury, the employee's past or present medical condition, the extent of the employee's disability, the amount, type or duration of benefits paid to the employee or any financial information provided to the department by a self-insured employer self-insurer or by an applicant for exemption under s. 102.28 (2) (b) is confidential and not open to public inspection or copying under s. 19.35 (1). The department may deny a request made under s. 19.35 (1) or, subject to s. 102.17 (2m) and (2s), refuse to honor a subpoena issued by an attorney of record in a civil or criminal action or special proceeding to inspect and copy a record that is confidential under this paragraph, unless one of the following applies:

AB686, s. 28 Section 28. 102.33 (2) (b) 3. of the statutes is amended to read:

AB686,16,11 102.33 (2) (b) 3. The record that is requested contains financial information provided by a self-insured employer self-insurer or by an applicant for exemption under s. 102.28 (2) (b) and the requester is the self-insured employer self-insurer or applicant for exemption or an attorney or authorized agent of the self-insured employer self-insurer or applicant for exemption. An attorney or authorized agent of the self-insured employer self-insurer or of the applicant for exemption shall provide a written authorization for inspection and copying from the self-insured employer self-insurer or applicant for exemption if requested by the department.

AB686, s. 29 Section 29. 102.75 (1) of the statutes is amended to read:

AB686,17,3 102.75 (1) The department shall assess upon and collect from each licensed worker's compensation insurance carrier, and from each employer and group of employers exempted under s. 102.28 (2) (b) by special order or by rule, the proportion of total costs and expenses incurred by the council on worker's compensation for travel and research and by the department and the commission in the administration of this chapter for the current fiscal year, plus any deficiencies in collections and anticipated costs from the previous fiscal year, that the total indemnity paid or payable under this chapter by each such carrier and, exempt employer, and exempt group of employers in worker's compensation cases initially closed during the preceding calendar year, other than for increased, double, or treble compensation, bore to the total indemnity paid in cases closed the previous calendar year under this chapter by all carriers and, exempt employer employers, and exempt groups of employers other than for increased, double, or treble compensation. The council on worker's compensation and the commission shall annually certify any costs and expenses for worker's compensation activities to the department at such time as the secretary requires.

AB686, s. 30 Section 30. 102.75 (2) of the statutes is amended to read:

AB686,17,10 102.75 (2) The department shall require that payments for costs and expenses for each fiscal year shall be made on such dates as the department prescribes by each licensed worker's compensation insurance carrier and by each employer and group of employers exempted under s. 102.28 (2) (b). Each such payment shall be a sum equal to a proportionate share of the annual costs and expenses assessed upon each carrier and, employer, and group of employers as estimated by the department.

AB686, s. 31 Section 31. 102.75 (4) of the statutes is amended to read:

AB686,17,17 102.75 (4) From the appropriation under s. 20.445 (1) (ha), the department shall allocate the amounts that it collects in application fees from employers and groups of employers applying for exemption under s. 102.28 (2) (b) and the annual amount that it collects from employers and groups of employers that have been exempted under s. 102.28 (2) (b) to fund the activities of the department under s. 102.28 (2) (b) and (c).

AB686, s. 32 Section 32. 626.12 (2) of the statutes is amended to read:

AB686,18,2 626.12 (2) Classification. Risks may be classified in any reasonable way for the establishment of rates and minimum premiums. Classification rates may be modified to produce rates for individual risks in accordance with rating plans which establish standards for measuring variations in hazards or expense provisions, or both. Such standards may measure any differences among risks that can be demonstrated to have a probable effect upon losses or expenses. In classifying risks and establishing rates for the logging industry, the bureau shall establish separate classifications and rates for mechanized logging operations and for manual logging operations.

AB686,18,3 (End)