AB686, s. 8 18Section 8. 102.16 (2) (c) of the statutes is amended to read:
AB686,6,519 102.16 (2) (c) After a fee dispute is submitted to the department, the insurer
20or self-insured employer self-insurer that is a party to the dispute shall provide to
21the department information on that fee and information on fees charged by other
22health service providers for comparable services. The insurer or self-insured
23employer
self-insurer shall obtain the information on comparable fees from a
24database that is certified by the department under par. (h). Except as provided in
25par. (e) 1., if the insurer or self-insured employer self-insurer does not provide the

1information required under this paragraph, the department shall determine that the
2disputed fee is reasonable and order that it be paid. If the insurer or self-insured
3employer
self-insurer provides the information required under this paragraph, the
4department shall use that information to determine the reasonableness of the
5disputed fee.
AB686, s. 9 6Section 9. 102.16 (2) (e) 1. of the statutes is amended to read:
AB686,6,147 102.16 (2) (e) 1. Subject to subd. 2., if an insurer or self-insured employer
8self-insurer that disputes the reasonableness of a fee charged by a health service
9provider cannot provide information on fees charged by other health service
10providers for comparable services because the database to which the insurer or
11self-insured employer self-insurer subscribes is not able to provide accurate
12information for the health service procedure at issue, the department may use any
13other information that the department considers to be reliable and relevant to the
14disputed fee to determine the reasonableness of the disputed fee.
AB686, s. 10 15Section 10. 102.16 (2) (f) of the statutes is amended to read:
AB686,6,2316 102.16 (2) (f) Within 30 days after a determination under this subsection, the
17department may set aside, reverse, or modify the determination for any reason that
18the department considers sufficient. Within 60 days after a determination under
19this subsection, the department may set aside, reverse, or modify the determination
20on grounds of mistake. A health service provider, insurer, or self-insured employer
21self-insurer that is aggrieved by a determination of the department under this
22subsection may seek judicial review of that determination in the same manner that
23compensation claims are reviewed under s. 102.23.
AB686, s. 11 24Section 11. 102.16 (2m) (a) of the statutes is amended to read:
AB686,7,14
1102.16 (2m) (a) Except as provided in this paragraph, the department has
2jurisdiction under this subsection, sub. (1m) (b), and s. 102.17 to resolve a dispute
3between a health service provider and an insurer or self-insured employer
4self-insurer over the necessity of treatment provided for an injured employee who
5claims benefits under this chapter. A health service provider may not submit a
6dispute over necessity of treatment to the department under this subsection before
7all treatment by the health service provider of the employee's injury has ended if the
8amount in controversy, whether based on a single charge or a combination of charges
9for one or more days of service, is less than $25. After all treatment by a health
10service provider of an employee's injury has ended, the health service provider may
11submit any dispute over necessity of treatment to the department, regardless of the
12amount in controversy. The department shall deny payment for any treatment that
13the department determines under this subsection, sub. (1m) (b), or s. 102.18 (1) (b)
14to be unnecessary.
AB686, s. 12 15Section 12. 102.16 (2m) (am) of the statutes is amended to read:
AB686,8,516 102.16 (2m) (am) A health service provider and an insurer or self-insured
17employer
self-insurer that are parties to a dispute under this subsection over the
18necessity of treatment are bound by the department's determination under this
19subsection on the necessity of that treatment, unless that determination is set aside
20on judicial review as provided in par. (e). A health service provider and an insurer
21or self-insured employer self-insurer that are parties to a dispute under sub. (1m)
22(b) over the necessity of treatment are bound by the department's determination
23under sub. (1m) (b) on the necessity of that treatment, unless that determination is
24set aside or modified by the department under sub. (1). An insurer or self-insured
25employer
self-insurer that is a party to a dispute under s. 102.17 over the necessity

1of treatment and a health service provider are bound by the department's
2determination under s. 102.18 (1) (b) on the necessity of that treatment, unless that
3determination is set aside, reversed or modified by the department under s. 102.18
4(3) or by the commission under s. 102.18 (3) or (4) or is set aside on judicial review
5under s. 102.23.
AB686, s. 13 6Section 13. 102.16 (2m) (b) of the statutes is amended to read:
AB686,8,157 102.16 (2m) (b) An insurer or self-insured employer self-insurer that disputes
8the necessity of treatment provided by a health service provider or the department
9under sub. (1m) (b) or s. 102.18 (1) (bg) 2. shall provide reasonable notice to the health
10service provider that the necessity of that treatment is being disputed. After
11receiving reasonable notice under this paragraph or under sub. (1m) (b) or s. 102.18
12(1) (bg) 2. that the necessity of treatment is being disputed, a health service provider
13may not collect a fee for that disputed treatment from, or bring an action for collection
14of the fee for that disputed treatment against, the employee who received the
15treatment.
AB686, s. 14 16Section 14. 102.16 (2m) (c) of the statutes is amended to read:
AB686,9,617 102.16 (2m) (c) Before determining under this subsection the necessity of
18treatment provided for an injured employee who claims benefits under this chapter,
19the department shall obtain a written opinion on the necessity of the treatment in
20dispute from an expert selected by the department. Before determining under sub.
21(1m) (b) or s. 102.18 (1) (bg) 2. the necessity of treatment provided for an injured
22employee who claims benefits under this chapter, the department may, but is not
23required to, obtain such an expert opinion. To qualify as an expert, a person must
24be licensed to practice the same health care profession as the individual health
25service provider whose treatment is under review and must either be performing

1services for an impartial health care services review organization or be a member of
2an independent panel of experts established by the department under par. (f). The
3department shall adopt the written opinion of the expert as the department's
4determination on the issues covered in the written opinion, unless the health service
5provider or the insurer or self-insured employer present self-insurer presents clear
6and convincing written evidence that the expert's opinion is in error.
AB686, s. 15 7Section 15. 102.16 (2m) (d) of the statutes is amended to read:
AB686,9,178 102.16 (2m) (d) The department may charge a party to a dispute over the
9necessity of treatment provided for an injured employee who claims benefits under
10this chapter for the full cost of obtaining the written opinion of the expert under par.
11(c). The department shall charge the insurer or self-insured employer self-insurer
12for the full cost of obtaining the written opinion of the expert for the first dispute that
13a particular individual health service provider is involved in, unless the department
14determines that the individual health service provider's position in the dispute is
15frivolous or based on fraudulent representations. In a subsequent dispute involving
16the same individual health service provider, the department shall charge the losing
17party to the dispute for the full cost of obtaining the written opinion of the expert.
AB686, s. 16 18Section 16. 102.16 (2m) (e) of the statutes is amended to read:
AB686,9,2419 102.16 (2m) (e) Within 30 days after a determination under this subsection, the
20department may set aside, reverse, or modify the determination for any reason that
21the department considers sufficient. Within 60 days after a determination under
22this subsection, the department may set aside, reverse, or modify the determination
23on grounds of mistake. A health service provider, insurer, or self-insured employer
24self-insurer that is aggrieved by a determination of the department under this

1subsection may seek judicial review of that determination in the same manner that
2compensation claims are reviewed under s. 102.23.
AB686, s. 17 3Section 17. 102.17 (1) (g) of the statutes is amended to read:
AB686,10,164 102.17 (1) (g) Whenever the testimony presented at any hearing indicates a
5dispute or creates a doubt as to the extent or cause of disability or death, the
6department may direct that the injured employee be examined, that an autopsy be
7performed, or that an opinion be obtained without examination or autopsy, by or from
8an impartial, competent physician, chiropractor, dentist, psychologist or podiatrist
9designated by the department who is not under contract with or regularly employed
10by a compensation insurance carrier or self-insured employer self-insurer. The
11expense of the examination, autopsy, or opinion shall be paid by the employer or, if
12the employee claims compensation under s. 102.81, from the uninsured employers
13fund. The report of the examination, autopsy, or opinion shall be transmitted in
14writing to the department and a copy of the report shall be furnished by the
15department to each party, who shall have an opportunity to rebut such report on
16further hearing.
AB686, s. 18 17Section 18. 102.18 (1) (bg) 1. of the statutes is amended to read:
AB686,10,2518 102.18 (1) (bg) 1. If the department finds under par. (b) that an insurer or
19self-insured employer self-insurer is liable under this chapter for any health
20services provided to an injured employee by a health service provider, but that the
21reasonableness of the fee charged by the health service provider is in dispute, the
22department may include in its order under par. (b) a determination as to the
23reasonableness of the fee or the department may notify, or direct the insurer or
24self-insured employer self-insurer to notify, the health service provider under s.
25102.16 (2) (b) that the reasonableness of the fee is in dispute.
AB686, s. 19
1Section 19. 102.18 (1) (bw) of the statutes is amended to read:
AB686,11,82 102.18 (1) (bw) If an insurer, a self-insured employer self-insurer or, if
3applicable, the uninsured employers fund pays compensation to an employee in
4excess of its liability and another insurer is liable for all or part of the excess
5payment, the department may order the insurer or self-insured employer
6self-insurer that is liable to reimburse the insurer or self-insured employer
7self-insurer that made the excess payment or, if applicable, the uninsured employers
8fund.
AB686, s. 20 9Section 20. 102.26 (3) (b) 3. of the statutes is amended to read:
AB686,11,1810 102.26 (3) (b) 3. The claimant may request the insurer or self-insured employer
11self-insurer to pay any compensation that is due the claimant by depositing the
12payment directly into an account maintained by the claimant at a financial
13institution. If the insurer or self-insured employer self-insurer agrees to the
14request, the insurer or self-insured employer self-insurer may deposit the payment
15by direct deposit, electronic funds transfer, or any other money transfer technique
16approved by the department. The claimant may revoke a request under this
17subdivision at any time by providing appropriate written notice to the insurer or
18self-insured employer self-insurer.
AB686, s. 21 19Section 21. 102.28 (2) (b) of the statutes is amended to read:
AB686,12,1120 102.28 (2) (b) Exemption from duty to insure. The department may grant a
21written order of exemption to an employer who, or group of employers engaged in the
22logging industry, that
shows its financial ability to pay the amount of compensation,
23agrees to report faithfully all compensable injuries, and agrees to comply with this
24chapter and the rules of the department. The department may condition the
25granting of an exemption upon the employer's applicant's furnishing of satisfactory

1security to guarantee payment of all claims under compensation. The department
2may require that bonds or other personal guarantees be enforceable against sureties
3in the same manner as an award may be enforced. The department may from time
4to time require proof of financial ability of the employer or group of employers to pay
5compensation. Any exemption shall be void if the application for it contains a
6financial statement which that is false in any material respect. An employer who or
7an employer that is a member of a group of employers that
files an application
8containing a false financial statement remains subject to par. (a). The department
9may promulgate rules establishing an amount to be charged to an initial applicant
10for exemption under this paragraph and an annual amount to be charged to
11employers and groups of employers that have been exempted under this paragraph.
AB686, s. 22 12Section 22. 102.28 (2) (bm) of the statutes is created to read:
AB686,12,1913 102.28 (2) (bm) Exemption from duty to insure; logging industry groups. Two
14or more employers engaged in the logging industry may enter into an agreement to
15pool their liabilities under this chapter for purposes of obtaining an exemption under
16par. (b). If the department grants an exemption under par. (b) to a group of 2 or more
17employers engaged in the logging industry, each employer that is a member of the
18group shall be exempt under par. (b) and may operate as a self-insurer under this
19chapter.
AB686, s. 23 20Section 23. 102.28 (2) (c) of the statutes is amended to read:
AB686,13,1721 102.28 (2) (c) Revocation of exemption. The department, after seeking the
22advice of the self-insurers council, may revoke an exemption granted to an employer
23or group of employers under par. (b), upon giving the employer or group of employers
2410 days' written notice, if the department finds that the employer's financial
25condition of the employer or group of employers is inadequate to pay its employees'

1claims for compensation, that the employer or group of employers has received an
2excessive number of claims for compensation, or that the employer or group of
3employers
has failed to discharge faithfully its obligations according to the
4agreement contained in the application for exemption. The employer or group of
5employers
may, within 10 days after receipt of the notice of revocation, request in
6writing a review of the revocation by the secretary or the secretary's designee and the
7secretary or the secretary's designee shall review the revocation within 30 days after
8receipt of the request for review. If the employer or group of employers is aggrieved
9by the determination of the secretary or the secretary's designee, the employer or
10group of employers
may, within 10 days after receipt of notice of that determination,
11request a hearing under s. 102.17. If the secretary or the secretary's designee
12determines that the employer's exemption of the employer or group of employers
13should be revoked, the employer, or each employer that is a member of the group of
14employers,
shall obtain insurance coverage as required under par. (a) immediately
15upon receipt of notice of that determination and, notwithstanding the pendency of
16proceedings under ss. 102.17 to 102.25, shall keep that coverage in force until
17another exemption under par. (b) is granted.
AB686, s. 24 18Section 24. 102.28 (2) (d) of the statutes is amended to read:
AB686,13,2419 102.28 (2) (d) Effect of insuring with unauthorized insurer. An employer who
20or group of employers that procures an exemption under par. (b) and thereafter
21enters into any agreement for excess insurance coverage with an insurer not
22authorized to do business in this state shall report that agreement to the department
23immediately. The placing of such coverage shall not by itself be grounds for
24revocation of the exemption.
AB686, s. 25 25Section 25. 102.28 (7) (a) of the statutes is amended to read:
AB686,14,17
1102.28 (7) (a) If an employer who or group of employers that is currently or was
2formerly exempted by written order of the department under sub. (2) (b) is unable
3to pay an award, judgment is rendered in accordance with s. 102.20 against that
4employer or group of employers, and execution is levied and returned unsatisfied in
5whole or in part, payments for the employer's liability of the employer or group of
6employers
shall be made from the fund established under sub. (8). If a currently or
7formerly exempted employer or group of employers files for bankruptcy and not less
8than 60 days after that filing the department has reason to believe that
9compensation payments due are not being paid, the department in its discretion may
10make payment for the employer's liability of the employer or group of employers from
11the fund established under sub. (8). The secretary of administration shall proceed
12to recover such those payments from the employer, the group of employers, or the
13employer's receiver or trustee in bankruptcy of the employer or group of employers,
14and may commence an action or proceeding or file a claim therefor for those
15payments
. The attorney general shall appear on behalf of the secretary of
16administration in any such action or proceeding. All moneys recovered in any such
17action or proceeding shall be paid into the fund established under sub. (8).
AB686, s. 26 18Section 26. 102.28 (7) (b) of the statutes is amended to read:
AB686,15,1319 102.28 (7) (b) Each employer or group of employers exempted by written order
20of the department under sub. (2) (b) shall pay into the fund established by sub. (8)
21a sum equal to that assessed against each of the other such exempt employers and
22groups of employers
upon the issuance of an initial order. The order shall provide
23for a sum sufficient to secure estimated payments of the insolvent exempt employer
24or group of employers due for the period up to the date of the order and for one year
25following the date of the order and to pay the estimated cost of insurance carrier or

1insurance service organization services under par. (c). Payments ordered to be made
2to the fund shall be paid to the department within 30 days. If additional moneys are
3required, further assessments shall be made based on orders of the department with
4assessment prorated on the basis of the gross payroll for this state of the exempt
5employer, or of each employer that is a member of the group of employers, reported
6to the department for the previous calendar year for unemployment insurance
7purposes under ch. 108. If the exempt employer, or an employer that is a member
8of a group of employers,
is not covered under ch. 108, then the department shall
9determine the comparable gross payroll for the exempt employer or for each
10employer that is a member of the group of employers
. If payment of any assessment
11made under this subsection is not made within 30 days of after the order of the
12department, the attorney general may appear on behalf of the state to collect the
13assessment.
AB686, s. 27 14Section 27. 102.33 (2) (b) (intro.) of the statutes is amended to read:
AB686,16,215 102.33 (2) (b) (intro.) Notwithstanding par. (a), a record maintained by the
16department that reveals the identity of an employee who claims worker's
17compensation benefits, the nature of the employee's claimed injury, the employee's
18past or present medical condition, the extent of the employee's disability, the amount,
19type or duration of benefits paid to the employee or any financial information
20provided to the department by a self-insured employer self-insurer or by an
21applicant for exemption under s. 102.28 (2) (b) is confidential and not open to public
22inspection or copying under s. 19.35 (1). The department may deny a request made
23under s. 19.35 (1) or, subject to s. 102.17 (2m) and (2s), refuse to honor a subpoena
24issued by an attorney of record in a civil or criminal action or special proceeding to

1inspect and copy a record that is confidential under this paragraph, unless one of the
2following applies:
AB686, s. 28 3Section 28. 102.33 (2) (b) 3. of the statutes is amended to read:
AB686,16,114 102.33 (2) (b) 3. The record that is requested contains financial information
5provided by a self-insured employer self-insurer or by an applicant for exemption
6under s. 102.28 (2) (b) and the requester is the self-insured employer self-insurer
7or applicant for exemption or an attorney or authorized agent of the self-insured
8employer
self-insurer or applicant for exemption. An attorney or authorized agent
9of the self-insured employer self-insurer or of the applicant for exemption shall
10provide a written authorization for inspection and copying from the self-insured
11employer
self-insurer or applicant for exemption if requested by the department.
AB686, s. 29 12Section 29. 102.75 (1) of the statutes is amended to read:
AB686,17,313 102.75 (1) The department shall assess upon and collect from each licensed
14worker's compensation insurance carrier, and from each employer and group of
15employers
exempted under s. 102.28 (2) (b) by special order or by rule, the proportion
16of total costs and expenses incurred by the council on worker's compensation for
17travel and research and by the department and the commission in the
18administration of this chapter for the current fiscal year, plus any deficiencies in
19collections and anticipated costs from the previous fiscal year, that the total
20indemnity paid or payable under this chapter by each such carrier and, exempt
21employer, and exempt group of employers in worker's compensation cases initially
22closed during the preceding calendar year, other than for increased, double, or treble
23compensation, bore to the total indemnity paid in cases closed the previous calendar
24year under this chapter by all carriers and, exempt employer employers, and exempt
25groups of employers
other than for increased, double, or treble compensation. The

1council on worker's compensation and the commission shall annually certify any
2costs and expenses for worker's compensation activities to the department at such
3time as the secretary requires.
AB686, s. 30 4Section 30. 102.75 (2) of the statutes is amended to read:
AB686,17,105 102.75 (2) The department shall require that payments for costs and expenses
6for each fiscal year shall be made on such dates as the department prescribes by each
7licensed worker's compensation insurance carrier and by each employer and group
8of employers
exempted under s. 102.28 (2) (b). Each such payment shall be a sum
9equal to a proportionate share of the annual costs and expenses assessed upon each
10carrier and, employer, and group of employers as estimated by the department.
AB686, s. 31 11Section 31. 102.75 (4) of the statutes is amended to read:
AB686,17,1712 102.75 (4) From the appropriation under s. 20.445 (1) (ha), the department
13shall allocate the amounts that it collects in application fees from employers and
14groups of employers
applying for exemption under s. 102.28 (2) (b) and the annual
15amount that it collects from employers and groups of employers that have been
16exempted under s. 102.28 (2) (b) to fund the activities of the department under s.
17102.28 (2) (b) and (c).
AB686, s. 32 18Section 32. 626.12 (2) of the statutes is amended to read:
AB686,18,219 626.12 (2) Classification. Risks may be classified in any reasonable way for
20the establishment of rates and minimum premiums. Classification rates may be
21modified to produce rates for individual risks in accordance with rating plans which
22establish standards for measuring variations in hazards or expense provisions, or
23both. Such standards may measure any differences among risks that can be
24demonstrated to have a probable effect upon losses or expenses. In classifying risks
25and establishing rates for the logging industry, the bureau shall establish separate

1classifications and rates for mechanized logging operations and for manual logging
2operations.
AB686,18,33 (End)
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