The bill provides that any employer that fails to maintain group health care
coverage for an injured employee or the employer's worker's compensation insurer
is liable to the injured employee for an amount that is equal to 100 percent of the
contributions required of the employer that the employer failed to pay, in addition
to any temporary disability benefits payable under the worker's compensation law.
That liability also applies to an employer that fails to maintain group health care
coverage provided at the time of injury for an injured employee or to the employer's
worker's compensation insurer in a case in which the employer's liability for worker's
compensation for the employee's injury or the period of the employee's temporary
disability is in dispute, if the injured employee submits the dispute to DWD and the
injury or period of disability is found to be compensable under the worker's
compensation law. Under the bill, if an employer fails to maintain group health care
coverage for an injured employee as required under the bill, the injured employee
may request DWD to conduct a hearing on the violation. If, after hearing, the
hearing examiner finds that the employer has failed to maintain group health care
coverage as required under the bill, the hearing examiner may order the employer
to pay the injured employee the contributions for group health care coverage that the
employer failed to pay.
Prescription drug treatment
Under current law, an employer or insurer is liable for providing medicines as
may be reasonably required to cure and relieve an injured employee from the effects
of an injury sustained while performing services growing out of and incidental to
employment. Current law, however, limits the liability of an employer or insurer for
the cost of a prescription drug dispensed for outpatient use by an injured employee
to the average wholesale price of the prescription drug as quoted in the Drug Topics
Red Book (average wholesale price).
This bill provides that if a prescription drug dispensed for outpatient use by an
injured employee is a repackaged prescription drug, the liability of the employer or
insurer for the cost of the repackaged prescription drug is limited to the average
wholesale price of the prescription drug set by the original manufacturer of the
prescription drug, except that if the National Drug Code number of the prescription
drug as packaged by the original manufacturer cannot be determined from the
billing statement submitted to the employer or insurer, that liability is limited to the
average wholesale price of the lowest-priced drug product equivalent. That
limitation of liability, however, does not apply to a repackaged prescription drug
dispensed from a retail, mail-order, or institutional pharmacy.
Hearings and procedures
Health care records in electronic format
Under current law, a physician, chiropractor, psychologist, podiatrist, dentist,
physician assistant, advance practice nurse prescriber, hospital, or health service
provider, upon request by an injured employee, employer, insurer, or DWD, must
provide that person with any written material that is reasonably related to an injury
for which the employee claims worker's compensation, upon payment of the actual
cost of providing those materials, not to exceed the greater of 45 cents per page or
$7.50 per request, plus the actual costs of postage.
This bill permits that material to be provided in electronic format upon
payment of $26 per request.
Final practitioner's report
Under current law, if an injured employee has a period of temporary disability
of more than three weeks or a permanent disability, has undergone surgery to treat
an injury, other than surgery to correct a hernia, or sustains an eye injury requiring
medical treatment on three or more occasions off the employer's premises, the
employer or insurer must submit to DWD a final treating practitioner's report.
Current law, however, prohibits DWD from requiring submission of that report when
the employer or insurer denies the employee's claim for compensation and the
employee does not contest that denial. This bill limits that prohibition to cases in
which the employer or insurer denies the employee's claim for compensation in its
entirety.
Prospective vocational rehabilitation training orders
Under current law, any party in interest may submit to DWD any controversy
concerning worker's compensation and DWD, after hearing, must issue an order
determining the rights of the parties regarding the controversy. Current law also
permits DWD to issue interlocutory, i.e., nonfinal, findings, orders, and awards,
which may be enforced in the same manner as final awards. Current law specifically
permits DWD to include in an 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 an injured employee from the effects of the employee's injury.
This bill permits DWD to include in an interlocutory or final award or order an
order directing the employer or insurer to pay for a future course of instruction or
other rehabilitation training services provided under a rehabilitation training
program.
Administrative review of a worker's compensation decision
Under current law, a party to a worker's compensation proceeding may petition
the Labor and Industry Review Commission (LIRC) for review of a DWD hearing
examiner's decision awarding or denying worker's compensation (petition for
review) if DWD or LIRC receives the petition for review within 21 days after DWD
mailed a copy of the examiner's findings and order to the petitioner's last-known
address. Currently, LIRC must dismiss a petition for review that is not timely filed
unless the petitioner shows probable good cause that the reason for failure to timely
file the petition was beyond the petitioner's control. This bill requires a party to file
a petition for review with LIRC, not DWD. The bill also requires LIRC to dismiss a
petition for review that is not filed within those 21 days unless the petitioner shows
that the petition was filed late for a reason that was beyond the petitioner's control.
Under current law, within 28 days after a decision of LIRC is mailed to the
last-known address of each party to a worker's compensation proceeding, LIRC may,
on its own motion, set aside the decision for further consideration. This bill permits
LIRC to set aside a decision within 28 days after the date of the decision, not the date
of its mailing.
Judicial review of a worker's compensation decision
Under current law, a party that is aggrieved by an order or award made by LIRC
may commence an action against LIRC in circuit court for judicial review of the order
or award (action for judicial review). Current law requires the adverse party to also
be made a defendant in an action for judicial review. Recently, a concurring opinion
in Xcel Energy Services, Inc. v. LIRC, 2013 WI 64, "unequivocally and firmly"
recommended that the Council on Worker's Compensation propose legislative
revisions to clarify who must be included as a party in an action for judicial review.
Id. at p. 71. That concurring opinion further proposed that LIRC consider adopting
the practice of providing information with its order or award instructing the parties
as to who is to be named as an adverse party in an action for judicial review. Id. at
p. 73.
This bill requires LIRC to identify in an order or award the persons that must
be made parties to an action for judicial review. The bill also requires the summons
and complaint in the action to name those persons as defendants. In addition, the
bill permits the circuit court to join as a party to the action any other person
determined necessary for the proper resolution of the action, unless joinder of the
person would unduly delay the resolution of the action.
Program administration
Health service fee disputes
Under current law, if a health service provider, injured employee, insurer, or
employer submits to DWD a dispute over the reasonableness of a health service fee
charged by the health service provider for services provided to the injured employee,
DWD must determine the reasonableness of the disputed fee by comparing the
disputed fee to the mean fee for the procedure for which the disputed fee was charged,
as shown by data from a database certified by DWD. If the disputed fee is at or below
the mean fee, plus 1.2 standard deviations from that mean, DWD must determine
that the disputed fee is reasonable and order the fee to be paid. If the disputed fee
is above the mean fee, plus 1.2 standard deviations from that mean, DWD must
determine that the disputed fee is unreasonable and order that a reasonable fee be
paid, unless the health service provider proves that a higher fee is justified. This bill
lowers the standard deviations used to determine the reasonableness of a disputed
health service fee to 0.7 standard deviations from the mean.
Health service fee schedule
This bill requires DWD to establish a schedule of the maximum fees that a
health care provider may charge an employer or insurer for health services provided
to an injured employee who claims worker's compensation benefits. Under the bill,
DWD must, when that schedule is established, notify the Legislative Reference
Bureau (LRB), and the LRB must publish that notice in the Wisconsin
Administrative Register. On publication of that notice, the health service fee dispute
resolution process under current law no longer applies and instead the liability of an
employer or insurer for a health service included in the fee schedule is limited to the
maximum fee allowed under the schedule for that health service as of the date on
which the health service was provided, any fee agreed to by the contract between the
employer or insurer and health care provider for the health service as of that date,
or the health care provider's actual fee for the health service as of that date,
whichever is less.
The bill requires DWD, in determining those maximum fees, to divide the state
into five regions based on geographical and economical similarity, including
similarity in the cost of health services, and, for each region, to: 1) determine the
average payment made by insured and self-insured group health plans, and the
average copayment, coinsurance, and deductible payment made by persons covered
under those plans, for each health service included in the schedule; and 2) set the
maximum fee for each health service included in the schedule at 110 percent of the
sum of that average payment and that average copayment, coinsurance, and
deductible payment.
The bill also requires DWD to adjust those maximum fees annually by the
change in the consumer price index for medical care services and, no less often than
every two years, to redetermine the average payment made by group health plans
for the services included in the schedule and revise those maximum fees based on
that redetermined average.
Investigation and prosecution of fraudulent activity
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.
This bill permits DWD to request the Department of Justice (DOJ) to assist
DWD in an investigation of a false or fraudulent worker's compensation claim of any
other suspected fraudulent activity on the part of an employer, employee, insurer,
health care provider, or other person related to worker's compensation. If, based on
the investigation, DWD has a reasonable basis to believe that theft, forgery, fraud,
or any other criminal violation has occurred, DWD must refer the matter to the
district attorney or DOJ for prosecution.
Uninsured employers fund
Under current law, if an employee of an uninsured employer suffers an injury
for which the uninsured employer is liable, DWD, from the uninsured employers
fund, or, if DWD obtains excess or stop-loss reinsurance from a reinsurer, the
reinsurer pays benefits to the injured employee that are equal to the worker's
compensation owed by the uninsured employer.
This bill requires DWD to pay a claim of an employee of an uninsured employer
in excess of $1,000,000 from the uninsured employers fund in the first instance, but
provides that if the claim is not covered by excess or stop-loss reinsurance, the
secretary of administration annually must transfer from the worker's compensation
operations fund to the uninsured employers fund an amount equal to the amount by
which payments from the uninsured employers fund on all such claims in the prior
year are in excess of $1,000,000 per claim, subject to a $500,000 annual limit on the
amount that the secretary of administration may transfer. If the amount to be
transferred exceeds that $500,000 annual limit, the secretary of administration
must transfer the amount in excess of $500,000 in the next calendar year or in
subsequent calendar years until the amount in excess of $500,000 is transferred in
full.
Self-insured employers
Election by governmental employer to self-insure. Under current law,
every employer that is subject to the worker's compensation law must carry worker's
compensation insurance from an insurer that is authorized to do business in this
state (duty to insure), except that DWD may exempt an employer from the duty to
insure if the employer shows that it can self-insure its worker's compensation
liability and if the employer agrees to report all compensable injuries and to comply
with the worker's compensation law and the rules of DWD. DWD rules, however,
permit the state or a local governmental unit to self-insure without further order of
DWD.
This bill codifies those DWD rules into the statutes. Specifically, the bill
permits the state or a local governmental unit that has independent taxing authority
(governmental employer) to elect to self-insure its worker's compensation liability
without further order of DWD if the governmental employer agrees to report all
compensable injuries and to comply with the worker's compensation law and the
rules of DWD. Under the bill, a local governmental unit that elects to self-insure its
liability for the payment of worker's compensation must notify DWD of that election
in writing before commencing to self-insure that liability, must notify DWD of its
intent to continue to self-insure that liability every three years after that initial
notice, and must notify DWD of its intent to withdraw that election not less than 30
days before the effective date of that withdrawal.
Revocation of governmental employer election to self-insure. Current
law permits DWD, after seeking the advice of the Self-Insurer's Council, to revoke
an exemption from the duty to insure if DWD 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.
This bill permits DWD to revoke an election by a governmental employer to
self-insure its liability for worker's compensation, without seeking the advice of the
Self-Insurer's Council, if DWD finds that the governmental employer's financial
condition is inadequate to pay its employees' claims for compensation, that the
governmental employer has received an excessive number of claims for
compensation, or that the governmental employer has failed to discharge faithfully
its obligations under the worker's compensation law and the rules of DWD. Under
the bill, once such an election is revoked, the governmental employer whose election
is revoked may not elect to self-insure its liability for the payment of worker's
compensation unless at least three calendar years have elapsed since the revocation
and DWD finds that the governmental employer's financial condition is adequate to
pay its employees' claims for compensation, that the governmental employer has not
received an excessive number of claims for compensation, and that the governmental
employer has faithfully discharged its obligations under the worker's compensation
law and the rules of DWD.
Self-insured employer assessments. Current law establishes a self-insured
employers liability fund, consisting of assessments paid into the fund by self-insured
employers, that is used to pay the worker's compensation liability of current or
former self-insured employers that cannot pay that liability. Under current law, on
issuance of an order exempting an employer from the duty to insure, the exempt
employer must pay into the fund an amount that is equal to the amount assessed
upon each other exempt employer (initial assessment). Subsequent assessments,
however, are prorated on the basis of the gross payroll for this state of the exempt
employer, as reported to DWD for the previous calendar year for purposes of
unemployment insurance.
This bill requires an initial assessment, as well as subsequent assessments, for
the self-insurer's fund to be prorated on the basis of the gross payroll for this state
of the exempt employer, as reported to DWD for the previous calendar year for
purposes of unemployment insurance.
The bill also removes governmental employers from the coverage of the
self-insurer's fund. Specifically, the bill prohibits DWD from: 1) requiring a
governmental employer that elects to self-insure its liability for the payment of
worker's compensation to pay into the self-insurer's fund; and 2) making payments
from that fund for the liability under the worker's compensation law of such an
employer, whether currently or formerly exempt from the duty to insure.
Study of treatment outcomes
Finally, the bill requires the secretary of workforce development to create a
committee to review and evaluate the outcomes of treatment provided to injured
employees by health care providers under the worker's compensation program. The
committee must include representatives of employers, employees, health care
providers, worker's compensation insurers authorized to do business in this state,
and DWD. Upon completion of the study, the committee must report its findings,
conclusions, and recommendations to DWD and the Council on Worker's
Compensation, after which the committee ceases to exist.
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:
AB711,12,63
20.445
(1) (ra)
Worker's compensation operations fund; administration. From
4the worker's compensation operations fund, the amounts in the schedule for the
5administration of the worker's compensation program by the department
, for
6assistance to the department of justice in investigating and prosecuting fraudulent
7activity related to worker's compensation, for transfer to the uninsured employers
8fund under s. 102.81 (1) (c), and for transfer to the appropriation accounts under par.
9(rp) and sub. (2) (ra). All moneys received under ss. 102.28 (2) (b) and 102.75 shall
10be credited to this appropriation account. From this appropriation, an amount not
1to exceed $5,000 may be expended each fiscal year for payment of expenses for travel
2and research by the council on worker's compensation,
an amount not to exceed
3$500,000 may be transferred in each fiscal year to the uninsured employers fund
4under s. 102.81 (1) (c), the amount in the schedule under par. (rp) shall be transferred
5to the appropriation account under par. (rp), and the amount in the schedule under
6sub. (2) (ra) shall be transferred to the appropriation account under sub. (2) (ra).
AB711,2
7Section
2. 101.654 (2) (b) of the statutes is amended to read:
AB711,12,128
101.654
(2) (b) If the applicant is required under s. 102.28 (2) (a) to have in force
9a policy of worker's compensation insurance or if the applicant is self-insured in
10accordance with s. 102.28 (2) (b)
or (bm), that the applicant has in force a policy of
11worker's compensation insurance issued by an insurer authorized to do business in
12this state or is self-insured in accordance with s. 102.28 (2) (b)
or (bm).
AB711,3
13Section
3. 102.01 (2) (d) of the statutes is amended to read:
AB711,12,1914
102.01
(2) (d)
"Municipality" includes a county, city, town, village, school
15district, sewer district, drainage district and long-term care district and "Local
16governmental unit" means a political subdivision of this state; a special purpose
17district or taxing jurisdiction, as defined in s. 70.114 (1) (f), in this state; an
18instrumentality, corporation, combination, or subunit of any of the foregoing; or any 19other public or quasi-public
corporations corporation.
AB711,4
20Section
4. 102.03 (4) of the statutes is amended to read:
AB711,13,221
102.03
(4) The right to compensation and the amount of the compensation shall
22in all cases be determined in accordance with the provisions of law in effect as of the
23date of the injury except as to employees whose rate of compensation is changed as
24provided in ss. 102.43 (7) or 102.44 (1)
, (1m), (4m), or (5) or, before May 1,
2014 2016,
25as provided in s. 102.43 (5) (c) and employees who are eligible to receive private
1rehabilitative counseling and rehabilitative training under s. 102.61 (1m) and except
2as provided in s. 102.555 (12) (b).
AB711,5
3Section
5. 102.04 (1) (a) of the statutes is amended to read:
AB711,13,64
102.04
(1) (a) The state
, and each
county, city, town, village, school district,
5sewer district, drainage district, long-term care district and other public or
6quasi-public corporations therein local governmental unit in this state.
AB711,6
7Section
6. 102.04 (2m) of the statutes is amended to read:
AB711,13,168
102.04
(2m) A temporary help agency is the employer of an employee whom
9the temporary help agency has placed with or leased to another employer that
10compensates the temporary help agency for the employee's services. A temporary
11help agency is liable under s. 102.03 for all compensation and other payments
12payable under this chapter to or with respect to that employee, including any
13payments required under s. 102.16 (3), 102.18 (1) (b)
3. or (bp), 102.22 (1), 102.35 (3),
14102.57, or 102.60. Except as permitted under s. 102.29, a temporary help agency may
15not seek or receive reimbursement from another employer for any payments made
16as a result of that liability.
AB711,7
17Section
7. 102.07 (1) (a) of the statutes is amended to read:
AB711,14,418
102.07
(1) (a) Every person, including all officials, in the service of the state,
19or of any
municipality therein local governmental unit in this state, whether elected
20or under any appointment
, or contract of hire, express or implied, and whether a
21resident
of the state or employed or injured within or without the state. The state
22and or any
municipality local governmental unit may require a bond from a
23contractor to protect the state or
municipality local governmental unit against
24compensation to employees of
such the contractor or
to employees of a subcontractor
25under the contractor. This paragraph does not apply beginning on the first day of the
1first July beginning after the day that the secretary files the certificate under s.
2102.80 (3) (a), except that if the secretary files the certificate under s. 102.80 (3) (ag)
3this paragraph does apply to claims for compensation filed on or after the date
4specified in that certificate.
AB711,8
5Section
8. 102.07 (1) (b) of the statutes is amended to read:
AB711,14,136
102.07
(1) (b) Every person, including all officials, in the service of the state,
7or of any
municipality therein local governmental unit in this state, whether elected
8or under any appointment
, or contract of hire, express or implied, and whether a
9resident
of the state or employed or injured within or without the state. This
10paragraph first applies on the first day of the first July beginning after the day that
11the secretary files the certificate under s. 102.80 (3) (a), except that if the secretary
12files the certificate under s. 102.80 (3) (ag) this paragraph does apply to claims for
13compensation filed on or after the date specified in that certificate.
AB711,9
14Section
9. 102.07 (3) of the statutes is amended to read:
AB711,14,2115
102.07
(3) Nothing
herein contained shall prevent municipalities in this
16chapter prevents a local governmental unit from paying
teachers, police officers, fire
17fighters and other employees a teacher, police officer, fire fighter, or any other
18employee his or her full
salaries salary during
a period of disability, nor
interfere 19interferes with any pension
funds
fund, nor
prevent prevents payment to
teachers,
20police officers or fire fighters therefrom a teacher, police officer, fire fighter, or any
21other employee from a pension fund.
AB711,10
22Section
10. 102.07 (7) (a) of the statutes is amended to read:
AB711,15,723
102.07
(7) (a) Every member of a volunteer fire company or fire department
24organized under ch. 213, a legally organized rescue squad
, or a legally organized
25diving team is considered to be an employee of that company, department, squad
, or
1team. Every member of a company, department, squad
, or team described in this
2paragraph, while serving as an auxiliary police officer at an emergency, is also
3considered to be an employee of that company, department, squad
, or team. If a
4company, department, squad
, or team described in this paragraph has not insured
5its liability for compensation to its employees, the
municipality or county political
6subdivision within which that company, department, squad
, or team was organized
7shall be liable for that compensation.
AB711,11
8Section
11. 102.07 (10) of the statutes is amended to read:
AB711,15,199
102.07
(10) Further to effectuate the policy of the state that the benefits of this
10chapter shall extend and be granted to employees in the service of the state, or of any
11municipality therein local governmental unit in this state, on the same basis, in the
12same manner, under the same conditions, and with like right of recovery as in the
13case of employees of persons, firms
, or private corporations, any question whether
14any person is an employee under this chapter shall be governed by and determined
15under the same standards, considerations, and rules of decision in all cases under
16subs. (1) to (9). Any
statutes, ordinances, or administrative regulations which 17statute, ordinance, or rule that may be otherwise applicable to the classes of
18employees enumerated in sub. (1) shall not be controlling in deciding whether any
19person is an employee for the purposes of this chapter.
AB711,12
20Section
12. 102.07 (12m) of the statutes is renumbered 102.07 (12m) (b) and
21amended to read:
AB711,16,522
102.07
(12m) (b) A student of a public school,
as described in s. 115.01 (1), or 23a private school,
as defined in s. 115.001 (3r),
or an institution of higher education, 24while he or she is engaged in performing services as part of a school work training,
25work experience
, or work study program, and who is not on the payroll of an employer
1that is providing the work training or work experience or who is not otherwise
2receiving compensation on which a worker's compensation carrier could assess
3premiums on that employer, is an employee of a school district
or, private school
, or
4institution of higher education that elects under s. 102.077 to name the student as
5its employee.
AB711,13
6Section
13. 102.07 (12m) (a) of the statutes is created to read:
AB711,16,77
102.07
(12m) (a) In this subsection:
AB711,16,128
1. "Institution of higher education" means an institution within the University
9of Wisconsin System, a technical college, a tribally controlled college controlled by
10an Indian tribe that has elected under s. 102.05 (2) to become subject to this chapter,
11a school approved under s. 38.50, or a private, nonprofit institution of higher
12education located in this state.
AB711,16,1313
2. "Private school" has the meaning given in s. 115.001 (3r).
AB711,16,1414
3. "Public school" means a school described in s. 115.01 (1).
AB711,14
15Section
14. 102.077 (1) of the statutes is amended to read:
AB711,17,216
102.077
(1) A school district
or a , private school,
as defined in s. 115.001 (3r), 17or institution of higher education may elect to name as its employee for purposes of
18this chapter a student described in s. 102.07 (12m)
(b) by an endorsement on its policy
19of worker's compensation insurance or, if the school district
or, private school
, or
20institution of higher education is exempt from the duty to insure under s. 102.28 (2)
21(a), by filing a declaration with the department in the manner provided in s. 102.31
22(2) (a) naming the student as an employee of the school district
or, private school
, or
23institution of higher education for purposes of this chapter. A declaration under this
24subsection shall list the name of the student to be covered under this chapter, the
25name and address of the employer that is providing the work training or work
1experience for that student
, and the title, if any, of the work training, work
2experience
, or work study program in which the student is participating.
AB711,15
3Section
15. 102.077 (2) of the statutes is amended to read:
AB711,17,94
102.077
(2) A school district
or, private school
, or institution of higher
5education may revoke a declaration under sub. (1) by providing written notice to the
6department in the manner provided in s. 102.31 (2) (a), the student
, and the employer
7who is providing the work training or work experience for that student. A revocation
8under this subsection is effective 30 days after the department receives notice of that
9revocation.
AB711,16
10Section
16. 102.11 (1) (intro.) of the statutes is amended to read:
AB711,18,211
102.11
(1) (intro.) The average weekly earnings for temporary disability,
12permanent total disability, or death benefits for injury in each calendar year on or
13after January 1, 1982, shall be not less than $30 nor more than the wage rate that
14results in a maximum compensation rate of 110 percent of the state's average weekly
15earnings as determined under s. 108.05 as of June 30 of the previous year. The
16average weekly earnings for permanent partial disability shall be not less than $30
17and, for permanent partial disability for injuries occurring on or after
April 17, 2012,
18and before January 1, 2013, not more than $468, resulting in a maximum
19compensation rate of $312, and, for permanent partial disability for injuries
20occurring on or after January 1, 2013, not more than $483, resulting in a maximum
21compensation rate of $322, except as provided in 2011 Wisconsin Act 183, section 30
22(2) (a) 1 the effective date of this subsection .... [LRB inserts date], and before January
231, 2015, not more than $506, resulting in a maximum compensation rate of $337, and,
24for permanent partial disability for injuries occurring on or after January 1, 2015,
1not more than $528, resulting in a maximum compensation rate of $352. Between
2such limits the average weekly earnings shall be determined as follows:
AB711,17
3Section
17. 102.125 (title) of the statutes is amended to read:
AB711,18,5
4102.125 (title)
Fraudulent claims Fraud reporting and, investigation,
5and prosecution.
AB711,18
6Section
18. 102.125 of the statutes is renumbered 102.125 (1) and amended
7to read:
AB711,18,178
102.125
(1) Fraudulent claims reporting and investigation. If an insurer or
9self-insured employer has evidence that a claim is false or fraudulent in violation of
10s. 943.395 and if the insurer or self-insured employer is satisfied that reporting the
11claim to the department will not impede its ability to defend the claim, the insurer
12or self-insured employer shall report the claim to the department. The department
13may require an insurer or self-insured employer to investigate an allegedly false or
14fraudulent claim and may provide the insurer or self-insured employer with any
15records of the department relating to that claim. An insurer or self-insured
16employer that investigates a claim under this
section
subsection shall report on the
17results of that investigation to the department.
AB711,18,23
18(3) Prosecution. If based on
the an investigation
under sub. (1) or (2) the
19department has a reasonable basis to believe that a violation of s.
943.20, 943.38,
20943.39, 943.392, 943.395
, 943.40, or any other criminal law has occurred, the
21department shall refer the results of the investigation
to the department of justice
22or to the district attorney of the county in which the alleged violation occurred for
23prosecution.
AB711,19
24Section
19. 102.125 (2) of the statutes is created to read:
AB711,19,5
1102.125
(2) Assistance by department of justice. The department of workforce
2development may request the department of justice to assist the department of
3workforce development in an investigation under sub. (1) or in the investigation of
4any other suspected fraudulent activity on the part of an employer, employee,
5insurer, health care provider, or other person related to worker's compensation.
AB711,20
6Section
20. 102.13 (2) (b) of the statutes is amended to read: