The department shall promulgate rules establishing procedures and requirements for the necessity of treatment dispute resolution process under this subsection, including rules setting the fees under par. (f)
and rules establishing standards for determining the necessity of treatment provided to an injured employee. Before the department may amend the rules establishing those standards, the department shall establish an advisory committee under s. 227.13
composed of health care providers providing treatment under s. 102.42
to advise the department and the council on worker's compensation on amending those rules.
See also s. DWD 80.73
and ch. DWD 81
, Wis. adm. code.
No employer subject to this chapter may solicit, receive, or collect any money from an employee or any other person or make any deduction from their wages, either directly or indirectly, for the purpose of discharging any liability under this chapter or recovering premiums paid on a contract described under s. 102.31 (1) (a)
or a policy described under s. 102.315 (3)
, or (5) (a)
; nor may any employer subject to this chapter sell to an employee or other person, or solicit or require the employee or other person to purchase, medical, chiropractic, podiatric, psychological, dental, or hospital tickets or contracts for medical, surgical, hospital, or other health care treatment that is required to be furnished by that employer.
The department and the division have jurisdiction to pass on any question arising out of sub. (3)
and 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 under any arrangement made in violation of sub. (3)
without regard to that employee's actual disbursements for those services.
Except as provided in s. 102.28 (3)
, no agreement by an employee to waive the right to compensation is valid.
The continuing obligation to compensate an employee for work related medical expenses under s. 102.42 does not allow agency review of compromise agreements after the one-year statute of limitations in sub. (1) has run if the employee incurs medical expenses after that time. Schenkoski v. LIRC, 203 Wis. 2d 109
, 552 N.W.2d 120
(Ct. App. 1996), 96-0051
An appeal under sub. (2m) (e) of a Department of Workforce Development determination may be served under s. 102.23 (1) (b) on the department or the Labor and Industry Review Commission. McDonough v. DWD, 227 Wis. 2d 271
, 595 N.W.2d 686
The Department of Workforce Development (DWD) does not possess authority to independently determine, for worker's compensation purposes, the reasonableness and medical necessity of a protectively-placed injured employee's court-ordered transfer to the least restrictive environment under ch. 55. DWD's authority is limited to resolving disputes regarding the reasonableness or necessity of treatment provided to an injured employee, which permits DWD to evaluate the treatment an employee receives within a placement, but not the placement itself. LaBeree v. LIRC, 2010 WI App 148
, 330 Wis. 2d 101
, 793 N.W.2d 77
Procedure; notice of hearing; witnesses, contempt; testimony, medical examination. 102.17(1)(a)1.1.
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.
Subject to subd. 3.
, the 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.
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) 3.
, that party shall provide written notice stating with reasonable specificity the basis for the claim to the employer, the insurer, the department, and the division before the division schedules a hearing on the claim of malice or bad faith.
The hearing may be adjourned in the discretion of the division, and hearings may be held at such places as the division designates, within or without the state. The 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 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 division.
In any dispute or controversy pending before the division, the 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 that may avoid unnecessary proof, and such other matters as may aid in disposition of the dispute or controversy. After that conference the division may issue an order requiring disclosure or exchange of any information or written material 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 division may issue an order dismissing the claim without prejudice or excluding evidence or testimony relating to the information or written material. The division shall provide each party with a copy of any order issued under this paragraph.
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 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 division or any member or employee of the 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
, is otherwise qualified, and has obtained from the division a license with authorization to appear in matters or proceedings before the division. Except as provided under pars. (cm)
, and (ct)
, the license shall be issued by the division under rules promulgated by the division. The division shall maintain in its office a current list of persons to whom licenses have been issued.
Any license issued under subd. 1.
may be suspended or revoked by the division for fraud or serious misconduct on the part of an agent, may be denied, suspended, nonrenewed, or otherwise withheld by the division for failure to pay court-ordered payments as provided in par. (cm)
on the part of an agent, and 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 of workforce development certifies under s. 108.227
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 division 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 division shall follow the procedure provided in a memorandum of understanding entered into under s. 49.857
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 periodically renewed by the division, but each renewed license shall expire on the June 30 following the issuance of the renewed license.
Except as provided in subd. 2m.
, the division shall require each applicant for a license under par. (c)
who is an individual to provide the division with the applicant's social security number, and shall require each applicant for a license under par. (c)
who is not an individual to provide the division with the applicant's federal employer identification number, when initially applying for or applying to renew the license.
If an applicant who is an individual fails to provide the applicant's social security number to the division or if an applicant who is not an individual fails to provide the applicant's federal employer identification number to the division, the division may not issue or renew a license under par. (c)
to or for the applicant unless the applicant is an individual who does not have a social security number and the applicant submits a statement made or subscribed under oath or affirmation as required under subd. 2m.
If an applicant who is an individual does not have a social security number, the applicant shall submit a statement made or subscribed under oath or affirmation to the division that the applicant does not have a social security number. The form of the statement shall be prescribed by the division. A license issued in reliance upon a false statement submitted under this subdivision is invalid.
The division may not disclose any information received under subd. 1.
to any person except to the department of revenue for the sole purpose of requesting certifications under s. 73.0301
, the department of workforce development for the sole purpose of requesting certifications under s. 108.227
, or the department of children and families for purposes of administering s. 49.22
The department of workforce development shall deny, suspend, restrict, refuse to renew, or otherwise withhold a license under par. (c)
for failure of the applicant or agent to pay court-ordered payments of child or family support, maintenance, birth expenses, medical expenses, or other expenses related to the support of a child or former spouse or for failure of the applicant or agent to comply, after appropriate notice, with a subpoena or warrant issued by the department of children and families or a county child support agency under s. 59.53 (5)
and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857
. Notwithstanding par. (c)
, an action taken under this paragraph is subject to review only as provided in the memorandum of understanding entered into under s. 49.857
and not as provided in ch. 227
The division shall deny an application for the issuance or renewal of a license under par. (c)
, or revoke such a license already issued, if the department of revenue certifies under s. 73.0301
that the applicant or licensee is liable for delinquent taxes. Notwithstanding par. (c)
, an action taken under this paragraph is subject to review only as provided under s. 73.0301 (5)
and not as provided in ch. 227
The division shall deny an application for the issuance or renewal of a license under par. (c)
, or revoke such a license already issued, if the department certifies under s. 108.227
that the applicant or licensee is liable for delinquent contributions, as defined in s. 108.227 (1) (d)
. Notwithstanding par. (c)
, an action taken under this paragraph is subject to review only as provided under s. 108.227 (5)
and not as provided in ch. 227
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)
, 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 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 a certified report may be fined or imprisoned, or both, under s. 943.395
The record of a hospital or sanatorium in this state that is satisfactory to the division, established by certificate, affidavit, or testimony of the supervising officer of the hospital or sanatorium, 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.
The 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)
. The 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 division and all parties in interest at least 15 days before the date of the hearing, unless the division is satisfied that there is good cause for the failure to file the report.
A report or record described in subd. 1.
, or 3.
that is admitted or received into evidence by the division constitutes substantial evidence under s. 102.23 (6)
as to the matter contained in the report or record.
The 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 division for its consideration upon final hearing. All ex parte testimony taken by the division shall be reduced to writing, and any party shall have opportunity to rebut that testimony on final hearing.
shall not apply to proceedings under this chapter, except as to a witness who is any of the following:
About to go out of the state, not intending to return in time for the hearing.
So sick, infirm, or aged as to make it probable that the witness will not be able to attend the hearing.
A member of the legislature, if any committee of the legislature or of the house of which the witness is a member is in session and the witness waives his or her privilege.
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 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 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 division and a copy of the report shall be furnished by the division to each party, who shall have an opportunity to rebut the report on further hearing.
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 division constitutes substantial evidence under s. 102.23 (6)
as to the matter contained in the report.
If the division has reason to believe that the payment of compensation has not been made, 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. The notice shall contain a statement of the matter to be considered. All provisions of this chapter governing proceedings on an application shall apply, insofar as applicable, to a proceeding under this subsection. When the division schedules a hearing on its own motion, the division does not become a party in interest and is not required to appear at the hearing.
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
. Except as provided in sub. (2s)
, the subpoena shall be on a form provided by the division and shall give the name and address of the party requesting the subpoena.
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 hearing examiner or other representative of the division responsible for conducting the proceeding.
Any person who shall willfully and unlawfully fail or neglect to appear or to testify or to produce books, papers and records as required, shall be fined not less than $25 nor more than $100, or imprisoned in the county jail not longer than 30 days. Each day such person shall so refuse or neglect shall constitute a separate offense.
Except as provided in this subsection and s. 102.555 (12) (b)
, in the case of occupational disease, the right of an employee, the employee's legal representative, a dependent, the employee's employer or the employer's insurance company, or other named party to proceed under this section shall not extend beyond 12 years after the date of the injury or death or after the date that compensation, other than for treatment or burial expenses, was last paid, or would have been last payable if no advancement were made, whichever date is latest, and in the case of traumatic injury, that right shall not extend beyond 6 years after that date.
In the case of occupational disease; a traumatic injury resulting in the loss or total impairment of a hand or any part of the rest of the arm proximal to the hand or of a foot or any part of the rest of the leg proximal to the foot, any loss of vision, or any permanent brain injury; or a traumatic injury causing the need for an artificial spinal disc or a total or partial knee or hip replacement, there shall be no statute of limitations, except that benefits or treatment expense for an occupational disease becoming due 12 years after the date of injury or death or last payment of compensation, other than for treatment or burial expenses, shall be paid from the work injury supplemental benefit fund under s. 102.65
and in the manner provided in s. 102.66
and benefits or treatment expense for such a traumatic injury becoming due 6 years after that date shall be paid from that fund and in that manner if the date of injury or death or last payment of compensation, other than for treatment or burial expenses, is before April 1, 2006.
Payment of wages by the employer during disability or absence from work to obtain treatment shall be considered payment of compensation for the purpose of this section if the employer knew of the employee's condition and its alleged relation to the employment.
This section does not limit the time within which the state may bring an action to recover the amounts specified in ss. 102.49 (5)
If an employee or dependent shall, at the time of injury, or at the time the employee's or dependent's right accrues, be under 18 years of age, the limitations of time within which the employee or dependent may file application or proceed under this chapter, if they would otherwise sooner expire, shall be extended to one year after the employee or dependent attains the age of 18 years. If, within any part of the last year of any such period of limitation, an employee, the employee's personal representative, or surviving dependent be insane or on active duty in the armed forces of the United States such period of limitation shall be extended to 2 years after the date that the limitation would otherwise expire. The provision hereof with respect to persons on active duty in the armed forces of the United States shall apply only where no applicable federal statute is in effect.
Except as provided in par. (b)
, in a claim under s. 102.44 (2)
, testimony or certified reports of expert witnesses on loss of earning capacity may be received in evidence and considered with all other evidence to decide on an employee's actual loss of earning capacity.
Except as provided in par. (c)
, the 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 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 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 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.
Notwithstanding the notice deadlines provided in par. (b)
, the 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.
Unless otherwise agreed to by all parties, an injured employee shall file with the 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 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 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 division is satisfied that there is good cause for the failure to file and serve the itemized statement.
“Fire fighter" means any person employed on a full-time basis by the state or any political subdivision as a member or officer of a fire department, including the 1st class cities and state fire marshal and deputies.
“Post-traumatic stress disorder” means that condition, as described in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association.
Subject to par. (c)
, in the case of a mental injury that is not accompanied by a physical injury and that results in a diagnosis of post-traumatic stress disorder in a law enforcement officer, as defined in s. 23.33 (1) (ig)
, or a fire fighter, the claim for compensation for the mental injury, in order to be compensable under this chapter, is subject to all of the following:
The mental injury must satisfy all of the following conditions:
The diagnosis of post-traumatic stress disorder is made by a licensed psychiatrist or psychologist.
The mental injury may not be a result of any of the following actions taken in good faith by the employer:
The diagnosis does not need to be based on unusual stress of greater dimensions than the day-to-day emotional strain and tension experienced by similarly situated employees.
No individual may receive compensation for a claim of mental injury under this subsection more than 3 times in his or her lifetime. The limitation under this paragraph applies irrespective of whether the individual becomes employed by a different employer or in a different position with the same employer.
History: 1971 c. 148
; 1971 c. 213
; 1973 c. 150
; Sup. Ct. Order, 67 Wis. 2d 585, 774 (1975); 1975 c. 147
; 1975 c. 199
; 1977 c. 29
; 1979 c. 278
; 1981 c. 92
; 1981 c. 317
; 1981 c. 380
; 1981 c. 391
; 1985 a. 83
; 1989 a. 64
; 1991 a. 85
; 1993 a. 81
; 1995 a. 27
; 1997 a. 38
; 1999 a. 9
; 2001 a. 37
; 2003 a. 144
; 2005 a. 172
; 2007 a. 185
; 2009 a. 180
; 2011 a. 183
; 2013 a. 36
; 2015 a. 55
; 2021 a. 29
; 2021 a. 238
See also ch. DWD 80
, Wis. adm. code.
A plaintiff-employer was not deprived of any substantial due process rights by the Department of Industry, Labor and Human Relations' refusal to invoke its rule requiring inspection of the opposing parties' medical reports when the plaintiff had ample notice of the nature of the employee's claim. Theodore Fleisner, Inc. v. DILHR, 65 Wis. 2d 317
, 222 N.W.2d 600
Under the facts of this case, the refusal to grant an employer's request for adjournment was a denial of due process. Bituminous Casualty Co. v. DILHR, 97 Wis. 2d 730
, 295 N.W.2d 183
(Ct. App. 1980).
Sub. (1) (d) does not create a presumption that evidence presented by treating physicians is correct. The statute enforces the idea that the Labor and Industry Review Commission determines the weight to be given medical witnesses. Conradt v. Mt. Carmel School Fireman's Fund Insurance Co., 197 Wis. 2d 60
, 539 N.W.2d 713
(Ct. App. 1995), 94-2842
The Labor and Industry Review Commission's authority under sub. (1) (a) to control its calendar and manage its internal affairs necessarily implies the power to deny an applicant's motion to withdraw an application for hearing. An appellant's failure to appear at a hearing after a motion to withdraw the application was denied was grounds for entry of a default judgment under s. 102.18 (1) (a). Baldwin v. LIRC, 228 Wis. 2d 601
, 599 N.W.2d 8
(Ct. App. 1999), 98-3090
In the absence of testimony in conflict with a claimant's medical experts, the Labor and Industry Review Commission may reject the expert evidence if there is countervailing testimony raising legitimate doubt about the employee's injury. Kowalchuk v. LIRC, 2000 WI App 85
, 234 Wis. 2d 203
, 610 N.W.2d 122
It was reasonable for the Labor and Industry Review Commission to conclude that the statute of limitations under sub. (4) for death benefits begins to run at the time of death, rather than the time of injury. International Paper Co. v. LIRC, 2001 WI App 248
, 248 Wis. 2d 348
, 635 N.W.2d 823
Neither sub. (1) (d) or (g) provides a statutory right to cross-examine an independent physician appointed by the Department of Workforce Development (DWD). When the legislature drafted sub. (1) (g), it chose to use the general term “rebut." Because it did not specify the right to cross-examination, it appears the legislature left to DWD's discretion whether to allow cross-examination in circumstances where it might provide relevant and probative evidence. Sub. (1) (d) governs experts that are presented by a party to establish a prima facie case, not experts appointed by DWD to provide an impartial report. The Labor and Industry Review Commission did not violate the plaintiff's due process rights when it declined to remand for cross-examination. Aurora Consolidated Health Care v. LIRC, 2012 WI 49
, 340 Wis. 2d 367
, 814 N.W.2d 824
Prehearing Discovery Under Wisconsin's Worker's Compensation Act: A Review and Critique. Towers. 68 MLR 597 (1985).
Apportionment of liability. 102.175(1)(1)
If it is established at the hearing that 2 or more accidental injuries, for each of which a party to the proceedings is liable under this chapter, have each contributed to a physical or mental condition for which benefits would be otherwise due, liability for such benefits shall be apportioned according to the proof of the relative contribution to disability resulting from the injury.
If after a hearing or a prehearing conference the 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 division may order one or more parties to pay compensation in an amount, time, and manner as determined by the division. If the division later determines that another party is liable for compensation, the division shall order that other party to reimburse any party that was ordered to pay compensation under this subsection.
If it is established by the certified report of a physician, podiatrist, surgeon, psychologist, or chiropractor under s. 102.17 (1) (d) 1.
, a record of a hospital or sanatorium under s. 102.17 (1) (d) 2.
, or other competent evidence that an injured employee has incurred permanent disability, but that a percentage of that disability was caused by an accidental injury sustained in the course of employment with the employer against whom compensation is claimed and a percentage of that disability was caused by other factors, whether occurring before or after the time of the accidental injury, the employer shall be liable only for the percentage of permanent disability that was caused by the accidental injury. If, however, previous permanent disability is attributable to occupational exposure with the same employer, the employer is also liable for that previous permanent disability so established.