SB21,2735
6Section
2735. 102.01 (2) (dm) of the statutes is amended to read:
SB21,1078,97
102.01
(2) (dm) "Order" means any decision, rule, regulation, direction,
8requirement
, or standard of the
department office, or any other determination
9arrived at or decision made by the
department office.
SB21,2736
10Section
2736. 102.01 (2) (em) of the statutes is repealed.
SB21,2737
11Section
2737. 102.04 (1) (a) of the statutes is amended to read:
SB21,1078,1412
102.04
(1) (a) The state, each county, city, town, village, school district, sewer
13district, drainage district,
long-term care district and other public or quasi-public
14corporations therein.
SB21,2738
15Section
2738. 102.05 (1) of the statutes is amended to read:
SB21,1079,216
102.05
(1) An employer who has had no employee at any time within a
17continuous period of 2 years shall be
deemed considered to have effected withdrawal,
18which shall be effective on the last day of
such
that period. An employer who has not
19usually employed 3 employees and who has not paid wages of at least $500 for
20employment in this state in every calendar quarter in a calendar year may file a
21withdrawal notice with the
department office, which withdrawal shall take effect 30
22days after the date of
such that filing or at such later date as is specified in the notice.
23If an employer who is subject to this chapter only because the employer elected to
24become subject to this chapter under sub. (2) cancels or terminates his or her contract
25for the insurance of compensation under this chapter, that employer is
deemed
1considered to have effected withdrawal, which shall be effective on the day after the
2contract is canceled or terminated.
SB21,2739
3Section
2739. 102.05 (3) of the statutes is amended to read:
SB21,1079,134
102.05
(3) Any If a person engaged in farming who has become subject to this
5chapter
has not employed 6 or more employees, as defined in s. 102.07 (5), on 20 or
6more days during the current or previous calendar year, the person may withdraw
7by filing with the
department office a notice of withdrawal,
if the person has not
8employed 6 or more employees as defined by s. 102.07 (5) on 20 or more days during
9the current or previous calendar year. Such which withdrawal shall
be effective take
10effect 30 days after the date of receipt
of the notice by the
department, office or at such
11later date as is specified in the notice.
Such A person
who withdraws under this
12subsection may again become subject to this chapter as provided
by in s. 102.04 (1)
13(c) and (e).
SB21,2740
14Section
2740. 102.06 of the statutes is amended to read:
SB21,1080,8
15102.06 Joint liability of employer and contractor. An employer shall be
16liable for compensation to an employee of a contractor or subcontractor under the
17employer who is not subject to this chapter
, or who has not complied with the
18conditions of s. 102.28 (2) in any case
where such
in which the employer would have
19been liable for compensation if
such the employee had been working directly for the
20employer, including
also work in the erection, alteration, repair
, or demolition of
21improvements or of fixtures upon premises of
such
the employer
which that are used
22or to be used in the operations of
such the employer. The contractor or subcontractor,
23if subject to this chapter, shall also be liable for
such that compensation, but the
24employee shall not recover compensation for the same injury from more than one
25party.
The An employer who becomes liable for and
who pays
such that compensation
1may recover the
same amount of compensation paid from
such that contractor
, or 2subcontractor
, or
from any other employer for whom the employee was working at
3the time of the injury
, if
such
that contractor, subcontractor
, or other employer was
4an employer
, as defined in s. 102.04. This section does not apply to injuries occurring
5on or after the first day of the first July beginning after the day
that on which the
6secretary commissioner files the certificate under s. 102.80 (3) (a), except that if the
7secretary commissioner files the certificate under s. 102.80 (3) (ag) this section does
8apply to claims for compensation filed on or after the date specified in that certificate.
SB21,2741
9Section
2741. 102.07 (1) (a) of the statutes is amended to read:
SB21,1080,2010
102.07
(1) (a) Every person, including all officials
, in the service of the state
, 11or of any municipality
therein in this state, whether elected or under any
12appointment
, or contract of hire, express or implied, and whether a resident
of this
13state or employed or injured within or without the state. The state
and or any
14municipality may require a bond from a contractor to protect the state or
15municipality against compensation to employees of
such
the contractor or employees
16of a subcontractor under the contractor. This paragraph does not apply beginning
17on the first day of the first July beginning after the day
that on which the
secretary 18commissioner files the certificate under s. 102.80 (3) (a), except that if the
secretary 19commissioner files the certificate under s. 102.80 (3) (ag) this paragraph does apply
20to claims for compensation filed on or after the date specified in that certificate.
SB21,2742
21Section
2742. 102.07 (1) (b) of the statutes is amended to read:
SB21,1081,422
102.07
(1) (b) Every person, including all officials
, in the service of the state
, 23or of any municipality
therein in this state, whether elected or under any
24appointment
, or contract of hire, express or implied, and whether a resident
of this
25state or employed or injured within or without the state. This paragraph first applies
1on the first day of the first July beginning after the day
that on which the
secretary 2commissioner files the certificate under s. 102.80 (3) (a), except that if the
secretary 3commissioner files the certificate under s. 102.80 (3) (ag) this paragraph does apply
4to claims for compensation filed on or after the date specified in that certificate.
SB21,2743
5Section
2743. 102.07 (7) (b) of the statutes is amended to read:
SB21,1081,116
102.07
(7) (b) The
department office may issue an order under s. 102.31 (1) (b)
7permitting the county within which a volunteer fire company or fire department
8organized under ch. 213, a legally organized rescue squad, an ambulance service
9provider, as defined in s. 256.01 (3), or a legally organized diving team is organized
10to assume full liability for the compensation provided under this chapter of all
11volunteer members of that company, department, squad, provider or team.
SB21,2744
12Section
2744. 102.07 (8) (c) of the statutes is amended to read:
SB21,1081,1613
102.07
(8) (c) The
department office may not admit in evidence
any state or
14federal
laws, regulations, documents law, regulation, or document granting
15operating authority
, or
licenses
license when determining whether an independent
16contractor meets the conditions specified in par. (b) 1. or 3.
SB21,2745
17Section
2745. 102.07 (11) of the statutes is amended to read:
SB21,1082,218
102.07
(11) The
department office may by rule prescribe classes of volunteer
19workers who may, at the election of the person for whom the service is being
20performed, be
deemed considered to be employees for
the purposes of this chapter.
21Election shall be by endorsement upon
the that person's worker's compensation
22insurance policy with written notice to the
department
office. In the case of an
23employer
that is exempt from insuring liability, election shall be by written notice to
24the
department office. The
department office shall by rule prescribe the means and
1manner in which notice of election by the employer is to be provided to the volunteer
2workers.
SB21,2746
3Section
2746. 102.07 (12m) of the statutes is renumbered 102.07 (12m) (b) and
4amended to read:
SB21,1082,135
102.07
(12m) (b) A student of a public school,
as described in s. 115.01 (1), or 6a private school,
as defined in s. 115.001 (3r),
or an institution of higher education, 7while he or she is engaged in performing services as part of a school work training,
8work experience
, or work study program, and who is not on the payroll of an employer
9that is providing the work training or work experience or who is not otherwise
10receiving compensation on which a worker's compensation carrier could assess
11premiums on that employer, is an employee of a school district
or, private school
, or
12institution of higher education that elects under s. 102.077 to name the student as
13its employee.
SB21,2747
14Section
2747. 102.07 (12m) (a) of the statutes is created to read:
SB21,1082,1515
102.07
(12m) (a) In this subsection:
SB21,1082,2016
1. "Institution of higher education" means an institution within the University
17of Wisconsin System, a technical college, a tribally controlled college controlled by
18an Indian tribe that has elected under s. 102.05 (2) to become subject to this chapter,
19a school approved under s. 38.50, or a private, nonprofit institution of higher
20education located in this state.
SB21,1082,2121
2. "Private school" has the meaning given in s. 115.001 (3r).
SB21,1082,2222
3. "Public school" means a school described in s. 115.01 (1).
SB21,2748
23Section
2748. 102.076 (2) of the statutes is amended to read:
SB21,1083,524
102.076
(2) If a corporation has not more than 10 stockholders, not more than
252 officers
, and no other employees and is not otherwise required under this chapter
1to have a policy of worker's compensation insurance, an officer of that corporation
2who elects not to be subject to this chapter shall file a notice of that election with the
3department office on a form approved by the
department office. The election is
4effective until the officer rescinds
it the election by notifying the
department office 5in writing.
SB21,2749
6Section
2749. 102.077 (1) of the statutes is amended to read:
SB21,1083,187
102.077
(1) A school district
or a , private school,
as defined in s. 115.001 (3r), 8or institution of higher education may elect to name as its employee for purposes of
9this chapter a student described in s. 102.07 (12m)
(b) by an endorsement on its policy
10of worker's compensation insurance or, if the school district
or, private school
, or
11institution of higher education is exempt from the duty to insure under s. 102.28 (2)
12(a), by filing a declaration with the department in the manner provided in s. 102.31
13(2) (a) naming the student as an employee of the school district
or, private school
, or
14institution of higher education for purposes of this chapter. A declaration under this
15subsection shall list the name of the student to be covered under this chapter, the
16name and address of the employer that is providing the work training or work
17experience for that student
, and the title, if any, of the work training, work
18experience
, or work study program in which the student is participating.
SB21,2750
19Section
2750
. 102.077 (1) of the statutes, as affected by 2015 Wisconsin Act
20.... (this act), is amended to read:
SB21,1084,721
102.077
(1) A school district, private school, or institution of higher education
22may elect to name as its employee for purposes of this chapter a student described
23in s. 102.07 (12m) (b) by an endorsement on its policy of worker's compensation
24insurance or, if the school district, private school, or institution of higher education
25is exempt from the duty to insure under s. 102.28 (2) (a), by filing a declaration with
1the
department office in the manner provided in s. 102.31 (2) (a) naming the student
2as an employee of the school district, private school, or institution of higher education
3for purposes of this chapter. A declaration under this subsection shall list the name
4of the student to be covered under this chapter, the name and address of the employer
5that is providing the work training or work experience for that student, and the title,
6if any, of the work training, work experience, or work study program in which the
7student is participating.
SB21,2751
8Section
2751. 102.077 (2) of the statutes is amended to read:
SB21,1084,149
102.077
(2) A school district
or, private school
, or institution of higher
10education may revoke a declaration under sub. (1) by providing written notice to the
11department in the manner provided in s. 102.31 (2) (a), the student
, and the employer
12who is providing the work training or work experience for that student. A revocation
13under this subsection is effective 30 days after the department receives notice of that
14revocation.
SB21,2752
15Section
2752
. 102.077 (2) of the statutes, as affected by 2015 Wisconsin Act
16.... (this act), is amended to read:
SB21,1084,2217
102.077
(2) A school district, private school, or institution of higher education
18may revoke a declaration under sub. (1) by providing written notice to the
19department office in the manner provided in s. 102.31 (2) (a), the student, and the
20employer who is providing the work training or work experience for that student.
21A revocation under this subsection is effective 30 days after the
department office 22receives notice of that revocation.
SB21,2753
23Section
2753. 102.08 of the statutes is amended to read:
SB21,1085,11
24102.08 Administration for state employees. The department of
25administration has responsibility for the timely delivery of benefits payable under
1this chapter to employees of the state and their dependents and other functions of
2the state as an employer under this chapter. The department of administration may
3delegate
this authority that responsibility to employing departments and agencies
4and require such reports as it
deems considers necessary to accomplish this purpose.
5The department of administration or its delegated authorities shall file with the
6department of workforce development office the reports that are required of all
7employers. The
department of workforce development
office shall monitor the
8delivery of benefits
payable under this chapter to state employees and their
9dependents and shall consult with and advise the department of administration in
10the manner and at the times necessary to ensure prompt and proper delivery
of those
11benefits.
SB21,2754
12Section
2754. 102.11 (1) (am) 1. of the statutes is amended to read:
SB21,1085,1913
102.11
(1) (am) 1. The employee is a member of a class of employees that does
14the same type of work at the same location and, in the case of an employee in the
15service of the state, is employed in the same office, department, independent agency,
16authority, institution, association, society, or other body in state government or, if the
17department office determines appropriate, in the same subunit of an office,
18department, independent agency, authority, institution, association, society, or other
19body in state government.
SB21,2755
20Section
2755. 102.12 of the statutes is amended to read:
SB21,1086,15
21102.12 Notice of injury, exception, laches. No claim for compensation may
22be maintained unless, within 30 days after the occurrence of the injury or within 30
23days after the employee knew or ought to have known the nature of his or her
24disability and its relation to the employment, actual notice was received by the
25employer or by an officer, manager
, or designated representative of an employer. If
1no representative has been designated by posters placed in one or more conspicuous
2places
where notices to employees are customarily posted, then notice received by
3any superior is sufficient. Absence of notice does not bar recovery if it is found that
4the employer was not misled
thereby by that absence. Regardless of whether notice
5was received, if no payment of compensation, other than medical treatment or burial
6expense, is made
, and and if no application is filed with the
department office within
72 years
from after the date of the injury or death
, or from or the date the employee
8or his or her dependent knew or ought to have known the nature of the disability and
9its relation to the employment, the right to compensation
therefor for the injury or
10death is barred, except that the right to compensation is not barred if the employer
11knew or should have known, within the 2-year period, that the employee had
12sustained the injury on which the claim is based. Issuance of notice of a hearing on
13the
department's division's own motion has the same effect for the purposes of this
14section as the filing of an application. This section does not affect any claim barred
15under s. 102.17 (4).
SB21,2756
16Section
2756. 102.125 of the statutes is amended to read:
SB21,1087,5
17102.125 Fraudulent claims reporting and investigation. If an insurer or
18self-insured employer has evidence that a claim is false or fraudulent in violation of
19s. 943.395 and if the insurer or self-insured employer is satisfied that reporting the
20claim to the
department office will not impede its ability to defend the claim, the
21insurer or self-insured employer shall report the claim to the
department office. The
22department office may require an insurer or self-insured employer to investigate an
23allegedly false or fraudulent claim and may provide the insurer or self-insured
24employer with any records of the
department office relating to that claim. An insurer
25or self-insured employer that investigates a claim under this section shall report on
1the results of that investigation to the
department office. If based on the
2investigation the
department office has a reasonable basis to believe that a violation
3of s. 943.395 has occurred, the
department office shall refer the results of the
4investigation to the district attorney of the county in which the alleged violation
5occurred for prosecution.
SB21,2757
6Section
2757. 102.13 (1) (c) of the statutes is amended to read:
SB21,1087,147
102.13
(1) (c) So long as the employee, after a written request of the employer
8or insurer
which that complies with par. (b), refuses to submit to or in any way
9obstructs the examination, the employee's right to begin or maintain any proceeding
10for the collection of compensation is suspended, except as provided in sub. (4). If the
11employee refuses to submit to the examination after direction by the
department 12division or an examiner, or in any way obstructs the examination, the employee's
13right to the weekly indemnity
which that accrues and becomes payable during the
14period of that refusal or obstruction, is barred, except as provided in sub. (4).
SB21,2758
15Section
2758. 102.13 (1) (d) 2. of the statutes is amended to read:
SB21,1087,2016
102.13
(1) (d) 2. Any physician, chiropractor, psychologist, dentist, physician
17assistant, advanced practice nurse prescriber, or podiatrist who attended a worker's
18compensation claimant for any condition or complaint reasonably related to the
19condition for which the claimant claims compensation may be required to testify
20before the
department division when the
department division so directs.
SB21,2759
21Section
2759. 102.13 (1) (d) 3. of the statutes is amended to read:
SB21,1088,322
102.13
(1) (d) 3. Notwithstanding any statutory provisions except par. (e), any
23physician, chiropractor, psychologist, dentist, physician assistant, advanced
24practice nurse prescriber, or podiatrist attending a worker's compensation claimant
25for any condition or complaint reasonably related to the condition for which the
1claimant claims compensation may furnish to the employee, employer, worker's
2compensation insurer,
or the department the office, or the division information and
3reports relative to a compensation claim.
SB21,2760
4Section
2760. 102.13 (1) (f) of the statutes is amended to read:
SB21,1088,75
102.13
(1) (f) If an employee claims compensation under s. 102.81 (1), the
6department office may require the employee to submit to physical or vocational
7examinations under this subsection.
SB21,2761
8Section
2761. 102.13 (2) (a) of the statutes is amended to read:
SB21,1088,199
102.13
(2) (a) An employee who reports an injury alleged to be work-related
10or
who files an application for hearing waives any physician-patient,
11psychologist-patient or chiropractor-patient privilege with respect to any condition
12or complaint reasonably related to the condition for which the employee claims
13compensation. Notwithstanding ss. 51.30 and 146.82 and any other law, any
14physician, chiropractor, psychologist, dentist, podiatrist, physician assistant,
15advanced practice nurse prescriber, hospital, or health care provider shall, within a
16reasonable time after written request by the employee, employer, worker's
17compensation insurer,
or department office, or division, or its representative, provide
18that person with any information or written material reasonably related to any
19injury for which the employee claims compensation.
SB21,2762
20Section
2762. 102.13 (2) (c) of the statutes is amended to read:
SB21,1089,1021
102.13
(2) (c) Except as provided in this paragraph, if an injured employee has
22a period of temporary disability that exceeds 3 weeks or a permanent disability, if the
23injured employee has undergone surgery to treat his or her injury, other than surgery
24to correct a hernia, or if the injured employee sustained an eye injury requiring
25medical treatment on 3 or more occasions off the employer's premises, the
1department office may by rule require the insurer or self-insured employer to submit
2to the
department office a final report of the employee's treating practitioner. The
3department office may not require an insurer or self-insured employer to submit to
4the
department office a final report of an employee's treating practitioner when the
5insurer or self-insured employer denies the employee's claim for compensation and
6the employee does not contest that denial. A treating practitioner may charge a
7reasonable fee for the completion of the final report, but may not require prepayment
8of that fee. An insurer or self-insured employer that disputes the reasonableness of
9a fee charged for the completion of a treatment practitioner's final report may submit
10that dispute to the
department office for resolution under s. 102.16 (2).
SB21,2763
11Section
2763. 102.13 (3) of the statutes is amended to read:
SB21,1089,2412
102.13
(3) If 2 or more physicians, chiropractors, psychologists, dentists or
13podiatrists disagree as to the extent of an injured employee's temporary disability,
14the end of an employee's healing period, an employee's ability to return to work at
15suitable available employment
, or the necessity for further treatment or for a
16particular type of treatment, the
department division may appoint another
17physician, chiropractor, psychologist, dentist or podiatrist to examine the employee
18and render an opinion as soon as possible. The
department division shall promptly
19notify the parties of this appointment. If the employee has not returned to work,
20payment for temporary disability shall continue until the
department division 21receives the opinion. The employer or its insurance carrier or both shall pay for the
22examination and opinion. The employer or insurance carrier or both shall receive
23appropriate credit for any overpayment to the employee determined by the
24department division after receipt of the opinion.
SB21,2764
25Section
2764. 102.13 (4) of the statutes is amended to read:
SB21,1090,15
1102.13
(4) The
rights of employees right of an employee to begin or maintain
2proceedings for the collection of compensation and to receive weekly indemnities
3which that accrue and become payable shall not be suspended or barred under sub.
4(1) when
an the employee refuses to submit to a physical examination, upon the
5request of the employer or worker's compensation insurer or at the direction of the
6department division or an examiner,
which that would require the employee to travel
7a distance of 100 miles or more from his or her place of residence, unless the employee
8has claimed compensation for treatment from a practitioner whose office is located
9100 miles or more from the employee's place of residence or the
department division 10or examiner determines that any other circumstances warrant the examination. If
11the employee has claimed compensation for treatment from a practitioner whose
12office is located 100 miles or more from the employee's place of residence, the
13employer or insurer may request, or the
department
division or an examiner may
14direct, the employee to submit to a physical examination in the area where the
15employee's treatment practitioner is located.
SB21,2765
16Section
2765. 102.13 (5) of the statutes is amended to read:
SB21,1090,2517
102.13
(5) The
department division may refuse to receive testimony as to
18conditions determined from an autopsy if it appears that the party offering the
19testimony had procured the autopsy and had failed to make reasonable effort to
20notify at least one party in adverse interest or the
department division at least 12
21hours before the autopsy of the time and place
it
at which the autopsy would be
22performed, or that the autopsy was performed by or at the direction of the coroner
23or medical examiner or at the direction of the district attorney for purposes not
24authorized
by under ch. 979. The
department division may withhold findings until
25an autopsy is held in accordance with its directions.
SB21,2766
1Section
2766. 102.14 (title) of the statutes is amended to read:
SB21,1091,2
2102.14 (title)
Jurisdiction of department office; advisory committee.
SB21,2767
3Section
2767. 102.14 (1) of the statutes is amended to read:
SB21,1091,54
102.14
(1) This Except as otherwise provided, this chapter shall be
5administered by the
department office.
SB21,2768
6Section
2768. 102.14 (2) of the statutes is amended to read:
SB21,1091,157
102.14
(2) The council on worker's compensation shall advise the
department 8office in carrying out the purposes of this chapter
. Such council, shall submit its
9recommendations with respect to amendments to this chapter to each regular
10session of the legislature
, and shall report its views upon any pending bill relating
11to this chapter to the proper legislative committee. At the request of the chairpersons
12of the senate and assembly committees on labor, the
department office shall schedule
13a meeting of the council with the members of the senate and assembly committees
14on labor to review and discuss matters of legislative concern arising under this
15chapter.
SB21,2769
16Section
2769. 102.15 (1) of the statutes is amended to read:
SB21,1091,1817
102.15
(1) Subject to this chapter, the
department division may adopt its own
18rules of procedure and may change the same from time to time.
SB21,2770
19Section
2770. 102.15 (2) of the statutes is amended to read:
SB21,1091,2220
102.15
(2) The
department division may provide by rule the conditions under
21which transcripts
or electronic recordings of testimony and proceedings shall be
22furnished.
SB21,2771
23Section
2771. 102.15 (3) of the statutes is amended to read:
SB21,1092,524
102.15
(3) All testimony at any hearing held under this chapter shall be
taken
25down by a stenographic reporter, except that in case of an emergency, as determined
1by recorded by electronic means. That testimony need not be transcribed, unless the
2examiner conducting the hearing
, testimony may be recorded by a recording machine 3orders otherwise. The division shall furnish a copy of an electronic recording made
4under this subsection or a transcript ordered under this subsection to the parties
5upon payment of any fee required by the division by rule.
SB21,2772
6Section
2772. 102.16 (1) of the statutes is amended to read:
SB21,1092,237
102.16
(1) Any controversy concerning compensation or a violation of sub. (3),
8including
controversies a controversy in which the state may be a party, shall be
9submitted to the
department division in the manner and with the effect provided in
10this chapter.
Every compromise of any claim for compensation may be reviewed and
11set aside, modified or confirmed by the department within Within one year
from after 12the date
the on which a compromise
of any claim for compensation is filed with the
13department, or from division or the date
on which an award has been entered
, based
14thereon, or the department may take that action based on a compromise, the
15division, on its own motion or upon application made within
one year that period,
16may review and set aside, modify, or confirm the compromise. Unless the word
17"compromise" appears in a stipulation of settlement, the settlement shall not be
18deemed considered a compromise, and further claim is not barred except as provided
19in s. 102.17 (4) regardless of whether an award is made. The employer, insurer
, or
20dependent under s. 102.51 (5) shall have equal rights with the employee to have
21review of a compromise or any other stipulation of settlement
reviewed under this
22subsection. Upon petition filed with the
department division, the
department 23division may set aside the award or otherwise determine the rights of the parties.
SB21,2773
24Section
2773. 102.16 (1m) (a) of the statutes is amended to read:
SB21,1093,16
1102.16
(1m) (a) If an insurer or self-insured employer concedes by compromise
2under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
3employer is liable under this chapter for any health services provided to an injured
4employee by a health service provider, but disputes the reasonableness of the fee
5charged by the health service provider, the
department
division may include in its
6order confirming the compromise or stipulation a determination
made by the office
7under sub. (2) as to the reasonableness of the fee or
the department, if such a
8determination has not yet been made, the division may notify, or direct the insurer
9or self-insured employer to notify, the health service provider under sub. (2) (b) that
10the reasonableness of the fee is in dispute.
The department shall deny payment of
11a health service fee that the department determines under this paragraph to be
12unreasonable. A health service provider and an insurer or self-insured employer
13that are parties to a fee dispute under this paragraph are bound by the department's
14determination under this paragraph on the reasonableness of the disputed fee,
15unless that determination is set aside, reversed, or modified by the department
16under sub. (2) (f) or is set aside on judicial review as provided in sub. (2) (f).
SB21,2774
17Section
2774. 102.16 (1m) (b) of the statutes is amended to read:
SB21,1094,1518
102.16
(1m) (b) If an insurer or self-insured employer concedes by compromise
19under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
20employer is liable under this chapter for any treatment provided to an injured
21employee by a health service provider, but disputes the necessity of the treatment,
22the
department division may include in its order confirming the compromise or
23stipulation a determination
made by the office under sub. (2m) as to the necessity of
24the treatment or
the department, if such a determination has not yet been made, the
25division may notify, or direct the insurer or self-insured employer to notify, the
1health service provider under sub. (2m) (b) that the necessity of the treatment is in
2dispute.
Before determining under this paragraph the necessity of treatment
3provided to an injured employee, the department may, but is not required to, obtain
4the opinion of an expert selected by the department who is qualified as provided in
5sub. (2m) (c). The standards promulgated under sub. (2m) (g) shall be applied by an
6expert and by the department in rendering an opinion as to, and in determining,
7necessity of treatment under this paragraph. In cases in which no standards
8promulgated under sub. (2m) (g) apply, the department shall find the facts regarding
9necessity of treatment. The department shall deny payment for any treatment that
10the department determines under this paragraph to be unnecessary. A health
11service provider and an insurer or self-insured employer that are parties to a dispute
12under this paragraph over the necessity of treatment are bound by the department's
13determination under this paragraph on the necessity of the disputed treatment,
14unless that determination is set aside, reversed, or modified by the department
15under sub. (2m) (e) or is set aside on judicial review as provided in sub. (2m) (e).
SB21,2775
16Section
2775. 102.16 (1m) (c) of the statutes is amended to read:
SB21,1095,1017
102.16
(1m) (c) If an insurer or self-insured employer concedes by compromise
18under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
19employer is liable under this chapter for the cost of a prescription drug dispensed
20under s. 102.425 (2) for outpatient use by an injured employee, but disputes the
21reasonableness of the amount charged for the prescription drug, the
department 22division may include in its order confirming the compromise or stipulation a
23determination
made by the office under s. 102.425 (4m) as to the reasonableness of
24the prescription drug charge or
the department, if such a determination has not yet
25been made, the division may notify, or direct the insurer or self-insured employer to
1notify, the pharmacist or practitioner dispensing the prescription drug under s.
2102.425 (4m) (b) that the reasonableness of the prescription drug charge is in
3dispute.
The department shall deny payment of a prescription drug charge that the
4department determines under this paragraph to be unreasonable. A pharmacist or
5practitioner and an insurer or self-insured employer that are parties to a dispute
6under this paragraph over the reasonableness of a prescription drug charge are
7bound by the department's determination under this paragraph on the
8reasonableness of the disputed prescription drug charge, unless that determination
9is set aside, reversed, or modified by the department under s. 102.425 (4m) (e) or is
10set aside on judicial review as provided in s. 102.425 (4m) (e).
SB21,2776
11Section
2776. 102.16 (2) (a) of the statutes is amended to read:
SB21,1095,2512
102.16
(2) (a) Except as provided in this paragraph, the
department office has
13jurisdiction
under this subsection, sub. (1m) (a), and s. 102.17 to resolve a dispute
14between a health service provider and an insurer or self-insured employer over the
15reasonableness of a fee charged by the health service provider for health services
16provided to an injured employee who claims benefits under this chapter. A health
17service provider may not submit a fee dispute to the
department office under this
18subsection before all treatment by the health service provider of the employee's
19injury has ended if the amount in controversy, whether based on a single charge or
20a combination of charges for one or more days of service, is less than $25. After all
21treatment by a health service provider of an employee's injury has ended, the health
22service provider may submit any fee dispute to the
department office, regardless of
23the amount in controversy. The
department office shall deny payment of a health
24service fee that the
department office determines under this subsection to be
25unreasonable.
SB21,2777
1Section
2777. 102.16 (2) (am) of the statutes is amended to read: