Rules Clearinghouse No. 15-030
ORDER OF THE WISCONSIN
DEPARTMENT OF WORKFORCE DEVELOPMENT
ADOPTING RULES
The Wisconsin department of workforce development adopts the following order to repeal DWD 80.49 (7) (a) (Note) and (d) (Note) and 80.62 (8); to renumber and amend DWD 80.02 (2) (j) (Note); to amend DWD 80.02 (2) (e) (intro.) and 1., 2. and 4., 80.49 (4) (intro.), (a), (6) (b) 1. to 3. and 4. (Note), (f) and (11) (a), 80.61 (3) (c) 1. and 2. a. to f., 80.62 (3) (a) (Note), 80.65, and 80.73 (3) (a) 1. to 7. and (6) (f); and to create DWD 80.02 (2) (e) 5., (k) and (Note), 80.49 (7) (e) (Note), 80.61 (2) (b) (Note), (3) (c) 1. (Note), 2. d. (Note) and (d) 1. (Note), 80.65 (Note) and 80.73 (6) (f) (Note); relating to the worker's compensation program.
Analysis Prepared by the Department of
Workforce Development
Statutes interpreted
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 by June 30 of each calendar year, on a form prescribed by the department, any payments for permanent total disability and supplemental benefits made during the previous calendar 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
The proposed rule will 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.
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 creates a note that specifies the methods approved by the department for giving notice of cancellation, termination or non-renewal to the Wisconsin Compensation Rating Bureau and provides the department may update the note without rulemaking when the means of notification are changed.
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.
