Notice of Cancellation and Termination of Insurance Coverage
Section
DWD 80.65 identifies specific methods of delivery to the Wisconsin Compensation Rating Bureau when a worker's compensation insurance company gives notice of a cancellation or terminates a policy. The proposed rule will allow methods of delivery which are approved by the department.
The proposed rule will also amend the section title to include nonrenewal of insurance coverage and create statutory cross-references for cancellations, terminations, and non-renewals of insurance policies issued to professional employer organizations and employee leasing companies.
Necessity of Treatment Disputes
Section
DWD 80.73 requires an insurer or self-insured employer to give written notice to a health care provider when the insurer or self-insured employer refuses to pay for treatment costs determined to be unnecessary. The insurer or self-insured employer is required to identify why it believes the treatment was unnecessary, including the organization and credentials of any person who provides supporting medical documentation. The proposed rule will require an insurer or self-insured employer to also include all supporting medical documentation used to determine the treatment unnecessary.
The department did not prepare an analysis of policy alternatives since the proposed rulemaking is only intended to simplify, reduce, or increase the efficiency of certain requirements, or is of a clarifying nature.
4. Detailed Explanation of Statutory Authority for the Rule (Including the Statutory Citation and Language)
The following statutory provisions provide authority for the proposed rulemaking:
“….if the injured employee sustained an eye injury requiring medical treatment on 3 or more occasions off the employer's premises, the department may by rule require the insurer or self-insured employer to submit to the department a final report of the employee's treating practitioner…"
“(1) Subject to this chapter, the department may adopt its own rules of procedure and may change the same from time to time."
“The department shall promulgate rules establishing procedures and requirements for the necessity of treatment dispute resolution process under this subsection, including rules setting the fees under par. (f) and rules establishing standards for determining the necessity of treatment provided to an injured employee…. "
“…The department may provide by rule that the notice of cancellation or termination be given to the Wisconsin compensation rating bureau rather than to the department in a medium approved by the department after consultation with the Wisconsin compensation rating bureau…."
“Every insurance company that transacts the business of compensation insurance, and every employer who is subject to this chapter, but whose liability is not insured, shall keep a record of all payments made under this chapter and of the time and manner of making the payments and shall furnish reports based upon these records and any other information to the department as the department may require by rule or general order, in a format approved by the department."
“The department shall promulgate rules establishing procedures and requirements for the private rehabilitation counseling and rehabilitative training process under this subsection. Those rules shall include rules specifying the procedure and requirements for certification of private rehabilitation counselors."
5. Estimate of Amount of Time that State Employees Will Spend Developing the Rule and of Other Resources Necessary to Develop the Rule
The estimated time is 120 hours.
6. List with Description of all Entities that May be Affected by the Proposed Rule
Injured employees with worker's compensation claims, worker's compensation insurance companies, self-insured employers, worker's compensation claims handling offices, third party administrators, health care providers and Wisconsin Compensation Rating Bureau.
7. Summary and Preliminary Comparison with Any Existing or Proposed Federal Regulation that is Intended to Address the Activities to be Regulated by the Proposed Rule.
There are no existing or proposed federal regulations related to the proposed rules.
8. Anticipated Economic Impact of Implementing the Rule (Note if the Rule is Likely to Have a Significant Economic Impact on Small Businesses)
The proposed rule will have no economic impact locally or statewide. The proposed rule is primarily procedural in nature and will have no economic impact on small businesses.
9. Contact Person
James T. O'Malley, Director, Worker's Compensation Bureau of Legal Affairs, (608) 267-6704, Jim.OMalley@ dwd.wisconsin.gov.
