Statutes Interpreted: Ch. 102, Stats. Statutory authority
Explanation of statutory authority
Chapter 102, Stats., governs the state's worker's compensation program. The department has general rule-making authority under s. 102.15 (1), Stats., to adopt rules of procedure, s. 102.15 (2) to provide by rule conditions in which transcripts of testimony and proceedings may be furnished and under s. 103.005 (1), Stats., to adopt reasonable and proper rules and regulations relative to the exercise of powers and proper rules to govern its proceedings and to regulate the mode and manner of all investigations and hearings. Section 102.13 (2) (c), Stats., authorizes the department to require worker's compensation insurance companies and self-insured employers to submit to the department a final report of the treating practitioner of an injured employee who has a period of temporary disability that exceeds 3 weeks, any permanent disability, surgery other than surgery to correct a hernia, and for any eye injury when the employee obtained treatment on 3 or more occasions off the employer's premises. Section 102.16 (2m) (g), Stats., authorizes the department to promulgate rules establishing procedures and requirements for the necessity of treatment dispute resolution process. Section 102.31 (2) (a), Stats., authorizes the department by rule to require notice of cancellation or termination of worker's compensation insurance policies be given to the Wisconsin Compensation Rating Bureau rather than the department in a medium approved by the department after consultation with the Wisconsin Compensation Rating Bureau.
Section 102.38, Stats., authorizes the department to promulgate rules that requires every insurance company that transacts the business of worker's compensation and every employer subject to ch. 102, to furnish all reports and records to the department identifying payments and the time and manner of those payments, and any other information the department may require by rule in a format approved by the department. Section 102.61 (1m) (f), Stats., requires the department to promulgate rules establishing procedures and requirements for the private rehabilitation counseling and rehabilitative training process, including rules specifying the procedure and requirements for certification of private rehabilitation counselors. Related statutes or rules
Chapter DWD 81, Wis. Admin. Rule, Worker's Compensation Treatment Guidelines. Plain language analysis
This proposed hearing draft includes the following:
Reports by Insurance Companies and Self-Insured Employers
Section DWD 80.02 (2) identifies the reports that self-insured employers and insurance companies are required to submit to the department for injuries if there is a disability beyond the third day after the employee leaves work as a result of the accident or disease. Under the proposed rule, the following amendments will clarify that a self-insured employer or insurance company is required to report to the department when:
Salary continuation payments to the employee are paid in lieu of compensation for injuries with disabilities that continue for more than three (3) days.
Salary continuation payments made to the employee in lieu of compensation are changed to payments for permanent disability.
Salary continuation payments made in lieu of compensation are reinstated.
The final payment of salary continuation in lieu of compensation is made. The proposed rule will also require a self-insured employer or insurance company to submit a final report of the employee's treating practitioner if the employee sustains an eye injury that requires medical treatment on 3 or more occasions off the employer's premises.
The proposed rule will create guidelines that require a self-insured employer or insurance company to file an update with the department, on a form prescribed by the department, and to the newly retained claims handling office or third party administrator, for any open claim with more than 26 weeks of temporary disability, or permanent total disability. The proposed rule will also establish guidelines when the department may require submission of this information for any open claims with less than 26 weeks of temporary disability, or permanent total disability.
In addition, the proposed rule will require a self-insured employer or insurance company to submit to the department, on a form prescribed by the department, on an annual basis within 12 months of the beginning of a new calendar year any payments for permanent total disability and supplemental benefits made during the previous year.
Vocational Rehabilitation Benefits
Section DWD 80.49 (4), (6) (b) 2 and (11) (a) references outdated terminology related to vocational specialists and retraining plans developed for injured employees pursuing vocational rehabilitation training. The proposed rule will repeal the obsolete terminology and use current terminology to define retraining plans developed for injured employees pursuing vocational rehabilitation training and describe vocational specialists. Wrap-up Insurance
Section DWD 80.61 (3) (c) requires the use of department forms WKCA-19.4 W-U and WKCA-19.5 W-U, which are no longer utilized by the department. The proposed rule will repeal the requirement to file forms WKCA-19.4 W-U and WKCA-19.5 W-U which are obsolete and create language to authorize the use of forms prescribed by the department. Uninsured Employers Fund
Section DWD 80.62 (8) requires the department to submit to the Governor, and presiding officer of each house of the legislature, a report on the Uninsured Employers Fund on a quarterly basis. Under 1989 Wisconsin Act 64, this requirement sunset on April 15, 1992 and will be repealed. 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 worker's compensation insurance policies 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 (3) (a) 5 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. Summary of, and comparison with, existing or proposed federal statutes and regulations
There are no proposed or existing federal statutes or regulations related to the proposed rule.
Comparison with rules in adjacent states
Reports by Insurance Companies and Self-Insured Employers
Iowa. Iowa rules 876 IAC 2.5, 2.6, 3.1 and 11.6 provide for worker's compensation insurance carriers, self-insured employers and their adjusting agents submitting reports to the Workers' Compensation Commissioner and copies to the employee's last known address with claim benefit payment information. This information includes notice of commencement of payments, correcting erroneous claim information, supplying additional information, denying compensability, recording the amount of benefits paid and when benefit payments are terminated or interrupted. This information is similar to the information required by Wisconsin rules. Medical data is to be filed when temporary total disability or temporary partial disability exceeds 13 weeks or when an employee sustains permanent disability. Current rules in Wisconsin require a final treating practitioner's report if there are more than three weeks of temporary disability, any permanent disability and surgery other than surgery to correct a hernia. The proposed rule will require a final treating practitioner's report for eye injuries when the employee obtained treatment on 3 or more occasions off the employer's premises.
Illinois. In Illinois worker's compensation insurance carriers and self-insured employers are required to report annually to the Illinois Industrial Commission detailed information as to the number of injuries and benefit amounts paid by categories of losses. These provisions are required by statute and found at 820 ILCS 305 section 29. Illinois rule 50 ILAC 7110.70 provides an employer, agent, service company or insurer is to give an employee a written explanation for non-payment, termination or suspension of temporary total disability, or denial of liability or further responsibility for medical care. The Illinois rule does not require notice of this claims information to the Illinois Industrial Commission. The Illinois rule covers denials of liability for medical treatment that are not covered by current or proposed rules in Wisconsin.
Michigan. Michigan rule R 408.31 provides for reporting injuries to the bureau (Michigan Workers' Compensation Agency) on an agency form with worker's compensation claim payment and status information. The information includes reporting on the day following the first payment, day after stopping payment of compensation including the amount paid in each case and changes in the rate of compensation paid. This is similar to information required by Wisconsin rules. A statement of an attending physician is required in every specific loss, including date and extent of loss. Current rules in Wisconsin require a final treating practitioner's report if there are more than 3 weeks of temporary disability, any permanent disability and surgery other than surgery to correct a hernia. The proposed rule will require a final treating practitioner's report for eye injuries when the employee obtained treatment on 3 or more occasions off the employer's premises.
