SB21-SSA1,2775d
1Section 2775d. 102.16 (1m) (c) of the statutes is amended to read:
SB21-SSA1,852,212 102.16 (1m) (c) If an insurer or self-insured employer concedes by compromise
3under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
4employer is liable under this chapter for the cost of a prescription drug dispensed
5under s. 102.425 (2) for outpatient use by an injured employee, but disputes the
6reasonableness of the amount charged for the prescription drug, the department or
7the division
may include in its order confirming the compromise or stipulation a
8determination made by the department under s. 102.425 (4m) as to the
9reasonableness of the prescription drug charge or the department, if such a
10determination has not yet been made, the department or the division
may notify, or
11direct the insurer or self-insured employer to notify, the pharmacist or practitioner
12dispensing the prescription drug under s. 102.425 (4m) (b) that the reasonableness
13of the prescription drug charge is in dispute. The department or the division shall
14deny payment of a prescription drug charge that the department determines under
15this paragraph s. 102.425 (4m) to be unreasonable. A pharmacist or practitioner and
16an insurer or self-insured employer that are parties to a dispute under this
17paragraph over the reasonableness of a prescription drug charge are bound by the
18department's determination under this paragraph s. 102.425 (4m) on the
19reasonableness of the disputed prescription drug charge, unless that determination
20is set aside, reversed, or modified by the department under s. 102.425 (4m) (e) or is
21set aside on judicial review as provided in s. 102.425 (4m) (e).
SB21-SSA1,2776d 22Section 2776d. 102.16 (2) (a) of the statutes is amended to read:
SB21-SSA1,853,1123 102.16 (2) (a) Except as provided in this paragraph, the department has
24jurisdiction under this subsection, the department and the division have jurisdiction
25under
sub. (1m) (a), and the division has jurisdiction under s. 102.17 to resolve a

1dispute between a health service provider and an insurer or self-insured employer
2over the reasonableness of a fee charged by the health service provider for health
3services provided to an injured employee who claims benefits under this chapter. A
4health service provider may not submit a fee dispute to the department under this
5subsection before all treatment by the health service provider of the employee's
6injury has ended if the amount in controversy, whether based on a single charge or
7a combination of charges for one or more days of service, is less than $25. After all
8treatment by a health service provider of an employee's injury has ended, the health
9service provider may submit any fee dispute to the department, regardless of the
10amount in controversy. The department shall deny payment of a health service fee
11that the department determines under this subsection to be unreasonable.
SB21-SSA1,2778d 12Section 2778d. 102.16 (2) (b) of the statutes is amended to read:
SB21-SSA1,853,2013 102.16 (2) (b) An insurer or self-insured employer that disputes the
14reasonableness of a fee charged by a health service provider or the department or the
15division
under sub. (1m) (a) or s. 102.18 (1) (bg) 1. shall provide reasonable written
16notice to the health service provider that the fee is being disputed. After receiving
17reasonable written notice under this paragraph or under sub. (1m) (a) or s. 102.18
18(1) (bg) 1. that a health service fee is being disputed, a health service provider may
19not collect the disputed fee from, or bring an action for collection of the disputed fee
20against, the employee who received the services for which the fee was charged.
SB21-SSA1,2785d 21Section 2785d. 102.16 (2m) (a) of the statutes is amended to read:
SB21-SSA1,854,1022 102.16 (2m) (a) Except as provided in this paragraph, the department has
23jurisdiction under this subsection, the department and the division have jurisdiction
24under
sub. (1m) (b), and the division has jurisdiction under s. 102.17 to resolve a
25dispute between a health service provider and an insurer or self-insured employer

1over the necessity of treatment provided for an injured employee who claims benefits
2under this chapter. A health service provider may not submit a dispute over
3necessity of treatment to the department under this subsection before all treatment
4by the health service provider of the employee's injury has ended if the amount in
5controversy, whether based on a single charge or a combination of charges for one or
6more days of service, is less than $25. After all treatment by a health service provider
7of an employee's injury has ended, the health service provider may submit any
8dispute over necessity of treatment to the department, regardless of the amount in
9controversy. The department shall deny payment for any treatment that the
10department determines under this subsection to be unnecessary.
SB21-SSA1,2787d 11Section 2787d. 102.16 (2m) (b) of the statutes is amended to read:
SB21-SSA1,854,2012 102.16 (2m) (b) An insurer or self-insured employer that disputes the
13necessity of treatment provided by a health service provider or the department or the
14division
under sub. (1m) (b) or s. 102.18 (1) (bg) 2. shall provide reasonable written
15notice to the health service provider that the necessity of that treatment is being
16disputed. After receiving reasonable written notice under this paragraph or under
17sub. (1m) (b) or s. 102.18 (1) (bg) 2. that the necessity of treatment is being disputed,
18a health service provider may not collect a fee for that disputed treatment from, or
19bring an action for collection of the fee for that disputed treatment against, the
20employee who received the treatment.
SB21-SSA1,2793d 21Section 2793d. 102.16 (4) of the statutes is amended to read:
SB21-SSA1,855,422 102.16 (4) The department has and the division have jurisdiction to pass on any
23question arising out of sub. (3) and has jurisdiction to order the employer to
24reimburse an employee or other person for any sum deducted from wages or paid by
25him or her in violation of that subsection. In addition to the penalty provided in s.

1102.85 (1), any employer violating sub. (3) shall be liable to an injured employee for
2the reasonable value of the necessary services rendered to that employee pursuant
3to
under any arrangement made in violation of sub. (3) without regard to that
4employee's actual disbursements for the same those services.
SB21-SSA1,2794d 5Section 2794d. 102.17 (1) (a) 1. of the statutes is amended to read:
SB21-SSA1,855,116 102.17 (1) (a) 1. Upon the filing with the department by any party in interest
7of any application in writing stating the general nature of any claim as to which any
8dispute or controversy may have arisen, the department shall mail a copy of the
9application to all other parties in interest, and the insurance carrier shall be
10considered a party in interest. The department or the division may bring in
11additional parties by service of a copy of the application.
SB21-SSA1,2795 12Section 2795. 102.17 (1) (a) 2. of the statutes is amended to read:
SB21-SSA1,855,2213 102.17 (1) (a) 2. Subject to subd. 3., the department division shall cause notice
14of hearing on the application to be given to each interested party , by service of that
15notice on the interested party personally or by mailing a copy of that notice to the
16interested party's last-known address at least 10 days before the hearing. If a party
17in interest is located without this state, and has no post-office address within this
18state, the copy of the application and copies of all notices shall be filed with the
19department of financial institutions and shall
also be sent by registered or certified
20mail to the last-known post-office address of the party. Such filing and mailing shall
21constitute sufficient service, with the same effect as if served upon a party located
22within this state.
SB21-SSA1,2796d 23Section 2796d. 102.17 (1) (a) 3. of the statutes is amended to read:
SB21-SSA1,856,324 102.17 (1) (a) 3. If a party in interest claims that the employer or insurer has
25acted with malice or bad faith as described in s. 102.18 (1) (b) or (bp), that party shall

1provide written notice stating with reasonable specificity the basis for the claim to
2the employer, the insurer, and the department , and the division before the
3department division schedules a hearing on the claim of malice or bad faith.
SB21-SSA1,2797 4Section 2797. 102.17 (1) (a) 4. of the statutes is amended to read:
SB21-SSA1,856,135 102.17 (1) (a) 4. The hearing may be adjourned in the discretion of the
6department division, and hearings may be held at such places as the department
7division designates, within or without the state. The department division may also
8arrange to have hearings held by the commission, officer, or tribunal having
9authority to hear cases arising under the worker's compensation law of any other
10state, of the District of Columbia, or of any territory of the United States, with the
11testimony and proceedings at any such hearing to be reported to the department
12division and to be made part of the record in the case. Any evidence so taken shall
13be subject to rebuttal upon final hearing before the department division.
SB21-SSA1,2798 14Section 2798. 102.17 (1) (b) of the statutes is amended to read:
SB21-SSA1,857,315 102.17 (1) (b) In any dispute or controversy pending before the department
16division, the department division may direct the parties to appear before an
17examiner for a conference to consider the clarification of issues, the joining of
18additional parties, the necessity or desirability of amendments to the pleadings, the
19obtaining of admissions of fact or of documents, records, reports , and bills which that
20may avoid unnecessary proof, and such other matters as may aid in disposition of the
21dispute or controversy. After this that conference the department division may issue
22an order requiring disclosure or exchange of any information or written material
23which it that the division considers material to the timely and orderly disposition of
24the dispute or controversy. If a party fails to disclose or exchange that information
25within the time stated in the order, the department division may issue an order

1dismissing the claim without prejudice or excluding evidence or testimony relating
2to the information or written material. The department division shall provide each
3party with a copy of any order issued under this paragraph.
SB21-SSA1,2799d 4Section 2799d. 102.17 (1) (c) of the statutes is renumbered 102.17 (1) (c) 1. and
5amended to read:
SB21-SSA1,857,196 102.17 (1) (c) 1. 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 division. No person, firm, or
9corporation, other than an attorney at law who is licensed to practice law in the state,
10may appear on behalf of any party in interest before the department division or any
11member or employee of the department division 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 division. Except as provided under
17pars. (cm), (cr), and (ct), the license shall be issued by the department under rules
18promulgated by the department. The department shall maintain in its office a
19current list of persons to whom licenses have been issued.
SB21-SSA1,858,10 202. Any license issued under subd. 1. 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

1or if the department determines under par. (ct) that the applicant or licensee is liable
2for delinquent unemployment insurance contributions. Before suspending or
3revoking the license of the agent on the grounds of fraud or misconduct, the
4department shall give notice in writing to the agent of the charges of fraud or
5misconduct and shall give the agent full opportunity to be heard in relation to those
6charges. In denying, suspending, restricting, refusing to renew, or otherwise
7withholding a license for failure to pay court-ordered payments as provided in par.
8(cm), the department shall follow the procedure provided in a memorandum of
9understanding entered into under s. 49.857. The license and certificate of authority
10shall, unless
SB21-SSA1,858,14 113. Unless otherwise suspended or revoked, a license issued under subd. 1. shall
12be in force from the date of issuance until the June 30 following the date of issuance
13and may be renewed by the department from time to time, but each renewed license
14shall expire on the June 30 following the issuance of the renewed license.
SB21-SSA1,2807 15Section 2807. 102.17 (1) (d) 1. of the statutes is amended to read:
SB21-SSA1,859,1016 102.17 (1) (d) 1. The contents of certified medical and surgical reports by
17physicians, podiatrists, surgeons, dentists, psychologists, physician assistants,
18advanced practice nurse prescribers, and chiropractors licensed in and practicing in
19this state, and of certified reports by experts concerning loss of earning capacity
20under s. 102.44 (2) and (3), presented by a party for compensation constitute prima
21facie evidence as to the matter contained in those reports, subject to any rules and
22limitations the department division prescribes. Certified reports of physicians,
23podiatrists, surgeons, dentists, psychologists, physician assistants, advanced
24practice nurse prescribers, and chiropractors, wherever licensed and practicing, who
25have examined or treated the claimant, and of experts, if the practitioner or expert

1consents to being subjected to cross-examination, also constitute prima facie
2evidence as to the matter contained in those reports. Certified reports of physicians,
3podiatrists, surgeons, psychologists, and chiropractors are admissible as evidence of
4the diagnosis, necessity of the treatment, and cause and extent of the disability.
5Certified reports by doctors of dentistry, physician assistants, and advanced practice
6nurse prescribers are admissible as evidence of the diagnosis and necessity of
7treatment but not of the cause and extent of disability. Any physician, podiatrist,
8surgeon, dentist, psychologist, chiropractor, physician assistant, advanced practice
9nurse prescriber, or expert who knowingly makes a false statement of fact or opinion
10in such a certified report may be fined or imprisoned, or both, under s. 943.395.
SB21-SSA1,2808 11Section 2808. 102.17 (1) (d) 2. of the statutes is amended to read:
SB21-SSA1,859,1912 102.17 (1) (d) 2. The record of a hospital or sanatorium in this state that is
13satisfactory to the department division, established by certificate, affidavit, or
14testimony of the supervising officer of the hospital or sanitorium, any other person
15having charge of the record, or a physician, podiatrist, surgeon, dentist, psychologist,
16physician assistant, advanced practice nurse prescriber, or chiropractor to be the
17record of the patient in question, and made in the regular course of examination or
18treatment of the patient, constitutes prima facie evidence as to the matter contained
19in the record, to the extent that the record is otherwise competent and relevant.
SB21-SSA1,2809 20Section 2809. 102.17 (1) (d) 3. of the statutes is amended to read:
SB21-SSA1,860,321 102.17 (1) (d) 3. The department division may, by rule, establish the
22qualifications of and the form used for certified reports submitted by experts who
23provide information concerning loss of earning capacity under s. 102.44 (2) and (3).
24The department division may not admit into evidence a certified report of a
25practitioner or other expert or a record of a hospital or sanatorium that was not filed

1with the department division and all parties in interest at least 15 days before the
2date of the hearing, unless the department division is satisfied that there is good
3cause for the failure to file the report.
SB21-SSA1,2810 4Section 2810. 102.17 (1) (d) 4. of the statutes is amended to read:
SB21-SSA1,860,75 102.17 (1) (d) 4. A report or record described in subd. 1., 2., or 3. that is admitted
6or received into evidence by the department division constitutes substantial
7evidence under s. 102.23 (6) as to the matter contained in the report or record.
SB21-SSA1,2811 8Section 2811. 102.17 (1) (e) of the statutes is amended to read:
SB21-SSA1,860,179 102.17 (1) (e) The department division may, with or without notice to any party,
10cause testimony to be taken, an inspection of the premises where the injury occurred
11to be made, or the time books and payrolls of the employer to be examined by any
12examiner, and may direct any employee claiming compensation to be examined by
13a physician, chiropractor, psychologist, dentist, or podiatrist. The testimony so
14taken, and the results of any such inspection or examination, shall be reported to the
15department division for its consideration upon final hearing. All ex parte testimony
16taken by the department division shall be reduced to writing, and any party shall
17have opportunity to rebut that testimony on final hearing.
SB21-SSA1,2812 18Section 2812. 102.17 (1) (f) of the statutes is amended to read:
SB21-SSA1,860,2019 102.17 (1) (f) Sections 804.05 and 804.07 shall not apply to proceedings under
20this chapter, except as to a witness who is any of the following:
SB21-SSA1,860,2121 1. Who is beyond Beyond reach of the subpoena of the department; or division.
SB21-SSA1,860,2322 2. Who is about About to go out of the state, not intending to return in time for
23the hearing; or hearing.
SB21-SSA1,860,2524 3. Who is so So sick, infirm , or aged as to make it probable that the witness will
25not be able to attend the hearing; or hearing.
SB21-SSA1,861,3
14. Who is a A member of the legislature, if any committee of the same or
2legislature or of the house of which the witness is a member, is in session, provided
3and the witness waives his or her privilege.
SB21-SSA1,2813 4Section 2813. 102.17 (1) (g) of the statutes is amended to read:
SB21-SSA1,861,175 102.17 (1) (g) Whenever the testimony presented at any hearing indicates a
6dispute or creates a doubt as to the extent or cause of disability or death, the
7department division may direct that the injured employee be examined, that an
8autopsy be performed, or that an opinion be obtained without examination or
9autopsy, by or from an impartial, competent physician, chiropractor, dentist,
10psychologist or podiatrist designated by the department division who is not under
11contract with or regularly employed by a compensation insurance carrier or
12self-insured employer. The expense of the examination, autopsy, or opinion shall be
13paid by the employer or, if the employee claims compensation under s. 102.81, from
14the uninsured employers fund. The report of the examination, autopsy, or opinion
15shall be transmitted in writing to the department division and a copy of the report
16shall be furnished by the department division to each party, who shall have an
17opportunity to rebut such the report on further hearing.
SB21-SSA1,2814d 18Section 2814d. 102.17 (1) (h) of the statutes is amended to read:
SB21-SSA1,862,219 102.17 (1) (h) The contents of certified reports of investigation, made by
20industrial safety specialists who are employed, contracted, or otherwise secured by
21the department or the division and who are available for cross-examination, if
22served upon the parties 15 days prior to hearing, shall constitute prima facie
23evidence as to matter contained in those reports. A report described in this
24paragraph that is admitted or received into evidence by the department division

1constitutes substantial evidence under s. 102.23 (6) as to the matter contained in the
2report.
SB21-SSA1,2815 3Section 2815. 102.17 (2) of the statutes is amended to read:
SB21-SSA1,862,134 102.17 (2) If the department shall have division has reason to believe that the
5payment of compensation has not been made, it the division may on its own motion
6give notice to the parties, in the manner provided for the service of an application,
7of a time and place when a hearing will be held for the purpose of determining the
8facts. Such The notice shall contain a statement of the matter to be considered.
9Thereafter all other All provisions of this chapter governing proceedings on an
10application shall attach apply, insofar as the same may be applicable, to a proceeding
11under this subsection
. When the department division schedules a hearing on its own
12motion, the department division does not become a party in interest and is not
13required to appear at the hearing.
SB21-SSA1,2816d 14Section 2816d. 102.17 (2m) of the statutes is amended to read:
SB21-SSA1,862,2015 102.17 (2m) Any The division or any party, including the department, may
16require any person to produce books, papers, and records at the hearing by personal
17service of a subpoena upon the person along with a tender of witness fees as provided
18in ss. 814.67 and 885.06. Except as provided in sub. (2s), the subpoena shall be on
19a form provided by the department division and shall give the name and address of
20the party requesting the subpoena.
SB21-SSA1,2817 21Section 2817. 102.17 (2s) of the statutes is amended to read:
SB21-SSA1,863,322 102.17 (2s) A party's attorney of record may issue a subpoena to compel the
23attendance of a witness or the production of evidence. A subpoena issued by an
24attorney must be in substantially the same form as provided in s. 805.07 (4) and must
25be served in the manner provided in s. 805.07 (5). The attorney shall, at the time of

1issuance, send a copy of the subpoena to the appeal tribunal hearing examiner or
2other representative of the department division responsible for conducting the
3proceeding.
SB21-SSA1,2818 4Section 2818. 102.17 (7) (b) of the statutes is amended to read:
SB21-SSA1,863,165 102.17 (7) (b) Except as provided in par. (c), the department division shall
6exclude from evidence testimony or certified reports from expert witnesses under
7par. (a) offered by the party that raises the issue of loss of earning capacity if that
8party failed to notify the department division and the other parties of interest, at
9least 60 days before the date of the hearing, of the party's intent to provide the
10testimony or reports and of the names of the expert witnesses involved. Except as
11provided in par. (c), the department division shall exclude from evidence testimony
12or certified reports from expert witnesses under par. (a) offered by a party of interest
13in response to the party that raises the issue of loss of earning capacity if the
14responding party failed to notify the department division and the other parties of
15interest, at least 45 days before the date of the hearing, of the party's intent to provide
16the testimony or reports and of the names of the expert witnesses involved.
SB21-SSA1,2819 17Section 2819. 102.17 (7) (c) of the statutes is amended to read:
SB21-SSA1,863,2218 102.17 (7) (c) Notwithstanding the notice deadlines provided in par. (b), the
19department division may receive in evidence testimony or certified reports from
20expert witnesses under par. (a) when the applicable notice deadline under par. (b) is
21not met if good cause is shown for the delay in providing the notice required under
22par. (b) and if no party is prejudiced by the delay.
SB21-SSA1,2820 23Section 2820. 102.17 (8) of the statutes is amended to read:
SB21-SSA1,864,1224 102.17 (8) Unless otherwise agreed to by all parties, an injured employee shall
25file with the department division and serve on all parties at least 15 days before the

1date of the hearing an itemized statement of all medical expenses and incidental
2compensation under s. 102.42 claimed by the injured employee. The itemized
3statement shall include, if applicable, information relating to any travel expenses
4incurred by the injured employee in obtaining treatment including the injured
5employee's destination, number of trips, round trip mileage, and meal and lodging
6expenses. The department division may not admit into evidence any information
7relating to medical expenses and incidental compensation under s. 102.42 claimed
8by an injured employee if the injured employee failed to file with the department
9division and serve on all parties at least 15 days before the date of the hearing an
10itemized statement of the medical expenses and incidental compensation under s.
11102.42 claimed by the injured employee, unless the department division is satisfied
12that there is good cause for the failure to file and serve the itemized statement.
SB21-SSA1,2821 13Section 2821. 102.175 (2) of the statutes is amended to read:
SB21-SSA1,864,2114 102.175 (2) If after a hearing or a prehearing conference the department
15division determines that an injured employee is entitled to compensation but that
16there remains in dispute only the issue of which of 2 or more parties is liable for that
17compensation, the department division may order one or more parties to pay
18compensation in an amount, time, and manner as determined by the department
19division. If the department division later determines that another party is liable for
20compensation, the department division shall order that other party to reimburse any
21party that was ordered to pay compensation under this subsection.
SB21-SSA1,2822 22Section 2822. 102.18 (1) (b) of the statutes is amended to read:
SB21-SSA1,865,1623 102.18 (1) (b) Within 90 days after the final hearing and close of the record, the
24department division shall make and file its findings upon the ultimate facts involved
25in the controversy, and its order, which shall state its the division's determination as

1to the rights of the parties. Pending the final determination of any controversy before
2it, the department may in its discretion division, after any hearing, may, in its
3discretion,
make interlocutory findings, orders, and awards, which may be enforced
4in the same manner as final awards. The department division may include in any
5interlocutory or final award or order an order directing the employer or insurer to pay
6for any future treatment that may be necessary to cure and relieve the employee from
7the effects of the injury. If the department division finds that the employer or insurer
8has not paid any amount that the employer or insurer was directed to pay in any
9interlocutory order or award and that the nonpayment was not in good faith, the
10department division may include in its final award a penalty not exceeding 25% 25
11percent
of each amount that was not paid as directed. When there is a finding that
12the employee is in fact suffering from an occupational disease caused by the
13employment of the employer against whom the application is filed, a final award
14dismissing the application upon the ground that the applicant has suffered no
15disability from the disease shall not bar any claim the employee may thereafter have
16for disability sustained after the date of the award.
SB21-SSA1,2823d 17Section 2823d. 102.18 (1) (bg) 1. of the statutes is amended to read:
SB21-SSA1,866,818 102.18 (1) (bg) 1. If the department division finds under par. (b) that an insurer
19or self-insured employer is liable under this chapter for any health services provided
20to an injured employee by a health service provider, but that the reasonableness of
21the fee charged by the health service provider is in dispute, the department division
22may include in its order under par. (b) a determination made by the department
23under s. 102.16 (2)
as to the reasonableness of the fee or the department, if such a
24determination has not yet been made, the division
may notify, or direct the insurer
25or self-insured employer to notify, the health service provider under s. 102.16 (2) (b)

1that the reasonableness of the fee is in dispute. The department shall deny payment
2of a health service fee that the department determines under this subdivision to be
3unreasonable. An insurer or self-insured employer and a health service provider
4that are parties to a fee dispute under this subdivision are bound by the department's
5determination under this subdivision on the reasonableness of the disputed fee,
6unless that determination is set aside, reversed, or modified by the department
7under sub. (3) or by the commission under sub. (3) or (4) or is set aside on judicial
8review under s. 102.23.
SB21-SSA1,2824d 9Section 2824d. 102.18 (1) (bg) 2. of the statutes is amended to read:
SB21-SSA1,867,710 102.18 (1) (bg) 2. If the department division finds under par. (b) that an
11employer or insurance carrier is liable under this chapter for any treatment provided
12to an injured employee by a health service provider, but that the necessity of the
13treatment is in dispute, the department division may include in its order under par.
14(b) a determination made by the department under s. 102.16 (2m) as to the necessity
15of the treatment or the department, if such a determination has not yet been made,
16the division
may notify, or direct the employer or insurance carrier to notify, the
17health service provider under s. 102.16 (2m) (b) that the necessity of the treatment
18is in dispute. Before determining under this subdivision the necessity of treatment
19provided to an injured employee, the department may, but is not required to, obtain
20the opinion of an expert selected by the department who is qualified as provided in
21s. 102.16 (2m) (c). The standards promulgated under s. 102.16 (2m) (g) shall be
22applied by an expert in rendering an opinion as to, and in determining, necessity of
23treatment under this subdivision. In cases in which no standards promulgated
24under s. 102.16 (2m) (g) apply, the department shall find the facts regarding
25necessity of treatment. The department shall deny payment for any treatment that

1the department determines under this subdivision to be unnecessary. An insurer or
2self-insured employer and a health service provider that are parties to a dispute
3under this subdivision over the necessity of treatment are bound by the department's
4determination under this subdivision on the necessity of the disputed treatment,
5unless that determination is set aside, reversed, or modified by the department
6division under sub. (3) or by the commission under sub. (3) or (4) or is set aside on
7judicial review under s. 102.23.
SB21-SSA1,2825d 8Section 2825d. 102.18 (1) (bg) 3. of the statutes is amended to read:
SB21-SSA1,868,29 102.18 (1) (bg) 3. If the department division finds under par. (b) that an insurer
10or self-insured employer is liable under this chapter for the cost of a prescription
11drug dispensed under s. 102.425 (2) for outpatient use by an injured employee, but
12that the reasonableness of the amount charged for that prescription drug is in
13dispute, the department division may include in its order under par. (b) a
14determination made by the department under s. 102.425 (4m) as to the
15reasonableness of the prescription drug charge or the department, if such a
16determination has not yet been made, the division
may notify, or direct the insurer
17or self-insured employer to notify, the pharmacist or practitioner dispensing the
18prescription drug under s. 102.425 (4m) (b) that the reasonableness of the
19prescription drug charge is in dispute. The department shall deny payment of a
20prescription drug charge that the department determines under this subdivision to
21be unreasonable. An insurer or self-insured employer and a pharmacist or
22practitioner that are parties to a dispute under this subdivision over the
23reasonableness of a prescription drug charge are bound by the department's
24determination under par. (b) on the reasonableness of the disputed prescription drug
25charge, unless that determination is set aside, reversed, or modified by the

1department under sub. (3) or by the commission under sub. (3) or (4) or is set aside
2on judicial review under s. 102.23.
SB21-SSA1,2826 3Section 2826. 102.18 (1) (bp) of the statutes is amended to read:
SB21-SSA1,868,194 102.18 (1) (bp) If the department division determines that the employer or
5insurance carrier suspended, terminated, or failed to make payments or failed to
6report an injury as a result of malice or bad faith, the department division may
7include a penalty in an award to an employee for each event or occurrence of malice
8or bad faith. This That penalty is the exclusive remedy against an employer or
9insurance carrier for malice or bad faith. If this the penalty is imposed for an event
10or occurrence of malice or bad faith that causes a payment that is due an injured
11employee to be delayed in violation of s. 102.22 (1) or overdue in violation of s. 628.46
12(1), the department division may not also order an increased payment under s.
13102.22 (1) or the payment of interest under s. 628.46 (1). The department division
14may award an amount that it the division considers just, not to exceed the lesser of
15200 percent of total compensation due or $30,000 for each event or occurrence of
16malice or bad faith. The department division may assess the penalty against the
17employer, the insurance carrier, or both. Neither the employer nor the insurance
18carrier is liable to reimburse the other for the penalty amount. The department
19division may, by rule, define actions which that demonstrate malice or bad faith.
SB21-SSA1,2827d 20Section 2827d. 102.18 (1) (bw) of the statutes is amended to read:
SB21-SSA1,869,221 102.18 (1) (bw) If an insurer, a self-insured employer, or, if applicable, the
22uninsured employers fund pays compensation to an employee in excess of its liability
23and another insurer or self-insured employer is liable for all or part of the excess
24payment, the department or the division may order the insurer or self-insured
25employer that is liable for that excess payment to reimburse the insurer or

1self-insured employer that made the excess payment or, if applicable, the uninsured
2employers fund.
SB21-SSA1,2828 3Section 2828. 102.18 (1) (c) of the statutes is amended to read:
SB21-SSA1,869,104 102.18 (1) (c) If 2 or more examiners have conducted a formal hearing on a claim
5and are unable to agree on the order or award to be issued, the decision shall be the
6decision of the majority. If the examiners are equally divided on the decision, the
7department division may appoint an additional examiner who shall review the
8record and consult with the other examiners concerning their personal impressions
9of the credibility of the evidence. Findings of fact and an order or award may then
10be issued by a majority of the examiners.
SB21-SSA1,2829d 11Section 2829d. 102.18 (1) (e) of the statutes is amended to read:
SB21-SSA1,869,1812 102.18 (1) (e) Except as provided in s. 102.21, if the department or the division
13orders a party to pay an award of compensation, the party shall pay the award no
14later than 21 days after the date on which the order is mailed to the last-known
15address of the party, unless the party files a petition for review under sub. (3). This
16paragraph applies to all awards of compensation ordered by the department or the
17division
, whether the award results from a hearing, the default of a party, or a
18compromise or stipulation confirmed by the department or the division.
SB21-SSA1,2830d 19Section 2830d. 102.18 (2) of the statutes is renumbered 102.18 (2) (a) and
20amended to read:
SB21-SSA1,869,2421 102.18 (2) (a) The department shall have and maintain on its staff such
22examiners as are necessary to hear and decide disputed claims for compensation
23described in s. 102.16 (1) (b)
and to assist in the effective administration of this
24chapter. These examiners
SB21-SSA1,870,4
1(c) Examiners under pars. (a) and (b) shall be attorneys and may be designated
2as administrative law judges. These Those examiners may make findings and
3orders, and may approve, review, set aside, modify, or confirm stipulations of
4settlement or compromises of claims for compensation.
SB21-SSA1,2830e 5Section 2830e. 102.18 (2) (b) of the statutes is created to read:
SB21-SSA1,870,106 102.18 (2) (b) The division shall have and maintain on its staff such examiners
7as are necessary to decide claims for compensation described in s. 102.16 (1) (c) and
8to assist in the effective adjudication of claims under this chapter. The administrator
9shall require at least 18 examiners employed by the division to devote not less than
1080 percent of their work time to the duties specified in this paragraph.
SB21-SSA1,2831d 11Section 2831d. 102.18 (3) of the statutes is amended to read:
SB21-SSA1,871,512 102.18 (3) A party in interest may petition the commission for review of an
13examiner's decision awarding or denying compensation if the department , the
14division,
or the commission receives the petition within 21 days after the department
15or the division mailed a copy of the examiner's findings and order to the party's
16last-known address addresses of the parties in interest. The commission shall
17dismiss a petition which that is not timely filed unless the petitioner shows probable
18good cause that the reason for failure to timely file was beyond the petitioner's
19control. If no petition is filed within 21 days from after the date that on which a copy
20of the findings or order of the examiner is mailed to the last-known address
21addresses of the parties in interest, the findings or order shall be considered final
22unless set aside, reversed, or modified by the examiner within that time. If the
23findings or order are set aside by the examiner, the status shall be the same as prior
24to the setting aside of the findings or order set aside. If the findings or order are
25reversed or modified by the examiner, the time for filing a petition commences with

1on the date that on which notice of reversal or modification is mailed to the
2last-known address addresses of the parties in interest. The commission shall either
3affirm, reverse, set aside, or modify the findings or order, in whole or in part, or direct
4the taking of additional evidence. This The commission's action shall be based on a
5review of the evidence submitted.
SB21-SSA1,2833d 6Section 2833d. 102.18 (4) (c) 3. of the statutes is amended to read:
SB21-SSA1,871,87 102.18 (4) (c) 3. Remand the case to the department or the division for further
8proceedings.
SB21-SSA1,2834d 9Section 2834d. 102.18 (4) (d) of the statutes is amended to read:
SB21-SSA1,871,1610 102.18 (4) (d) While a petition for review by the commission is pending or after
11entry of an order or award by the commission but before commencement of an action
12for judicial review or expiration of the period in which to commence an action for
13judicial review, the commission shall remand any compromise presented to it to the
14department or the division for consideration and approval or rejection pursuant to
15under s. 102.16 (1). Presentation of a compromise does not affect the period in which
16to commence an action for judicial review.
SB21-SSA1,2835 17Section 2835. 102.18 (5) of the statutes is amended to read:
SB21-SSA1,872,318 102.18 (5) If it shall appear to the department appears to the division that a
19mistake may have been made as to cause of injury in the findings, order, or award
20upon an alleged injury based on accident, when in fact the employee was suffering
21from an occupational disease, within 3 years after the date of the findings, order, or
22award
the department division may, upon its own motion, with or without hearing,
23within 3 years from the date of such findings, order or award, set aside such the
24findings, order or award, or the department division may take such that action upon
25application made within such those 3 years. Thereafter, and after After an

1opportunity for hearing, the department division may, if in fact the employee is
2suffering from disease arising out of the employment, make new findings , and a new
3order or
award, or it the division may reinstate the previous findings, order, or award.
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