Madison
Interested persons are invited to appear at the hearing and will be afforded the opportunity to make an oral presentation of their positions. Persons making oral presentations are requested to submit their facts, views, and suggested rewording in writing.
Visitors to the GEF 1 building are requested to enter through the left East Washington Avenue door and register with the customer service desk. The entrance is accessible via a ramp from the corner of Webster Street and East Washington Avenue. If you have special needs or circumstances that may make communication or accessibility difficult at the hearings, please call (608) 267-9403 at least 10 days prior to the hearing date. Accommodations such as ASL interpreters, English translators, or materials in audiotape format will be made available on request to the fullest extent possible.
Analysis Prepared by the Department of Workforce Development
The proposed rules make the following changes, as agreed to by the Worker's Compensation Advisory Council:
Supplementary reports by employers and insurance companies. Under the current rule self-insured employers and insurance companies are required to submit supplemental reports only if the reported injury meets the definition of lost time under DWD 80.02 (1) (a). The proposed amendment to s.
DWD 80.02 (2) (b) will require self-insured employers and insurance companies to submit supplemental reports for all claims reported whether or not they meet the lost-time definition. The amendment will not require the reporting of no lost time or denied claims but will require the filing of supplemental reports for all claims that are reported.
Written notice by employers and insurance companies. The proposed amendment to s.
DWD 80.02 (2) (g) 2. will require self-insured employers and insurance companies to provide notice of denial to the department and employees for claims that are initially reported and paid but later denied. The current rule is inconsistent with the requirement to report only compensable claims.
Written notice by employers and insurance companies. The proposed rules repeal s.
DWD 80.02 (2) (h). Under the current rule, self-insured employers and insurance companies are required to provide the department with written notice related to denial or continued investigation of claims with copies of the report provided to employees. This provision is repealed because the requirement for self-insured employers and insurance companies to submit reports about the denial or investigation of claims to the department is eliminated. The newly-created DWD 80. 02 (2m) replaces this provision and requires self-insured employers and insurance companies to provide notice of denial or investigation of claims to employees only and not to the department.
Notice by employers and insurance companies to employees. The proposed rules amend s.
DWD 80.02 (2m) to clarify that a notice of denial or investigation of claims is to be sent to the employee along with a statement advising the employee of the right to a hearing before the department. The notice of investigation will specify if additional medical or other information is needed to complete the investigation. This notice must be sent to the employee and is not required to be sent to the department.
Electronic reporting. The proposed amendment to s.
DWD 80.02 (3m) will permit the department to require self-insured employers and insurance companies to submit all or selected information in reports or amendments to reports to be filed via electronic, magnetic, or other media satisfactory to the department. Under the current rule self-insured employers and insurance companies may request to submit required reports electronically but are not required to do so. This amendment will allow the department discretion to require electronic reporting to help the self-insured employer or insurance company to meet reporting requirements. This amendment also permits the department to grant waivers from the requirement to submit reports by electronic means if the employer, self-insured employer or insurer can establish good cause.
Payment of permanent disability. A new section is created at s.
DWD 80.52 to establish when payment for compensation for permanent disability must begin in cases in which the self-insured employer or insurance company concedes liability but disputes the extent of permanent disability. Under this rule payment is to begin (1) within 30 days after the self-insured employer or insurance company receives a report that provides a permanent disability rating or (2) within 30 days after receiving a report from an examination performed under s.
102.13 (1) (a), Stats., in the amount of permanent disability found as a result of the examination. If no examination was previously performed, the self-insured employer or insurance company may give notice of a request for an examination within 30 days of receiving a report that establishes permanent disability. If the examining practitioner's report is not available within 90 days of the request for an examination, payment must begin by that date.
Uninsured employers fund. Section
DWD 80.62 (7) (a) 3. is amended to allow the department to seek reimbursement from uninsured employers for payments made by the Uninsured Employers Fund for claims administration expenses.
Notice of cancellation or termination. The proposed rules amend s.
DWD 80.65 to permit insurance companies to give notice of cancellation or termination of insurance policies to the Wisconsin Compensation Rating Bureau by facsimile machine transmission, electronic mail, or any electronic, magnetic, or other medium approved by the department. The current rule permits notice only by certified mail or personal service. The rule is amended to authorize notice by different means to comply with a recent amendment to s.
102.31 (2) (a), Stats.
Reasonableness of fee disputes. Section
DWD 80.72 (3) (a) is amended to require self-insured employers and insurance companies to raise disputes over liability or the extent of disability of the underlying claim and give notice within 30 days after receiving a completed bill from a healthcare provider, unless there is good cause for the delay in providing this notice.
Necessity of treatment. Section
DWD 80.73 (3) (a) is amended to require self-insured employers and insurance companies to raise disputes over liability or the extent of liability of the underlying claim and give notice within 60 days after receiving a bill from the healthcare provider, unless there is good cause for the delay in providing this notice.
Initial Regulatory Flexibility Analysis
The proposed rule changes may affect small business as defined in s.
227.114, Stats., but the changes would not have a significant economic impact.
Fiscal Impact
The proposed rule changes do not have a fiscal effect on state or local government.
Contact Information
Elaine Pridgen
Office of Legal Counsel
Dept. of Workforce Development
201 E. Washington Avenue
P.O. Box 7946
Madison, WI 53707-7946
(608) 267-9403
Written Comments
Written comments on the proposed rules received at the above address no later than January 20, 2004, will be given the same consideration as testimony presented at the hearing.
