SB673: Bill Text

SB673,41 Section 41. 102.16 (1m) (c) of the statutes is amended to read:

SB673,20,23 102.16 (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, 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 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 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).

SB673,42 Section 42. 102.16 (2) (a) of the statutes is amended to read:

SB673,21,14 102.16 (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.

SB673,43 Section 43. 102.16 (2) (b) of the statutes is amended to read:

SB673,21,23 102.16 (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.

SB673,44 Section 44. 102.16 (2m) (a) of the statutes is amended to read:

SB673,22,14 102.16 (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.

SB673,45 Section 45. 102.16 (2m) (b) of the statutes is amended to read:

SB673,22,24 102.16 (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.

SB673,46 Section 46. 102.16 (4) of the statutes is amended to read:

SB673,23,8 102.16 (4) The department and the division have has 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.

SB673,47 Section 47. 102.17 (1) (a) 1. of the statutes is amended to read:

SB673,23,15 102.17 (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.

SB673,48 Section 48. 102.17 (1) (a) 2. of the statutes is amended to read:

SB673,24,2 102.17 (1) (a) 2. Subject to subd. 3., the division department 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.

SB673,49 Section 49. 102.17 (1) (a) 3. of the statutes is amended to read:

SB673,24,8 102.17 (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) 3. 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 division department schedules a hearing on the claim of malice or bad faith.

SB673,50 Section 50. 102.17 (1) (a) 4. of the statutes is amended to read:

SB673,24,18 102.17 (1) (a) 4. The hearing may be adjourned in the discretion of the division department, and hearings may be held at such places as the division department designates, within or without the state. The division department 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 department 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 department.

SB673,51 Section 51. 102.17 (1) (b) of the statutes is amended to read:

SB673,25,8 102.17 (1) (b) In any dispute or controversy pending before the division department, the division department 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 department may issue an order requiring disclosure or exchange of any information or written material that the division department 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 department may issue an order dismissing the claim without prejudice or excluding evidence or testimony relating to the information or written material. The division department shall provide each party with a copy of any order issued under this paragraph.

SB673,52 Section 52. 102.17 (1) (c) 1. of the statutes is amended to read:

SB673,25,23 102.17 (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 division department. 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 department or any member or employee of the division department 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 division department. 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.

SB673,53 Section 53. 102.17 (1) (d) 1. of the statutes is amended to read:

SB673,26,20 102.17 (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 division department 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.

SB673,54 Section 54. 102.17 (1) (d) 2. of the statutes is amended to read:

SB673,27,4 102.17 (1) (d) 2. The record of a hospital or sanatorium in this state that is satisfactory to the division department, 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.

SB673,55 Section 55. 102.17 (1) (d) 3. of the statutes is amended to read:

SB673,27,13 102.17 (1) (d) 3. The division department 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 division department 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 department and all parties in interest at least 15 days before the date of the hearing, unless the division department is satisfied that there is good cause for the failure to file the report.

SB673,56 Section 56. 102.17 (1) (d) 4. of the statutes is amended to read:

SB673,27,17 102.17 (1) (d) 4. A report or record described in subd. 1., 2., or 3. that is admitted or received into evidence by the division department constitutes substantial evidence under s. 102.23 (6) as to the matter contained in the report or record.

SB673,57 Section 57. 102.17 (1) (e) of the statutes is amended to read:

SB673,28,2 102.17 (1) (e) The division department 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 department for its consideration upon final hearing. All ex parte testimony taken by the division department shall be reduced to writing, and any party shall have opportunity to rebut that testimony on final hearing.

SB673,58 Section 58. 102.17 (1) (f) 1. of the statutes is amended to read:

SB673,28,4 102.17 (1) (f) 1. Beyond reach of the subpoena of the division department.

SB673,59 Section 59. 102.17 (1) (g) of the statutes is amended to read:

SB673,28,18 102.17 (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 division department 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 department 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 department and a copy of the report shall be furnished by the division department to each party, who shall have an opportunity to rebut the report on further hearing.

SB673,60 Section 60. 102.17 (1) (h) of the statutes is amended to read:

SB673,29,2 102.17 (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 division department constitutes substantial evidence under s. 102.23 (6) as to the matter contained in the report.

SB673,61 Section 61. 102.17 (2) of the statutes is amended to read:

SB673,29,12 102.17 (2) If the division department has reason to believe that the payment of compensation has not been made, the division department 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 department schedules a hearing on its own motion, the division department does not become a party in interest and is not required to appear at the hearing.

SB673,62 Section 62. 102.17 (2m) of the statutes is amended to read:

SB673,29,19 102.17 (2m) The division or any 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 division department and shall give the name and address of the party requesting the subpoena.

SB673,63 Section 63. 102.17 (2s) of the statutes is amended to read:

SB673,30,2 102.17 (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 hearing examiner or other representative of the division department responsible for conducting the proceeding.

SB673,64 Section 64 . 102.17 (4) of the statutes is renumbered 102.17 (4) (a) and amended to read:

SB673,30,12 102.17 (4) (a) 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, or 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.

SB673,30,25 (b) 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.

SB673,31,4 (c) 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.

SB673,65 Section 65. 102.17 (7) (b) of the statutes is amended to read:

SB673,31,17 102.17 (7) (b) Except as provided in par. (c), the division department 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 department 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 department 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 department 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.

SB673,66 Section 66. 102.17 (7) (c) of the statutes is amended to read:

SB673,31,23 102.17 (7) (c) Notwithstanding the notice deadlines provided in par. (b), the division department 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.

SB673,67 Section 67. 102.17 (8) of the statutes is amended to read:

SB673,32,14 102.17 (8) Unless otherwise agreed to by all parties, an injured employee shall file with the division department 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 department 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 department 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 department is satisfied that there is good cause for the failure to file and serve the itemized statement.

SB673,68 Section 68. 102.17 (9) of the statutes is created to read:

SB673,32,16 102.17 (9) (a) In this subsection:

SB673,32,19 1. “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 first class cities and state fire marshal and deputies.

SB673,32,22 2. “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.

SB673,33,2 (b) 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:

SB673,33,3 1. The mental injury must satisfy all of the following conditions:

SB673,33,5 a. The diagnosis of post-traumatic stress disorder is made by a licensed psychiatrist or psychologist.

SB673,33,7 b. The conditions of liability under s. 102.03 (1) are proven by the preponderance of the evidence.

SB673,33,9 2. The mental injury may not be a result of any of the following actions taken in good faith by the employer:

SB673,33,10 a. A disciplinary action.

SB673,33,11 b. A work evaluation.

SB673,33,12 c. A job transfer.

SB673,33,13 d. A layoff.

SB673,33,14 e. A demotion.

SB673,33,15 f. A termination.

SB673,33,18 3. 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.

SB673,69 Section 69. 102.175 (2) of the statutes is amended to read:

SB673,34,2 102.175 (2) If after a hearing or a prehearing conference the division department 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 department may order one or more parties to pay compensation in an amount, time, and manner as determined by the division department. If the division department later determines that another party is liable for compensation, the division department shall order that other party to reimburse any party that was ordered to pay compensation under this subsection.

SB673,70 Section 70. 102.175 (3) (c) of the statutes is amended to read:

SB673,34,8 102.175 (3) (c) Upon request of the department, the division, the employer, or the employer's worker's compensation insurer, an injured employee who claims compensation for an injury causing permanent disability shall disclose all previous findings of permanent disability or other impairments that are relevant to that injury.

SB673,71 Section 71. 102.18 (1) (b) 1. of the statutes is amended to read:

SB673,34,16 102.18 (1) (b) 1. Within 90 days after the final hearing and close of the record, the division department shall make and file its findings upon the ultimate facts involved in the controversy, and its order, which shall state the division's department's determination as to the rights of the parties. Pending the final determination of any controversy before it, the division department, after any hearing, may, in its discretion, make interlocutory findings, orders, and awards, which may be enforced in the same manner as final awards.

SB673,72 Section 72. 102.18 (1) (b) 2. of the statutes is amended to read:

SB673,34,23 102.18 (1) (b) 2. The division department 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 or to pay for a future course of instruction or other rehabilitation training services provided under a rehabilitation training program developed under s. 102.61 (1) or (1m).

SB673,73 Section 73. 102.18 (1) (b) 3. of the statutes is amended to read:

SB673,35,5 102.18 (1) (b) 3. If the division department 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 division department may include in its final award a penalty not exceeding 25 percent of each amount that was not paid as directed.

SB673,74 Section 74. 102.18 (1) (bg) 1. of the statutes is amended to read:

SB673,35,15 102.18 (1) (bg) 1. If the division department 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 division department 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, if such a determination has not yet been made, the division department 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.

SB673,75 Section 75. 102.18 (1) (bg) 2. of the statutes is amended to read:

SB673,35,25 102.18 (1) (bg) 2. If the division department 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 division department 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, if such a determination has not yet been made, the division department 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.

SB673,76 Section 76. 102.18 (1) (bg) 3. of the statutes is amended to read:

SB673,36,12 102.18 (1) (bg) 3. If the division department 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 division department 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, if such a determination has not yet been made, the division department 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.

SB673,77 Section 77. 102.18 (1) (bp) of the statutes is amended to read: