Amendment SSA1-SB21

SB21-SSA1,851,25 102.16 (1m) (b) If an insurer or self-insured employer concedes by compromise under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured employer is liable under this chapter for any treatment provided to an injured employee by a health service provider, but disputes the necessity of the treatment, the department or the division may include in its order confirming the compromise or stipulation a determination made by the department under sub. (2m) as to the necessity of the treatment or the department, if such a determination has not yet been made, the department or the division may notify, or direct the insurer or self-insured employer to notify, the health service provider under sub. (2m) (b) that the necessity of the treatment is in dispute. Before determining under this paragraph sub. (2m) the necessity of treatment provided to an injured employee, the department may, but is not required to, obtain the opinion of an expert selected by the department who is qualified as provided in sub. (2m) (c). The standards promulgated under sub. (2m) (g) shall be applied by an expert and by the department in rendering an opinion as to, and in determining, necessity of treatment under this paragraph. In cases in which no standards promulgated under sub. (2m) (g) apply, the department shall find the facts regarding necessity of treatment. The department or the division shall deny payment for any treatment that the department determines under this paragraph sub. (2m) to be unnecessary. A health service provider and an insurer or self-insured employer that are parties to a dispute under this paragraph over the necessity of treatment are bound by the department's determination under this paragraph sub. (2m) on the necessity of the disputed treatment, unless that determination is set aside, reversed, or modified by the department under sub. (2m) (e) or is set aside on judicial review as provided in sub. (2m) (e).

SB21-SSA1,2775d Section 2775d. 102.16 (1m) (c) of the statutes is amended to read:

SB21-SSA1,852,21 102.16 (1m) (c) If an insurer or self-insured employer concedes by compromise under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured employer is liable under this chapter for the cost of a prescription drug dispensed under s. 102.425 (2) for outpatient use by an injured employee, but disputes the reasonableness of the amount charged for the prescription drug, the department or the division may include in its order confirming the compromise or stipulation a determination made by the department under s. 102.425 (4m) as to the reasonableness of the prescription drug charge or the department, if such a determination has not yet been made, the department or the division may notify, or direct the insurer or self-insured employer to notify, the pharmacist or practitioner dispensing the prescription drug under s. 102.425 (4m) (b) that the reasonableness of the prescription drug charge is in dispute. The department or the division shall deny payment of a prescription drug charge that the department determines under this paragraph s. 102.425 (4m) to be unreasonable. A pharmacist or practitioner and an insurer or self-insured employer that are parties to a dispute under this paragraph over the reasonableness of a prescription drug charge are bound by the department's determination under this paragraph s. 102.425 (4m) on the reasonableness of the disputed prescription drug charge, unless that determination is set aside, reversed, or modified by the department under s. 102.425 (4m) (e) or is set aside on judicial review as provided in s. 102.425 (4m) (e).

SB21-SSA1,2776d Section 2776d. 102.16 (2) (a) of the statutes is amended to read:

SB21-SSA1,853,11 102.16 (2) (a) Except as provided in this paragraph, the department has jurisdiction under this subsection, the department and the division have jurisdiction under sub. (1m) (a), and the division has jurisdiction under s. 102.17 to resolve a dispute between a health service provider and an insurer or self-insured employer over the reasonableness of a fee charged by the health service provider for health services provided to an injured employee who claims benefits under this chapter. A health service provider may not submit a fee dispute to the department under this subsection before all treatment by the health service provider of the employee's injury has ended if the amount in controversy, whether based on a single charge or a combination of charges for one or more days of service, is less than $25. After all treatment by a health service provider of an employee's injury has ended, the health service provider may submit any fee dispute to the department, regardless of the amount in controversy. The department shall deny payment of a health service fee that the department determines under this subsection to be unreasonable.

SB21-SSA1,2778d Section 2778d. 102.16 (2) (b) of the statutes is amended to read:

SB21-SSA1,853,20 102.16 (2) (b) An insurer or self-insured employer that disputes the reasonableness of a fee charged by a health service provider or the department or the division under sub. (1m) (a) or s. 102.18 (1) (bg) 1. shall provide reasonable written notice to the health service provider that the fee is being disputed. After receiving reasonable written notice under this paragraph or under sub. (1m) (a) or s. 102.18 (1) (bg) 1. that a health service fee is being disputed, a health service provider may not collect the disputed fee from, or bring an action for collection of the disputed fee against, the employee who received the services for which the fee was charged.

SB21-SSA1,2785d Section 2785d. 102.16 (2m) (a) of the statutes is amended to read:

SB21-SSA1,854,10 102.16 (2m) (a) Except as provided in this paragraph, the department has jurisdiction under this subsection, the department and the division have jurisdiction under sub. (1m) (b), and the division has jurisdiction under s. 102.17 to resolve a dispute between a health service provider and an insurer or self-insured employer over the necessity of treatment provided for an injured employee who claims benefits under this chapter. A health service provider may not submit a dispute over necessity of treatment to the department under this subsection before all treatment by the health service provider of the employee's injury has ended if the amount in controversy, whether based on a single charge or a combination of charges for one or more days of service, is less than $25. After all treatment by a health service provider of an employee's injury has ended, the health service provider may submit any dispute over necessity of treatment to the department, regardless of the amount in controversy. The department shall deny payment for any treatment that the department determines under this subsection to be unnecessary.

SB21-SSA1,2787d Section 2787d. 102.16 (2m) (b) of the statutes is amended to read:

SB21-SSA1,854,20 102.16 (2m) (b) An insurer or self-insured employer that disputes the necessity of treatment provided by a health service provider or the department or the division under sub. (1m) (b) or s. 102.18 (1) (bg) 2. shall provide reasonable written notice to the health service provider that the necessity of that treatment is being disputed. After receiving reasonable written notice under this paragraph or under sub. (1m) (b) or s. 102.18 (1) (bg) 2. that the necessity of treatment is being disputed, a health service provider may not collect a fee for that disputed treatment from, or bring an action for collection of the fee for that disputed treatment against, the employee who received the treatment.

SB21-SSA1,2793d Section 2793d. 102.16 (4) of the statutes is amended to read:

SB21-SSA1,855,4 102.16 (4) The department has and the division have jurisdiction to pass on any question arising out of sub. (3) and has jurisdiction to order the employer to reimburse an employee or other person for any sum deducted from wages or paid by him or her in violation of that subsection. In addition to the penalty provided in s. 102.85 (1), any employer violating sub. (3) shall be liable to an injured employee for the reasonable value of the necessary services rendered to that employee pursuant to under any arrangement made in violation of sub. (3) without regard to that employee's actual disbursements for the same those services.

SB21-SSA1,2794d Section 2794d. 102.17 (1) (a) 1. of the statutes is amended to read:

SB21-SSA1,855,11 102.17 (1) (a) 1. Upon the filing with the department by any party in interest of any application in writing stating the general nature of any claim as to which any dispute or controversy may have arisen, the department shall mail a copy of the application to all other parties in interest, and the insurance carrier shall be considered a party in interest. The department or the division may bring in additional parties by service of a copy of the application.

SB21-SSA1,2795 Section 2795. 102.17 (1) (a) 2. of the statutes is amended to read:

SB21-SSA1,855,22 102.17 (1) (a) 2. Subject to subd. 3., the department division shall cause notice of hearing on the application to be given to each interested party , by service of that notice on the interested party personally or by mailing a copy of that notice to the interested party's last-known address at least 10 days before the hearing. If a party in interest is located without this state, and has no post-office address within this state, the copy of the application and copies of all notices shall be filed with the department of financial institutions and shall also be sent by registered or certified mail to the last-known post-office address of the party. Such filing and mailing shall constitute sufficient service, with the same effect as if served upon a party located within this state.

SB21-SSA1,2796d Section 2796d. 102.17 (1) (a) 3. of the statutes is amended to read:

SB21-SSA1,856,3 102.17 (1) (a) 3. If a party in interest claims that the employer or insurer has acted with malice or bad faith as described in s. 102.18 (1) (b) or (bp), that party shall provide written notice stating with reasonable specificity the basis for the claim to the employer, the insurer, and the department , and the division before the department division schedules a hearing on the claim of malice or bad faith.

SB21-SSA1,2797 Section 2797. 102.17 (1) (a) 4. of the statutes is amended to read:

SB21-SSA1,856,13 102.17 (1) (a) 4. The hearing may be adjourned in the discretion of the department division, and hearings may be held at such places as the department division designates, within or without the state. The department division may also arrange to have hearings held by the commission, officer, or tribunal having authority to hear cases arising under the worker's compensation law of any other state, of the District of Columbia, or of any territory of the United States, with the testimony and proceedings at any such hearing to be reported to the department division and to be made part of the record in the case. Any evidence so taken shall be subject to rebuttal upon final hearing before the department division.

SB21-SSA1,2798 Section 2798. 102.17 (1) (b) of the statutes is amended to read:

SB21-SSA1,857,3 102.17 (1) (b) In any dispute or controversy pending before the department division, the department division may direct the parties to appear before an examiner for a conference to consider the clarification of issues, the joining of additional parties, the necessity or desirability of amendments to the pleadings, the obtaining of admissions of fact or of documents, records, reports , and bills which that may avoid unnecessary proof, and such other matters as may aid in disposition of the dispute or controversy. After this that conference the department division may issue an order requiring disclosure or exchange of any information or written material which it that the division considers material to the timely and orderly disposition of the dispute or controversy. If a party fails to disclose or exchange that information within the time stated in the order, the department division may issue an order dismissing the claim without prejudice or excluding evidence or testimony relating to the information or written material. The department division shall provide each party with a copy of any order issued under this paragraph.

SB21-SSA1,2799d Section 2799d. 102.17 (1) (c) of the statutes is renumbered 102.17 (1) (c) 1. and amended to read:

SB21-SSA1,857,19 102.17 (1) (c) 1. Any party shall have the right to be present at any hearing, in person or by attorney or any other agent, and to present such testimony as may be pertinent to the controversy before the department division. No person, firm, or corporation, other than an attorney at law who is licensed to practice law in the state, may appear on behalf of any party in interest before the department division or any member or employee of the department division assigned to conduct any hearing, investigation, or inquiry relative to a claim for compensation or benefits under this chapter, unless the person is 18 years of age or older, does not have an arrest or conviction record, subject to ss. 111.321, 111.322 and 111.335, is otherwise qualified, and has obtained from the department a license with authorization to appear in matters or proceedings before the department division. Except as provided under pars. (cm), (cr), and (ct), the license shall be issued by the department under rules promulgated by the department. The department shall maintain in its office a current list of persons to whom licenses have been issued.

SB21-SSA1,858,10 2. Any license issued under subd. 1. may be suspended or revoked by the department for fraud or serious misconduct on the part of an agent, any license may be denied, suspended, nonrenewed, or otherwise withheld by the department for failure to pay court-ordered payments as provided in par. (cm) on the part of an agent, and any license may be denied or revoked if the department of revenue certifies under s. 73.0301 that the applicant or licensee is liable for delinquent taxes or if the department determines under par. (ct) that the applicant or licensee is liable for delinquent unemployment insurance contributions. Before suspending or revoking the license of the agent on the grounds of fraud or misconduct, the department shall give notice in writing to the agent of the charges of fraud or misconduct and shall give the agent full opportunity to be heard in relation to those charges. In denying, suspending, restricting, refusing to renew, or otherwise withholding a license for failure to pay court-ordered payments as provided in par. (cm), the department shall follow the procedure provided in a memorandum of understanding entered into under s. 49.857. The license and certificate of authority shall, unless

SB21-SSA1,858,14 3. Unless otherwise suspended or revoked, a license issued under subd. 1. shall be in force from the date of issuance until the June 30 following the date of issuance and may be renewed by the department from time to time, but each renewed license shall expire on the June 30 following the issuance of the renewed license.

SB21-SSA1,2807 Section 2807. 102.17 (1) (d) 1. of the statutes is amended to read:

SB21-SSA1,859,10 102.17 (1) (d) 1. The contents of certified medical and surgical reports by physicians, podiatrists, surgeons, dentists, psychologists, physician assistants, advanced practice nurse prescribers, and chiropractors licensed in and practicing in this state, and of certified reports by experts concerning loss of earning capacity under s. 102.44 (2) and (3), presented by a party for compensation constitute prima facie evidence as to the matter contained in those reports, subject to any rules and limitations the department division prescribes. Certified reports of physicians, podiatrists, surgeons, dentists, psychologists, physician assistants, advanced practice nurse prescribers, and chiropractors, wherever licensed and practicing, who have examined or treated the claimant, and of experts, if the practitioner or expert consents to being subjected to cross-examination, also constitute prima facie evidence as to the matter contained in those reports. Certified reports of physicians, podiatrists, surgeons, psychologists, and chiropractors are admissible as evidence of the diagnosis, necessity of the treatment, and cause and extent of the disability. Certified reports by doctors of dentistry, physician assistants, and advanced practice nurse prescribers are admissible as evidence of the diagnosis and necessity of treatment but not of the cause and extent of disability. Any physician, podiatrist, surgeon, dentist, psychologist, chiropractor, physician assistant, advanced practice nurse prescriber, or expert who knowingly makes a false statement of fact or opinion in such a certified report may be fined or imprisoned, or both, under s. 943.395.

SB21-SSA1,2808 Section 2808. 102.17 (1) (d) 2. of the statutes is amended to read:

SB21-SSA1,859,19 102.17 (1) (d) 2. The record of a hospital or sanatorium in this state that is satisfactory to the department division, established by certificate, affidavit, or testimony of the supervising officer of the hospital or sanitorium, any other person having charge of the record, or a physician, podiatrist, surgeon, dentist, psychologist, physician assistant, advanced practice nurse prescriber, or chiropractor to be the record of the patient in question, and made in the regular course of examination or treatment of the patient, constitutes prima facie evidence as to the matter contained in the record, to the extent that the record is otherwise competent and relevant.

SB21-SSA1,2809 Section 2809. 102.17 (1) (d) 3. of the statutes is amended to read:

SB21-SSA1,860,3 102.17 (1) (d) 3. The department division may, by rule, establish the qualifications of and the form used for certified reports submitted by experts who provide information concerning loss of earning capacity under s. 102.44 (2) and (3). The department division may not admit into evidence a certified report of a practitioner or other expert or a record of a hospital or sanatorium that was not filed with the department division and all parties in interest at least 15 days before the date of the hearing, unless the department division is satisfied that there is good cause for the failure to file the report.

SB21-SSA1,2810 Section 2810. 102.17 (1) (d) 4. of the statutes is amended to read:

SB21-SSA1,860,7 102.17 (1) (d) 4. A report or record described in subd. 1., 2., or 3. that is admitted or received into evidence by the department division constitutes substantial evidence under s. 102.23 (6) as to the matter contained in the report or record.

SB21-SSA1,2811 Section 2811. 102.17 (1) (e) of the statutes is amended to read:

SB21-SSA1,860,17 102.17 (1) (e) The department division may, with or without notice to any party, cause testimony to be taken, an inspection of the premises where the injury occurred to be made, or the time books and payrolls of the employer to be examined by any examiner, and may direct any employee claiming compensation to be examined by a physician, chiropractor, psychologist, dentist, or podiatrist. The testimony so taken, and the results of any such inspection or examination, shall be reported to the department division for its consideration upon final hearing. All ex parte testimony taken by the department division shall be reduced to writing, and any party shall have opportunity to rebut that testimony on final hearing.

SB21-SSA1,2812 Section 2812. 102.17 (1) (f) of the statutes is amended to read:

SB21-SSA1,860,20 102.17 (1) (f) Sections 804.05 and 804.07 shall not apply to proceedings under this chapter, except as to a witness who is any of the following:

SB21-SSA1,860,21 1. Who is beyond Beyond reach of the subpoena of the department; or division.

SB21-SSA1,860,23 2. Who is about About to go out of the state, not intending to return in time for the hearing; or hearing.

SB21-SSA1,860,25 3. Who is so So sick, infirm , or aged as to make it probable that the witness will not be able to attend the hearing; or hearing.

SB21-SSA1,861,3 4. Who is a A member of the legislature, if any committee of the same or legislature or of the house of which the witness is a member, is in session, provided and the witness waives his or her privilege.

SB21-SSA1,2813 Section 2813. 102.17 (1) (g) of the statutes is amended to read:

SB21-SSA1,861,17 102.17 (1) (g) Whenever the testimony presented at any hearing indicates a dispute or creates a doubt as to the extent or cause of disability or death, the department division may direct that the injured employee be examined, that an autopsy be performed, or that an opinion be obtained without examination or autopsy, by or from an impartial, competent physician, chiropractor, dentist, psychologist or podiatrist designated by the department division who is not under contract with or regularly employed by a compensation insurance carrier or self-insured employer. The expense of the examination, autopsy, or opinion shall be paid by the employer or, if the employee claims compensation under s. 102.81, from the uninsured employers fund. The report of the examination, autopsy, or opinion shall be transmitted in writing to the department division and a copy of the report shall be furnished by the department division to each party, who shall have an opportunity to rebut such the report on further hearing.

SB21-SSA1,2814d Section 2814d. 102.17 (1) (h) of the statutes is amended to read:

SB21-SSA1,862,2 102.17 (1) (h) The contents of certified reports of investigation, made by industrial safety specialists who are employed, contracted, or otherwise secured by the department or the division and who are available for cross-examination, if served upon the parties 15 days prior to hearing, shall constitute prima facie evidence as to matter contained in those reports. A report described in this paragraph that is admitted or received into evidence by the department division constitutes substantial evidence under s. 102.23 (6) as to the matter contained in the report.

SB21-SSA1,2815 Section 2815. 102.17 (2) of the statutes is amended to read:

SB21-SSA1,862,13 102.17 (2) If the department shall have division has reason to believe that the payment of compensation has not been made, it the division may on its own motion give notice to the parties, in the manner provided for the service of an application, of a time and place when a hearing will be held for the purpose of determining the facts. Such The notice shall contain a statement of the matter to be considered. Thereafter all other All provisions of this chapter governing proceedings on an application shall attach apply, insofar as the same may be applicable, to a proceeding under this subsection. When the department division schedules a hearing on its own motion, the department division does not become a party in interest and is not required to appear at the hearing.

SB21-SSA1,2816d Section 2816d. 102.17 (2m) of the statutes is amended to read:

SB21-SSA1,862,20 102.17 (2m) Any The division or any party, including the department, may require any person to produce books, papers, and records at the hearing by personal service of a subpoena upon the person along with a tender of witness fees as provided in ss. 814.67 and 885.06. Except as provided in sub. (2s), the subpoena shall be on a form provided by the department division and shall give the name and address of the party requesting the subpoena.

SB21-SSA1,2817 Section 2817. 102.17 (2s) of the statutes is amended to read:

SB21-SSA1,863,3 102.17 (2s) A party's attorney of record may issue a subpoena to compel the attendance of a witness or the production of evidence. A subpoena issued by an attorney must be in substantially the same form as provided in s. 805.07 (4) and must be served in the manner provided in s. 805.07 (5). The attorney shall, at the time of issuance, send a copy of the subpoena to the appeal tribunal hearing examiner or other representative of the department division responsible for conducting the proceeding.

SB21-SSA1,2818 Section 2818. 102.17 (7) (b) of the statutes is amended to read:

SB21-SSA1,863,16 102.17 (7) (b) Except as provided in par. (c), the department division shall exclude from evidence testimony or certified reports from expert witnesses under par. (a) offered by the party that raises the issue of loss of earning capacity if that party failed to notify the department division and the other parties of interest, at least 60 days before the date of the hearing, of the party's intent to provide the testimony or reports and of the names of the expert witnesses involved. Except as provided in par. (c), the department division shall exclude from evidence testimony or certified reports from expert witnesses under par. (a) offered by a party of interest in response to the party that raises the issue of loss of earning capacity if the responding party failed to notify the department division and the other parties of interest, at least 45 days before the date of the hearing, of the party's intent to provide the testimony or reports and of the names of the expert witnesses involved.

SB21-SSA1,2819 Section 2819. 102.17 (7) (c) of the statutes is amended to read:

SB21-SSA1,863,22 102.17 (7) (c) Notwithstanding the notice deadlines provided in par. (b), the department division may receive in evidence testimony or certified reports from expert witnesses under par. (a) when the applicable notice deadline under par. (b) is not met if good cause is shown for the delay in providing the notice required under par. (b) and if no party is prejudiced by the delay.

SB21-SSA1,2820 Section 2820. 102.17 (8) of the statutes is amended to read:

SB21-SSA1,864,12 102.17 (8) Unless otherwise agreed to by all parties, an injured employee shall file with the department division and serve on all parties at least 15 days before the date of the hearing an itemized statement of all medical expenses and incidental compensation under s. 102.42 claimed by the injured employee. The itemized statement shall include, if applicable, information relating to any travel expenses incurred by the injured employee in obtaining treatment including the injured employee's destination, number of trips, round trip mileage, and meal and lodging expenses. The department division may not admit into evidence any information relating to medical expenses and incidental compensation under s. 102.42 claimed by an injured employee if the injured employee failed to file with the department division and serve on all parties at least 15 days before the date of the hearing an itemized statement of the medical expenses and incidental compensation under s. 102.42 claimed by the injured employee, unless the department division is satisfied that there is good cause for the failure to file and serve the itemized statement.

SB21-SSA1,2821 Section 2821. 102.175 (2) of the statutes is amended to read:

SB21-SSA1,864,21 102.175 (2) If after a hearing or a prehearing conference the department division determines that an injured employee is entitled to compensation but that there remains in dispute only the issue of which of 2 or more parties is liable for that compensation, the department division may order one or more parties to pay compensation in an amount, time, and manner as determined by the department division. If the department division later determines that another party is liable for compensation, the department division shall order that other party to reimburse any party that was ordered to pay compensation under this subsection.

SB21-SSA1,2822 Section 2822. 102.18 (1) (b) of the statutes is amended to read:

SB21-SSA1,865,16 102.18 (1) (b) Within 90 days after the final hearing and close of the record, the department division shall make and file its findings upon the ultimate facts involved in the controversy, and its order, which shall state its the division's determination as to the rights of the parties. Pending the final determination of any controversy before it, the department may in its discretion division, after any hearing, may, in its discretion, make interlocutory findings, orders, and awards, which may be enforced in the same manner as final awards. The department division may include in any interlocutory or final award or order an order directing the employer or insurer to pay for any future treatment that may be necessary to cure and relieve the employee from the effects of the injury. If the department division finds that the employer or insurer has not paid any amount that the employer or insurer was directed to pay in any interlocutory order or award and that the nonpayment was not in good faith, the department division may include in its final award a penalty not exceeding 25% 25 percent of each amount that was not paid as directed. When there is a finding that the employee is in fact suffering from an occupational disease caused by the employment of the employer against whom the application is filed, a final award dismissing the application upon the ground that the applicant has suffered no disability from the disease shall not bar any claim the employee may thereafter have for disability sustained after the date of the award.

SB21-SSA1,2823d Section 2823d. 102.18 (1) (bg) 1. of the statutes is amended to read:

SB21-SSA1,866,8 102.18 (1) (bg) 1. If the department division finds under par. (b) that an insurer or self-insured employer is liable under this chapter for any health services provided to an injured employee by a health service provider, but that the reasonableness of the fee charged by the health service provider is in dispute, the department division may include in its order under par. (b) a determination made by the department under s. 102.16 (2) as to the reasonableness of the fee or the department, if such a determination has not yet been made, the division may notify, or direct the insurer or self-insured employer to notify, the health service provider under s. 102.16 (2) (b) that the reasonableness of the fee is in dispute. The department shall deny payment of a health service fee that the department determines under this subdivision to be unreasonable. An insurer or self-insured employer and a health service provider that are parties to a fee dispute under this subdivision are bound by the department's determination under this subdivision on the reasonableness of the disputed fee, unless that determination is set aside, reversed, or modified by the department under sub. (3) or by the commission under sub. (3) or (4) or is set aside on judicial review under s. 102.23.

SB21-SSA1,2824d Section 2824d. 102.18 (1) (bg) 2. of the statutes is amended to read:

SB21-SSA1,867,7 102.18 (1) (bg) 2. If the department division finds under par. (b) that an employer or insurance carrier is liable under this chapter for any treatment provided to an injured employee by a health service provider, but that the necessity of the treatment is in dispute, the department division may include in its order under par. (b) a determination made by the department under s. 102.16 (2m) as to the necessity of the treatment or the department, if such a determination has not yet been made, the division may notify, or direct the employer or insurance carrier to notify, the health service provider under s. 102.16 (2m) (b) that the necessity of the treatment is in dispute. Before determining under this subdivision the necessity of treatment provided to an injured employee, the department may, but is not required to, obtain the opinion of an expert selected by the department who is qualified as provided in s. 102.16 (2m) (c). The standards promulgated under s. 102.16 (2m) (g) shall be applied by an expert in rendering an opinion as to, and in determining, necessity of treatment under this subdivision. In cases in which no standards promulgated under s. 102.16 (2m) (g) apply, the department shall find the facts regarding necessity of treatment. The department shall deny payment for any treatment that the department determines under this subdivision to be unnecessary. An insurer or self-insured employer and a health service provider that are parties to a dispute under this subdivision over the necessity of treatment are bound by the department's determination under this subdivision on the necessity of the disputed treatment, unless that determination is set aside, reversed, or modified by the department division under sub. (3) or by the commission under sub. (3) or (4) or is set aside on judicial review under s. 102.23.

SB21-SSA1,2825d Section 2825d. 102.18 (1) (bg) 3. of the statutes is amended to read:

SB21-SSA1,868,2 102.18 (1) (bg) 3. If the department division finds under par. (b) that an insurer or self-insured employer is liable under this chapter for the cost of a prescription drug dispensed under s. 102.425 (2) for outpatient use by an injured employee, but that the reasonableness of the amount charged for that prescription drug is in dispute, the department division may include in its order under par. (b) a determination made by the department under s. 102.425 (4m) as to the reasonableness of the prescription drug charge or the department, if such a determination has not yet been made, the division may notify, or direct the insurer or self-insured employer to notify, the pharmacist or practitioner dispensing the prescription drug under s. 102.425 (4m) (b) that the reasonableness of the prescription drug charge is in dispute. The department shall deny payment of a prescription drug charge that the department determines under this subdivision to be unreasonable. An insurer or self-insured employer and a pharmacist or practitioner that are parties to a dispute under this subdivision over the reasonableness of a prescription drug charge are bound by the department's determination under par. (b) on the reasonableness of the disputed prescription drug charge, unless that determination is set aside, reversed, or modified by the department under sub. (3) or by the commission under sub. (3) or (4) or is set aside on judicial review under s. 102.23.

SB21-SSA1,2826 Section 2826. 102.18 (1) (bp) of the statutes is amended to read:

SB21-SSA1,868,19 102.18 (1) (bp) If the department division determines that the employer or insurance carrier suspended, terminated, or failed to make payments or failed to report an injury as a result of malice or bad faith, the department division may include a penalty in an award to an employee for each event or occurrence of malice or bad faith. This That penalty is the exclusive remedy against an employer or insurance carrier for malice or bad faith. If this the penalty is imposed for an event or occurrence of malice or bad faith that causes a payment that is due an injured employee to be delayed in violation of s. 102.22 (1) or overdue in violation of s. 628.46 (1), the department division may not also order an increased payment under s. 102.22 (1) or the payment of interest under s. 628.46 (1). The department division may award an amount that it the division considers just, not to exceed the lesser of 200 percent of total compensation due or $30,000 for each event or occurrence of malice or bad faith. The department division may assess the penalty against the employer, the insurance carrier, or both. Neither the employer nor the insurance carrier is liable to reimburse the other for the penalty amount. The department division may, by rule, define actions which that demonstrate malice or bad faith.

SB21-SSA1,2827d Section 2827d. 102.18 (1) (bw) of the statutes is amended to read:

SB21-SSA1,869,2 102.18 (1) (bw) If an insurer, a self-insured employer, or, if applicable, the uninsured employers fund pays compensation to an employee in excess of its liability and another insurer or self-insured employer is liable for all or part of the excess payment, the department or the division may order the insurer or self-insured employer that is liable for that excess payment to reimburse the insurer or self-insured employer that made the excess payment or, if applicable, the uninsured employers fund.

SB21-SSA1,2828 Section 2828. 102.18 (1) (c) of the statutes is amended to read:

SB21-SSA1,869,10 102.18 (1) (c) If 2 or more examiners have conducted a formal hearing on a claim and are unable to agree on the order or award to be issued, the decision shall be the decision of the majority. If the examiners are equally divided on the decision, the department division may appoint an additional examiner who shall review the record and consult with the other examiners concerning their personal impressions of the credibility of the evidence. Findings of fact and an order or award may then be issued by a majority of the examiners.

SB21-SSA1,2829d Section 2829d. 102.18 (1) (e) of the statutes is amended to read:

SB21-SSA1,869,18 102.18 (1) (e) Except as provided in s. 102.21, if the department or the division orders a party to pay an award of compensation, the party shall pay the award no later than 21 days after the date on which the order is mailed to the last-known address of the party, unless the party files a petition for review under sub. (3). This paragraph applies to all awards of compensation ordered by the department or the division, whether the award results from a hearing, the default of a party, or a compromise or stipulation confirmed by the department or the division.

SB21-SSA1,2830d Section 2830d. 102.18 (2) of the statutes is renumbered 102.18 (2) (a) and amended to read:

SB21-SSA1,869,24 102.18 (2) (a) The department shall have and maintain on its staff such examiners as are necessary to hear and decide disputed claims for compensation described in s. 102.16 (1) (b) and to assist in the effective administration of this chapter. These examiners

SB21-SSA1,870,4 (c) Examiners under pars. (a) and (b) shall be attorneys and may be designated as administrative law judges. These Those examiners may make findings and orders, and may approve, review, set aside, modify, or confirm stipulations of settlement or compromises of claims for compensation.

SB21-SSA1,2830e Section 2830e. 102.18 (2) (b) of the statutes is created to read:

SB21-SSA1,870,10 102.18 (2) (b) The division shall have and maintain on its staff such examiners as are necessary to decide claims for compensation described in s. 102.16 (1) (c) and to assist in the effective adjudication of claims under this chapter. The administrator shall require at least 18 examiners employed by the division to devote not less than 80 percent of their work time to the duties specified in this paragraph.

SB21-SSA1,2831d Section 2831d. 102.18 (3) of the statutes is amended to read:

SB21-SSA1,871,5 102.18 (3) A party in interest may petition the commission for review of an examiner's decision awarding or denying compensation if the department , the division, or the commission receives the petition within 21 days after the department or the division mailed a copy of the examiner's findings and order to the party's last-known address addresses of the parties in interest. The commission shall dismiss a petition which that is not timely filed unless the petitioner shows probable good cause that the reason for failure to timely file was beyond the petitioner's control. If no petition is filed within 21 days from after the date that on which a copy of the findings or order of the examiner is mailed to the last-known address addresses of the parties in interest, the findings or order shall be considered final unless set aside, reversed, or modified by the examiner within that time. If the findings or order are set aside by the examiner, the status shall be the same as prior to the setting aside of the findings or order set aside. If the findings or order are reversed or modified by the examiner, the time for filing a petition commences with on the date that on which notice of reversal or modification is mailed to the last-known address addresses of the parties in interest. The commission shall either affirm, reverse, set aside, or modify the findings or order, in whole or in part, or direct the taking of additional evidence. This The commission's action shall be based on a review of the evidence submitted.

SB21-SSA1,2833d Section 2833d. 102.18 (4) (c) 3. of the statutes is amended to read:

SB21-SSA1,871,8 102.18 (4) (c) 3. Remand the case to the department or the division for further proceedings.

SB21-SSA1,2834d Section 2834d. 102.18 (4) (d) of the statutes is amended to read:

SB21-SSA1,871,16 102.18 (4) (d) While a petition for review by the commission is pending or after entry of an order or award by the commission but before commencement of an action for judicial review or expiration of the period in which to commence an action for judicial review, the commission shall remand any compromise presented to it to the department or the division for consideration and approval or rejection pursuant to under s. 102.16 (1). Presentation of a compromise does not affect the period in which to commence an action for judicial review.

SB21-SSA1,2835 Section 2835. 102.18 (5) of the statutes is amended to read: