Ins 5.01 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96; correction in (1) made under s.
13.92 (4) (b) 7., Stats.,
Register January 2011 No. 661;
CR 18-092: am. (1) Register March 2020 No. 771, eff. 4-1-20.
Ins 5.03
Ins 5.03
Definitions. In this chapter:
Ins 5.03(1)
(1) “Commissioner" means the commissioner of insurance or the deputy commissioner of insurance acting under s.
601.11 (1) (b), Stats.
Ins 5.03(3)
(3) “Declaratory ruling" means an administrative decision by the commissioner or a board which, after a contested case proceeding, determines the applicability of a statute or rule enforced by the commissioner to any person, property or state of facts.
Ins 5.03(4)
(4) “Hearing" means the trial of the issues in a contested case.
Ins 5.03(6)
(6) “License" means any license, permit, approval, certificate of authority, certificate of registration or similar form of permission required by law and issued under chs.
601 to
655, Stats.
Ins 5.03(7)
(7) “Office" means the office of the commissioner.
Ins 5.03(8)
(8) “PCF board" means the board of governors of the Wisconsin health care liability insurance plan and patients compensation fund established under s.
619.04 (3), Stats.
Ins 5.03(9)
(9) “Person" means a natural person, corporation, limited liability company, partnership, cooperative, association, trust, other business entity or government entity.
Ins 5.03(10)
(10) “Subpoena" means a command to give testimony or provide evidence.
Ins 5.03 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96; correction in (5) made under s. 13.93 (2m) (b) 7., Stats.,
Register June 2005 No. 594;
CR 18-092: r. (5) Register March 2020 No. 771, eff. 4-1-20.
Ins 5.05
Ins 5.05
Petition for declaratory ruling. An interested person may file with the commissioner or a board a petition for a declaratory ruling under s.
227.41, Stats. The petition shall comply with s.
227.41 (2), Stats., and shall state how the petitioner may be affected by the statute or rule referenced in the petition.
Ins 5.05 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96.
Ins 5.06
Ins 5.06
Response to petition. Within a reasonable time after a petition is filed under s.
Ins 5.05, the commissioner or board shall grant or deny the petition. If the petition is granted, the commissioner or board shall initiate a contested case under s.
227.41 (1), Stats., by issuing a notice of hearing in the form specified in s.
Ins 5.12. If the petition is denied, the commissioner or board shall issue a denial notice in writing, specifying the reason for the denial. The commissioner or board may permit the petitioner to amend the petition if it does not fully comply with s.
227.41 (2), Stats., or s.
Ins 5.05.
Ins 5.06 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96.
Ins 5.07
Ins 5.07
Complaint; investigation. Ins 5.07(1)(1)
Any person may file with the office a complaint about any person subject to regulation under ch.
153, Stats., or chs.
600 to
655, Stats.
Ins 5.07(2)
(2) Based on a complaint under sub.
(1) or other information available, the office may investigate to determine whether there is probable cause to take action against a person subject to regulation under ch.
153, Stats., or chs.
600 to
655, Stats.
Ins 5.07 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96.
Ins 5.08(1)(1)
Issuance. If the office determines, based on its examination or investigation of a person regulated under ch.
153, Stats., or chs.
600 to
655, Stats., that there is probable cause to believe that a person has violated any provisions of those chapters, a rule promulgated under those chapters or an order under s.
601.41 (4) (a) and
601.63,
601.64 or
601.65, Stats., the office may issue an order under s.
153.78 or
601.41 (4) (a), Stats., or issue a notice of hearing under s.
601.62, Stats., and s.
Ins 5.12, or both.
Ins 5.08(2)(a)1.
1. The identity and, if known, the address of each respondent to whom the order is directed.
Ins 5.08(2)(a)2.
2. A statement of the facts constituting the basis for the order.
Ins 5.08(2)(a)3.
3. A reference to each statute, rule or order which each respondent allegedly violated.
Ins 5.08(2)(a)4.
4. A description of what the order requires each respondent to do.
Ins 5.08(2)(a)5.
5. The signature and title of the designated employee of the office who issued the order.
Ins 5.08(2)(b)
(b) An order under s.
631.20 (4), Stats., disapproving a form filing shall be accompanied by notice of the right to a hearing under s.
601.62 (3) (a), Stats., and shall include all of the following:
Ins 5.08(2)(b)2.
2. A reference to each statute or administrative rule relied on for the disapproval.
Ins 5.08(2)(b)3.
3. The signature of the employee of the office issuing the disapproval.
Ins 5.08(3)(a)1.
1. A summary order under ss.
227.51 (3) and
628.10 (2) (b), Stats., suspending an intermediary agent's license and ordering the agent to cease and desist from all activities of a licensed intermediary.
Ins 5.08(3)(a)3.
3. A summary order under any other section of the statutes suspending a license issued by the office.
Ins 5.08(3)(b)
(b) A summary order shall take effect upon service under s.
Ins 5.17 (3) or upon actual notice of the order to the respondent or the respondent's attorney, whichever is sooner, and shall continue in effect until the effective date of the final decision and order in any contested case proceeding arising out of the order.
Ins 5.08(3)(c)
(c) In addition to the requirements of sub.
(2), a summary order shall include all of the following:
Ins 5.08(3)(c)1.
1. A finding either that the public health, safety or welfare requires emergency action or that irreparable harm to the property or business of the insurer or to the interests of its policyholders, creditors or the public may occur unless the summary order is issued.
Ins 5.08(3)(c)2.
2. A statement that the order is in effect and remains in effect until the effective date of the final decision and order in any contested case proceeding arising out of the order unless otherwise ordered by the commissioner.
Ins 5.08(3)(d)
(d) The office shall simultaneously serve a notice of hearing under s.
Ins 5.12 with a summary order under this subsection.
Ins 5.08 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96; corrections in (1) and (2) (a) (intro.) made under s.
13.92 (4) (b) 7., Stats.,
Register January 2011 No. 661.
subch. IV of ch. Ins 5
Subchapter IV — Adverse Decision of Office, Board, Plan, Fund or Council; Right to Hearing; Petition
Ins 5.09
Ins 5.09
Right to hearing before commissioner. Any of the following may initiate a contested case proceeding before the commissioner by filing with the commissioner a petition meeting the requirements of s.
Ins 5.11 within the time limit specified in the applicable statute or administrative rule:
Ins 5.09(2)
(2) An insurer whose form filing has been disapproved under s.
631.20, Stats.
Ins 5.09(3)
(3) A person whose application for a license is denied.
Ins 5.09(4)
(4) A person specified under s.
626.31 (4) (a), Stats., entitled to a review of an action or decision of the Wisconsin compensation rating bureau.
Ins 5.09(5)
(5) An insurer entitled to a hearing under s.
102.31 (4), Stats., based on a recommendation of the department of workforce development.
Ins 5.09(6)
(6) An applicant or policyholder who receives notice under s.
Ins 4.10 (16) from the Wisconsin insurance plan of cancellation, nonrenewal, reduction in coverage or declination.
Ins 5.09(7)
(7) An applicant, policyholder or insurer entitled under s.
Ins 3.49 (3) (d) 1. to appeal a decision of the governing committee of the Wisconsin automobile insurance plan.
Ins 5.09(8)
(8) A person who receives a forfeiture assessment from the office of health care information under s.
153.78, Stats.
Ins 5.09 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96; correction in (5) made under s. 13.93 (2m) (b) 6., Stats.,
Register, June, 1997, No. 498; correction in (8) made under s. 13.92 (4) (b) 7., Stats.,
Register January 2011 No. 661.
Ins 5.10
Ins 5.10
Right to hearing before PCF board. Ins 5.10(1)(1)
Any of the following may initiate a contested case proceeding before the PCF board by filing with the board a petition meeting the requirements of s.
Ins 5.11:
Ins 5.10(1)(a)
(a) A person adversely affected by a classification decision of the Wisconsin health care liability insurance plan or patients compensation fund under s.
Ins 17.24 (3).
Ins 5.10(1)(b)
(b) A health care provider whose coverage under the Wisconsin health care liability insurance plan is cancelled or nonrenewed under s.
Ins 17.25 (16).
Ins 5.10(1)(c)
(c) A health care provider entitled to a hearing under s.
Ins 17.285 (9) (a) on a recommendation of the patients compensation fund peer review council.
Ins 5.10(2)
(2) A health care provider is not entitled to a contested case proceeding to resolve an issue regarding coverage by the Wisconsin health care liability insurance plan, patients compensation fund or both. Any such issue shall be resolved by civil litigation.
Ins 5.10 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96.
Ins 5.11
Ins 5.11
Petition; response; effect. Ins 5.11(1)(a)(a) A petition for a hearing need not be in any particular form, but shall be in writing and shall include all of the following:
Ins 5.11(1)(a)3.a.
a. The case number of the order that adversely affects the petitioner and an explanation of why the petitioner believes the order should be withdrawn or modified.
Ins 5.11(1)(a)3.b.
b. A statement of how the petitioner is adversely affected by a decision of the office, board, plan, fund or council, a reference to any legal deficiency in the decision and the date on which the petitioner received notice of the decision.
Ins 5.11(1)(a)3.c.
c. If the petition relates to a denial by the office of the petitioner's application for a license, a statement of why the petitioner believes the denial should be modified or rescinded.
Ins 5.11(1)(a)3.d.
d. If the petition relates to a form filing disapproval, a statement of why the petitioner believes the form should be approved.
Ins 5.11(1)(a)4.
4. If an attorney will appear on behalf of the petitioner, the attorney's name and address.
Ins 5.11(2)
(2) Response. After receipt of a petition, the office shall take one of the following actions:
Ins 5.11(2)(b)
(b) If the petition is not timely filed, notify the petitioner that the order is final because the petition was not filed within the specified time period.
Ins 5.11(2)(c)
(c) If the petition does not satisfy the requirements of sub.
(1) (a), notify the petitioner that the order is final because of the inadequacy of the petition or, in the case of an unrepresented individual, refer the matter to the administrative law judge who shall notify the petitioner in writing what additional information is needed to complete or clarify the petition before the matter can be scheduled for hearing.
Ins 5.11(2)(d)
(d) If neither the commissioner, a board or an official or employee of the office designated by the commissioner or a board will act as administrative law judge, refer the petition to the person who will act as administrative law judge for appropriate action under pars.
(a) to
(c).
Ins 5.11(3)
(3) Effect. A petition for a hearing on an order under ss.
601.41 (4) (a) and
601.63, Stats., does not stay or modify the order, but the administrative law judge may, upon a motion by the respondent, suspend the order as provided under s.
601.63 (4), Stats.
Ins 5.11 History
History: Cr.
Register, March, 1996, No. 483, eff. 4-1-96.
Ins 5.12(1)(1)
Form. The office or administrative law judge shall serve on each named party in a contested case a notice of hearing which shall include all of the following:
Ins 5.12(1)(b)
(b) The name and address of each party. In the case of a person licensed by the office, the latest address on file with the office shall be conclusively presumed to be the person's correct address.
