SB409: Bill Text

SB409,19,3 102.61 (1m) (d) If an employee receives services from a private rehabilitation counselor under par. (a) and later receives similar services from the department under sub. (1) without the prior approval of the employer or insurance carrier, the employer or insurance carrier is not liable for temporary disability benefits under s. 102.43 (5) (b) or for tuition, fee, book, travel, and maintenance expenses costs under sub. (1) that exceed what the employer or insurance carrier would have been liable for under the rehabilitative training program developed by the private rehabilitation counselor.

SB409, s. 24 Section 24. 102.61 (1r) (c) of the statutes is amended to read:

SB409,19,9 102.61 (1r) (c) The employee may not have expenses of travel and the costs of tuition, fees, books, travel, and maintenance paid under sub. (1) or the costs of private rehabilitation counseling and rehabilitative training paid under sub. (1m) on account of training for a period in excess of 80 weeks in all, except as provided in s. 102.43 (5) (b).

SB409, s. 25 Section 25. 102.64 (2) of the statutes is amended to read:

SB409,19,22 102.64 (2) Upon request of the department of administration, the attorney general shall appear on behalf of the state in proceedings upon claims for compensation against the state. The Except as provided in s. 102.65 (3), the department of justice shall represent the interests of the state in proceedings under s. 102.44 (1), 102.49, 102.59, 102.60, or 102.66. The department of justice may compromise claims in those proceedings, but the compromises are subject to review by the department of workforce development. Costs incurred by the department of justice in prosecuting or defending any claim for payment into or out of the work injury supplemental benefit fund under s. 102.65, including expert witness and witness fees but not including attorney fees or attorney travel expenses for services performed under this subsection, shall be paid from the work injury supplemental benefit fund.

SB409, s. 26 Section 26. 102.65 (3) of the statutes is created to read:

SB409,20,6 102.65 (3) The department of workforce development may retain the department of administration to process, investigate, and pay claims under ss. 102.44 (1), 102.49, 102.59, and 102.66. If retained by the department of workforce development, the department of administration may compromise a claim processed by that department, but a compromise made by that department is subject to review by the department of workforce development. The department of workforce development shall pay for the services retained under this subsection from the appropriation account under s. 20.445 (1) (t).

SB409, s. 27 Section 27. 102.65 (4) of the statutes is created to read:

SB409,20,19 102.65 (4) The secretary shall monitor the cash balance in, and incurred losses to, the work injury supplemental benefit fund using generally accepted actuarial principles. If the secretary determines that the expected ultimate losses to the work injury supplemental benefit fund on known claims exceed 85 percent of the cash balance in that fund, the secretary shall consult with the council on worker's compensation. If the secretary, after consulting with the council on worker's compensation, determines that there is a reasonable likelihood that the cash balance in the work injury supplemental benefit fund may become inadequate to fund all claims under ss. 102.44 (1) (c), 102.49, 102.59, and 102.66, the secretary shall file with the secretary of administration a certificate attesting that the cash balance in that fund is likely to become inadequate to fund all claims under ss. 102.44 (1) (c), 102.49, 102.59, and 102.66 and specifying one of the following:

SB409,20,21 (a) That payment of those claims will be made as provided in a schedule that the department shall promulgate by rule.

SB409,20,22 (b) A date after which payment of those claims will be reduced.

SB409,20,23 (c) A date after which no new claims under those provisions will be paid.

SB409, s. 28 Section 28. 102.66 (1) of the statutes is amended to read:

SB409,21,14 102.66 (1) In the event that Subject to any certificate filed under s. 102.65 (4), if there is an otherwise meritorious claim for occupational disease, or for a traumatic injury described in s. 102.17 (4) in which the date of injury or death or last payment of compensation, other than for treatment or burial expenses, is before April 1, 2006, and if the claim is barred solely by the statute of limitations under s. 102.17 (4), the department may, in lieu of worker's compensation benefits, direct payment from the work injury supplemental benefit fund under s. 102.65 of such compensation and such medical expenses as would otherwise be due, based on the date of injury, to or on behalf of the injured employee. The benefits shall be supplemental, to the extent of compensation liability, to any disability or medical benefits payable from any group insurance policy whose premium is paid in whole or in part by any employer, or under any federal insurance or benefit program providing disability or medical benefits. Death benefits payable under any such group policy do not limit the benefits payable under this section.

SB409, s. 29 Section 29. 102.66 (2) of the statutes is amended to read:

SB409,21,22 102.66 (2) In the case of occupational disease, or of a traumatic injury described in s. 102.17 (4) in which the date of injury or death or last payment of compensation, other than for treatment for burial expenses, is before April 1, 2006, appropriate benefits may be awarded from the work injury supplemental benefit fund when the status or existence of the employer or its insurance carrier cannot be determined or when there is otherwise no adequate remedy, subject to the limitations contained in sub. (1).

SB409, s. 30 Section 30 . Nonstatutory provisions.

SB409,22,3 (1) Reimbursement of supplemental benefits paid before 2011. Notwithstanding section 102.44 (1) (c) of the statutes, as affected by this act, to receive reimbursement under that provision for supplemental benefits paid before 2011, an employer or insurance carrier must file a claim for that reimbursement with the department of workforce development by no later than December 31, 2012.

SB409,22,17 (2) Audit of health service fee dispute databases. The department of workforce development shall conduct an audit of the health service fee databases certified by that department under section 102.16 (2) (h) of the statutes. The secretary of workforce development shall create a committee under section 15.04 (1) (c) of the statutes to determine the scope of that audit. The committee shall consist of one representative of employers, one representative of employees, one representative of the department of workforce development, and one representative who is a liaison from the health care community to the council on worker's compensation. Upon determining the scope of the audit, the committee shall report its findings, conclusions, and recommendations to the department of workforce development and the council on worker's compensation, after which the committee shall terminate its activities and cease to exist. If the audit is not commenced by the first day of the 7th month beginning after the effective date of this subsection, all of the following apply:

SB409,22,22 (a) Permanent partial disability compensation amount. Notwithstanding section 102.11 (1) (intro.) of the statues, as affected by this act, the average weekly earnings for permanent partial disability for injuries occurring on or after January 1, 2013, shall be not more than $475, resulting in a maximum compensation rate of $317.

SB409,23,11 (b) Reasonableness of disputed health service fees. Notwithstanding section 102.16 (2) (d) of the statutes, as affected by this act, beginning on January 1, 2013, the department of workforce development shall determine that a disputed health service fee is reasonable and order that the disputed fee be paid if that fee is at or below the mean fee for the health service procedure for which the disputed fee was charged, plus 1.3 standard deviations from that mean, as shown by data from a database that is certified by that department under section 102.16 (2) (h) of the statutes, and shall determine that a disputed health service fee is unreasonable and order that a reasonable fee be paid if the disputed fee is above the mean fee for the health service procedure for which the disputed fee was charged, plus 1.3 standard deviations from that mean, as shown by data from such a database, unless the health service provider proves to the satisfaction of that department that a higher fee is justified because the service provided in the disputed case was more difficult or more complicated to provide than in the usual case.

SB409,23,24 (3) Study of funding of permanent total disability increases. The secretary of workforce development shall create a committee under section 15.04 (1) (c) of the statutes to study methods of funding the cost of providing regular, periodic increases in the weekly indemnity for permanent total disability, if legislation providing for those increases were to be enacted. The study shall include methods of funding the cost of providing those increases for injured employees receiving that indemnity on the day before the effective date of that legislation. The committee shall include representatives of employers, employees, worker's compensation insurers authorized to do business in this state, and the department of workforce development. Upon completion of the study, the committee shall report its findings, conclusions, and recommendations to the department of workforce development and the council on worker's compensation, after which the committee shall terminate its activities and cease to exist.

SB409, s. 31 Section 31 . Initial applicability.

SB409,24,3 (1) Third-party actions by work injury supplemental benefit fund. The treatment of section 102.29 (1) of the statutes first applies to an injury or death occurring on the effective date of this subsection.

SB409,24,6 (2) Work injury supplemental benefit fund surcharges. The treatment of section 102.35 (1) of the statutes first applies to surcharges imposed on the effective date of this subsection.

SB409,24,9 (3) Reimbursement of supplemental benefits. Except as provided in Section 30 (1 ) of this act, the treatment of 102.44 (1) (c) of the statutes first applies to supplemental benefits paid by an employer or insurance carrier in 2011.

SB409,24,10 (4) Vocational rehabilitation.

SB409,24,13 (a) Temporary disability compensation during vocational rehabilitation. The treatment of sections 102.03 (4) and 102.43 (5) (c) of the statutes first applies to a week of disability beginning after the effective date of this paragraph.

SB409,24,17 (b) Vocational rehabilitation costs. The treatment of section 102.61 (1), (1g) (b), (1m) (c) and (d), and (1r) (c) of the statutes and the amendment of section 102.43 (5) (with respect to the cost of tuition, fees, and books) of the statutes first apply to tuition, fee, and book costs incurred on the effective date of this paragraph.

SB409,24,20 (5) Fee disputes. The treatment of section 102.16 (2) (d) of the statutes first applies to a fee dispute submitted to the department of workforce development on the effective date of this subsection.

SB409,24,21 (End)