AB56,695,248
102.16
(1m) (a) If an insurer or self-insured employer concedes by compromise
9under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
10employer is liable under this chapter for any health services provided to an injured
11employee by a health service provider, but disputes the reasonableness of the fee
12charged by the health service provider, the department
or the division may include
13in its order confirming the compromise or stipulation a determination made by the
14department under sub. (2) as to the reasonableness of the fee or, if such a
15determination has not yet been made, the department
or the division may notify, or
16direct the insurer or self-insured employer to notify, the health service provider
17under sub. (2) (b) that the reasonableness of the fee is in dispute. The department
18or the division shall deny payment of a health service fee that the department
19determines under sub. (2) to be unreasonable. A health service provider and an
20insurer or self-insured employer that are parties to a fee dispute under this
21paragraph are bound by the department's determination under sub. (2) on the
22reasonableness of the disputed fee, unless that determination is set aside, reversed,
23or modified by the department under sub. (2) (f) or is set aside on judicial review as
24provided in sub. (2) (f).
AB56,1128
25Section
1128. 102.16 (1m) (b) of the statutes is amended to read:
AB56,696,24
1102.16
(1m) (b) If an insurer or self-insured employer concedes by compromise
2under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
3employer is liable under this chapter for any treatment provided to an injured
4employee by a health service provider, but disputes the necessity of the treatment,
5the department
or the division may include in its order confirming the compromise
6or stipulation a determination made by the department under sub. (2m) as to the
7necessity of the treatment or, if such a determination has not yet been made, the
8department
or the division may notify, or direct the insurer or self-insured employer
9to notify, the health service provider under sub. (2m) (b) that the necessity of the
10treatment is in dispute. Before determining under sub. (2m) the necessity of
11treatment provided to an injured employee, the department may, but is not required
12to, obtain the opinion of an expert selected by the department who is qualified as
13provided in sub. (2m) (c). The standards promulgated under sub. (2m) (g) shall be
14applied by an expert and by the department in rendering an opinion as to, and in
15determining, necessity of treatment under this paragraph. In cases in which no
16standards promulgated under sub. (2m) (g) apply, the department shall find the facts
17regarding necessity of treatment. The department
or the division shall deny
18payment for any treatment that the department determines under sub. (2m) to be
19unnecessary. A health service provider and an insurer or self-insured employer that
20are parties to a dispute under this paragraph over the necessity of treatment are
21bound by the department's determination under sub. (2m) on the necessity of the
22disputed treatment, unless that determination is set aside, reversed, or modified by
23the department under sub. (2m) (e) or is set aside on judicial review as provided in
24sub. (2m) (e).
AB56,1129
25Section
1129. 102.16 (1m) (c) of the statutes is amended to read:
AB56,697,20
1102.16
(1m) (c) If an insurer or self-insured employer concedes by compromise
2under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
3employer is liable under this chapter for the cost of a prescription drug dispensed
4under s. 102.425 (2) for outpatient use by an injured employee, but disputes the
5reasonableness of the amount charged for the prescription drug, the department
or
6the division may include in its order confirming the compromise or stipulation a
7determination made by the department under s. 102.425 (4m) as to the
8reasonableness of the prescription drug charge or, if such a determination has not
9yet been made, the department
or the division may notify, or direct the insurer or
10self-insured employer to notify, the pharmacist or practitioner dispensing the
11prescription drug under s. 102.425 (4m) (b) that the reasonableness of the
12prescription drug charge is in dispute. The department
or the division shall deny
13payment of a prescription drug charge that the department determines under s.
14102.425 (4m) to be unreasonable. A pharmacist or practitioner and an insurer or
15self-insured employer that are parties to a dispute under this paragraph over the
16reasonableness of a prescription drug charge are bound by the department's
17determination under s. 102.425 (4m) on the reasonableness of the disputed
18prescription drug charge, unless that determination is set aside, reversed, or
19modified by the department under s. 102.425 (4m) (e) or is set aside on judicial review
20as provided in s. 102.425 (4m) (e).
AB56,1130
21Section
1130. 102.16 (2) (a) of the statutes is amended to read:
AB56,698,1022
102.16
(2) (a) Except as provided in this paragraph, the department has
23jurisdiction under this subsection,
the department and the division have jurisdiction
24under sub. (1m) (a), and
the division has jurisdiction under s. 102.17 to resolve a
25dispute between a health service provider and an insurer or self-insured employer
1over the reasonableness of a fee charged by the health service provider for health
2services provided to an injured employee who claims benefits under this chapter. A
3health service provider may not submit a fee dispute to the department under this
4subsection before all treatment by the health service provider of the employee's
5injury has ended if the amount in controversy, whether based on a single charge or
6a combination of charges for one or more days of service, is less than $25. After all
7treatment by a health service provider of an employee's injury has ended, the health
8service provider may submit any fee dispute to the department, regardless of the
9amount in controversy. The department shall deny payment of a health service fee
10that the department determines under this subsection to be unreasonable.
AB56,1131
11Section
1131. 102.16 (2) (b) of the statutes is amended to read:
AB56,698,1912
102.16
(2) (b) An insurer or self-insured employer that disputes the
13reasonableness of a fee charged by a health service provider or the department
or the
14division under sub. (1m) (a) or s. 102.18 (1) (bg) 1. shall provide reasonable written
15notice to the health service provider that the fee is being disputed. After receiving
16reasonable written notice under this paragraph or under sub. (1m) (a) or s. 102.18
17(1) (bg) 1. that a health service fee is being disputed, a health service provider may
18not collect the disputed fee from, or bring an action for collection of the disputed fee
19against, the employee who received the services for which the fee was charged.
AB56,1132
20Section
1132. 102.16 (2m) (a) of the statutes is amended to read:
AB56,699,921
102.16
(2m) (a) Except as provided in this paragraph, the department has
22jurisdiction under this subsection,
the department and the division have jurisdiction
23under sub. (1m) (b), and
the division has jurisdiction under s. 102.17 to resolve a
24dispute between a health service provider and an insurer or self-insured employer
25over the necessity of treatment provided for an injured employee who claims benefits
1under this chapter. A health service provider may not submit a dispute over
2necessity of treatment to the department under this subsection before all treatment
3by the health service provider of the employee's injury has ended if the amount in
4controversy, whether based on a single charge or a combination of charges for one or
5more days of service, is less than $25. After all treatment by a health service provider
6of an employee's injury has ended, the health service provider may submit any
7dispute over necessity of treatment to the department, regardless of the amount in
8controversy. The department shall deny payment for any treatment that the
9department determines under this subsection to be unnecessary.
AB56,1133
10Section
1133. 102.16 (2m) (b) of the statutes is amended to read:
AB56,699,1911
102.16
(2m) (b) An insurer or self-insured employer that disputes the
12necessity of treatment provided by a health service provider or the department
or the
13division under sub. (1m) (b) or s. 102.18 (1) (bg) 2. shall provide reasonable written
14notice to the health service provider that the necessity of that treatment is being
15disputed. After receiving reasonable written notice under this paragraph or under
16sub. (1m) (b) or s. 102.18 (1) (bg) 2. that the necessity of treatment is being disputed,
17a health service provider may not collect a fee for that disputed treatment from, or
18bring an action for collection of the fee for that disputed treatment against, the
19employee who received the treatment.
AB56,1134
20Section
1134. 102.16 (4) of the statutes is amended to read:
AB56,700,321
102.16
(4) The department
and the division have has jurisdiction to pass on any
22question arising out of sub. (3) and to order the employer to reimburse an employee
23or other person for any sum deducted from wages or paid by him or her in violation
24of that subsection. In addition to the penalty provided in s. 102.85 (1), any employer
25violating sub. (3) shall be liable to an injured employee for the reasonable value of
1the necessary services rendered to that employee under any arrangement made in
2violation of sub. (3) without regard to that employee's actual disbursements for those
3services.
AB56,1135
4Section
1135. 102.17 (1) (a) 1. of the statutes is amended to read:
AB56,700,105
102.17
(1) (a) 1. Upon the filing with the department by any party in interest
6of any application in writing stating the general nature of any claim as to which any
7dispute or controversy may have arisen, the department shall mail a copy of the
8application to all other parties in interest, and the insurance carrier shall be
9considered a party in interest. The department
or the division may bring in
10additional parties by service of a copy of the application.
AB56,1136
11Section
1136. 102.17 (1) (a) 2. of the statutes is amended to read:
AB56,700,2112
102.17
(1) (a) 2. Subject to subd. 3., the
division department shall cause notice
13of hearing on the application to be given to each interested party by service of that
14notice on the interested party personally or by mailing a copy of that notice to the
15interested party's last-known address at least 10 days before the hearing. If a party
16in interest is located without this state, and has no post-office address within this
17state, the copy of the application and copies of all notices shall be filed with the
18department of financial institutions and shall also be sent by registered or certified
19mail to the last-known post-office address of the party. Such filing and mailing shall
20constitute sufficient service, with the same effect as if served upon a party located
21within this state.
AB56,1137
22Section
1137. 102.17 (1) (a) 3. of the statutes is amended to read:
AB56,701,223
102.17
(1) (a) 3. If a party in interest claims that the employer or insurer has
24acted with malice or bad faith as described in s. 102.18 (1) (b) 3. or (bp), that party
25shall provide written notice stating with reasonable specificity the basis for the claim
1to the employer, the insurer,
and the department,
and the division before the
division 2department schedules a hearing on the claim of malice or bad faith.
AB56,1138
3Section
1138. 102.17 (1) (a) 4. of the statutes is amended to read:
AB56,701,124
102.17
(1) (a) 4. The hearing may be adjourned in the discretion of the
division 5department, and hearings may be held at such places as the
division department 6designates, within or without the state. The
division department may also arrange
7to have hearings held by the commission, officer, or tribunal having authority to hear
8cases arising under the worker's compensation law of any other state, of the District
9of Columbia, or of any territory of the United States, with the testimony and
10proceedings at any such hearing to be reported to the
division department and to be
11made part of the record in the case. Any evidence so taken shall be subject to rebuttal
12upon final hearing before the
division department.
AB56,1139
13Section
1139. 102.17 (1) (b) of the statutes is amended to read:
AB56,702,214
102.17
(1) (b) In any dispute or controversy pending before the
division 15department, the
division
department may direct the parties to appear before an
16examiner for a conference to consider the clarification of issues, the joining of
17additional parties, the necessity or desirability of amendments to the pleadings, the
18obtaining of admissions of fact or of documents, records, reports, and bills that may
19avoid unnecessary proof, and such other matters as may aid in disposition of the
20dispute or controversy. After that conference the
division department may issue an
21order requiring disclosure or exchange of any information or written material that
22the
division department considers material to the timely and orderly disposition of
23the dispute or controversy. If a party fails to disclose or exchange that information
24within the time stated in the order, the
division
department may issue an order
25dismissing the claim without prejudice or excluding evidence or testimony relating
1to the information or written material. The
division department shall provide each
2party with a copy of any order issued under this paragraph.
AB56,1140
3Section
1140. 102.17 (1) (c) 1. of the statutes is amended to read:
AB56,702,174
102.17
(1) (c) 1. Any party shall have the right to be present at any hearing,
5in person or by attorney or any other agent, and to present such testimony as may
6be pertinent to the controversy before the
division
department. No person, firm, or
7corporation, other than an attorney at law who is licensed to practice law in the state,
8may appear on behalf of any party in interest before the
division department or any
9member or employee of the
division department assigned to conduct any hearing,
10investigation, or inquiry relative to a claim for compensation or benefits under this
11chapter, unless the person is 18 years of age or older, does not have an arrest or
12conviction record, subject to ss. 111.321, 111.322 and 111.335, is otherwise qualified,
13and has obtained from the department a license with authorization to appear in
14matters or proceedings before the
division
department. Except as provided under
15pars. (cm), (cr), and (ct), the license shall be issued by the department under rules
16promulgated by the department. The department shall maintain in its office a
17current list of persons to whom licenses have been issued.
AB56,1141
18Section
1141. 102.17 (1) (d) 1. of the statutes is amended to read:
AB56,703,1319
102.17
(1) (d) 1. The contents of certified medical and surgical reports by
20physicians, podiatrists, surgeons, dentists, psychologists, physician assistants,
21advanced practice nurse prescribers, and chiropractors licensed in and practicing in
22this state, and of certified reports by experts concerning loss of earning capacity
23under s. 102.44 (2) and (3), presented by a party for compensation constitute prima
24facie evidence as to the matter contained in those reports, subject to any rules and
25limitations the
division department prescribes. Certified reports of physicians,
1podiatrists, surgeons, dentists, psychologists, physician assistants, advanced
2practice nurse prescribers, and chiropractors, wherever licensed and practicing, who
3have examined or treated the claimant, and of experts, if the practitioner or expert
4consents to being subjected to cross-examination, also constitute prima facie
5evidence as to the matter contained in those reports. Certified reports of physicians,
6podiatrists, surgeons, psychologists, and chiropractors are admissible as evidence of
7the diagnosis, necessity of the treatment, and cause and extent of the disability.
8Certified reports by doctors of dentistry, physician assistants, and advanced practice
9nurse prescribers are admissible as evidence of the diagnosis and necessity of
10treatment but not of the cause and extent of disability. Any physician, podiatrist,
11surgeon, dentist, psychologist, chiropractor, physician assistant, advanced practice
12nurse prescriber, or expert who knowingly makes a false statement of fact or opinion
13in a certified report may be fined or imprisoned, or both, under s. 943.395.
AB56,1142
14Section
1142. 102.17 (1) (d) 2. of the statutes is amended to read:
AB56,703,2215
102.17
(1) (d) 2. The record of a hospital or sanatorium in this state that is
16satisfactory to the
division department, established by certificate, affidavit, or
17testimony of the supervising officer of the hospital or sanatorium, any other person
18having charge of the record, or a physician, podiatrist, surgeon, dentist, psychologist,
19physician assistant, advanced practice nurse prescriber, or chiropractor to be the
20record of the patient in question, and made in the regular course of examination or
21treatment of the patient, constitutes prima facie evidence as to the matter contained
22in the record, to the extent that the record is otherwise competent and relevant.
AB56,1143
23Section
1143. 102.17 (1) (d) 3. of the statutes is amended to read:
AB56,704,624
102.17
(1) (d) 3. The
division
department may, by rule, establish the
25qualifications of and the form used for certified reports submitted by experts who
1provide information concerning loss of earning capacity under s. 102.44 (2) and (3).
2The
division department may not admit into evidence a certified report of a
3practitioner or other expert or a record of a hospital or sanatorium that was not filed
4with the
division department and all parties in interest at least 15 days before the
5date of the hearing, unless the
division department is satisfied that there is good
6cause for the failure to file the report.
AB56,1144
7Section
1144. 102.17 (1) (d) 4. of the statutes is amended to read:
AB56,704,108
102.17
(1) (d) 4. A report or record described in subd. 1., 2., or 3. that is admitted
9or received into evidence by the
division department constitutes substantial
10evidence under s. 102.23 (6) as to the matter contained in the report or record.
AB56,1145
11Section
1145. 102.17 (1) (e) of the statutes is amended to read:
AB56,704,2012
102.17
(1) (e) The
division
department may, with or without notice to any party,
13cause testimony to be taken, an inspection of the premises where the injury occurred
14to be made, or the time books and payrolls of the employer to be examined by any
15examiner, and may direct any employee claiming compensation to be examined by
16a physician, chiropractor, psychologist, dentist, or podiatrist. The testimony so
17taken, and the results of any such inspection or examination, shall be reported to the
18division department for its consideration upon final hearing. All ex parte testimony
19taken by the
division department shall be reduced to writing, and any party shall
20have opportunity to rebut that testimony on final hearing.
AB56,1146
21Section
1146. 102.17 (1) (f) 1. of the statutes is amended to read:
AB56,704,2222
102.17
(1) (f) 1. Beyond reach of the subpoena of the
division department.
AB56,1147
23Section
1147. 102.17 (1) (g) of the statutes is amended to read:
AB56,705,1124
102.17
(1) (g) Whenever the testimony presented at any hearing indicates a
25dispute or creates a doubt as to the extent or cause of disability or death, the
division
1department may direct that the injured employee be examined, that an autopsy be
2performed, or that an opinion be obtained without examination or autopsy, by or from
3an impartial, competent physician, chiropractor, dentist, psychologist or podiatrist
4designated by the
division department who is not under contract with or regularly
5employed by a compensation insurance carrier or self-insured employer. The
6expense of the examination, autopsy, or opinion shall be paid by the employer or, if
7the employee claims compensation under s. 102.81, from the uninsured employers
8fund. The report of the examination, autopsy, or opinion shall be transmitted in
9writing to the
division department and a copy of the report shall be furnished by the
10division department to each party, who shall have an opportunity to rebut the report
11on further hearing.
AB56,1148
12Section
1148. 102.17 (1) (h) of the statutes is amended to read:
AB56,705,2013
102.17
(1) (h) The contents of certified reports of investigation made by
14industrial safety specialists who are employed, contracted, or otherwise secured by
15the department
or the division and who are available for cross-examination, if
16served upon the parties 15 days prior to hearing, shall constitute prima facie
17evidence as to matter contained in those reports. A report described in this
18paragraph that is admitted or received into evidence by the
division department 19constitutes substantial evidence under s. 102.23 (6) as to the matter contained in the
20report.
AB56,1149
21Section
1149. 102.17 (2) of the statutes is amended to read:
AB56,706,522
102.17
(2) If the
division
department has reason to believe that the payment
23of compensation has not been made, the
division
department may on its own motion
24give notice to the parties, in the manner provided for the service of an application,
25of a time and place when a hearing will be held for the purpose of determining the
1facts. The notice shall contain a statement of the matter to be considered. All
2provisions of this chapter governing proceedings on an application shall apply,
3insofar as applicable, to a proceeding under this subsection. When the
division 4department schedules a hearing on its own motion, the
division department does not
5become a party in interest and is not required to appear at the hearing.
AB56,1150
6Section
1150. 102.17 (2m) of the statutes is amended to read:
AB56,706,127
102.17
(2m) The division or any
Any party, including the department, may
8require any person to produce books, papers, and records at the hearing by personal
9service of a subpoena upon the person along with a tender of witness fees as provided
10in ss. 814.67 and 885.06. Except as provided in sub. (2s), the subpoena shall be on
11a form provided by the
division department and shall give the name and address of
12the party requesting the subpoena.
AB56,1151
13Section
1151. 102.17 (2s) of the statutes is amended to read:
AB56,706,1914
102.17
(2s) A party's attorney of record may issue a subpoena to compel the
15attendance of a witness or the production of evidence. A subpoena issued by an
16attorney must be in substantially the same form as provided in s. 805.07 (4) and must
17be served in the manner provided in s. 805.07 (5). The attorney shall, at the time of
18issuance, send a copy of the subpoena to the hearing examiner or other
19representative of the
division department responsible for conducting the proceeding.
AB56,1152
20Section
1152. 102.17 (7) (b) of the statutes is amended to read:
AB56,707,721
102.17
(7) (b) Except as provided in par. (c), the
division department shall
22exclude from evidence testimony or certified reports from expert witnesses under
23par. (a) offered by the party that raises the issue of loss of earning capacity if that
24party failed to notify the
division department and the other parties of interest, at
25least 60 days before the date of the hearing, of the party's intent to provide the
1testimony or reports and of the names of the expert witnesses involved. Except as
2provided in par. (c), the
division department shall exclude from evidence testimony
3or certified reports from expert witnesses under par. (a) offered by a party of interest
4in response to the party that raises the issue of loss of earning capacity if the
5responding party failed to notify the
division
department and the other parties of
6interest, at least 45 days before the date of the hearing, of the party's intent to provide
7the testimony or reports and of the names of the expert witnesses involved.
AB56,1153
8Section
1153. 102.17 (7) (c) of the statutes is amended to read:
AB56,707,139
102.17
(7) (c) Notwithstanding the notice deadlines provided in par. (b), the
10division department may receive in evidence testimony or certified reports from
11expert witnesses under par. (a) when the applicable notice deadline under par. (b) is
12not met if good cause is shown for the delay in providing the notice required under
13par. (b) and if no party is prejudiced by the delay.
AB56,1154
14Section
1154. 102.17 (8) of the statutes is amended to read:
AB56,708,315
102.17
(8) Unless otherwise agreed to by all parties, an injured employee shall
16file with the
division department and serve on all parties at least 15 days before the
17date of the hearing an itemized statement of all medical expenses and incidental
18compensation under s. 102.42 claimed by the injured employee. The itemized
19statement shall include, if applicable, information relating to any travel expenses
20incurred by the injured employee in obtaining treatment including the injured
21employee's destination, number of trips, round trip mileage, and meal and lodging
22expenses. The
division department may not admit into evidence any information
23relating to medical expenses and incidental compensation under s. 102.42 claimed
24by an injured employee if the injured employee failed to file with the
division 25department and serve on all parties at least 15 days before the date of the hearing
1an itemized statement of the medical expenses and incidental compensation under
2s. 102.42 claimed by the injured employee, unless the
division department is satisfied
3that there is good cause for the failure to file and serve the itemized statement.
AB56,1155
4Section
1155. 102.175 (2) of the statutes is amended to read:
AB56,708,125
102.175
(2) If after a hearing or a prehearing conference the
division 6department determines that an injured employee is entitled to compensation but
7that there remains in dispute only the issue of which of 2 or more parties is liable for
8that compensation, the
division department may order one or more parties to pay
9compensation in an amount, time, and manner as determined by the
division 10department. If the
division
department later determines that another party is liable
11for compensation, the
division department shall order that other party to reimburse
12any party that was ordered to pay compensation under this subsection.
AB56,1156
13Section
1156. 102.175 (3) (c) of the statutes is amended to read:
AB56,708,1814
102.175
(3) (c) Upon request of the department,
the division, the employer, or
15the employer's worker's compensation insurer, an injured employee who claims
16compensation for an injury causing permanent disability shall disclose all previous
17findings of permanent disability or other impairments that are relevant to that
18injury.
AB56,1157
19Section
1157. 102.18 (1) (b) 1. of the statutes is amended to read:
AB56,709,220
102.18
(1) (b) 1. Within 90 days after the final hearing and close of the record,
21the
division department shall make and file its findings upon the ultimate facts
22involved in the controversy, and its order, which shall state the
division's 23department's determination as to the rights of the parties. Pending the final
24determination of any controversy before it, the
division department, after any
1hearing, may, in its discretion, make interlocutory findings, orders, and awards,
2which may be enforced in the same manner as final awards.
AB56,1158
3Section
1158. 102.18 (1) (b) 2. of the statutes is amended to read:
AB56,709,94
102.18
(1) (b) 2. The
division
department may include in any interlocutory or
5final award or order an order directing the employer or insurer to pay for any future
6treatment that may be necessary to cure and relieve the employee from the effects
7of the injury or to pay for a future course of instruction or other rehabilitation
8training services provided under a rehabilitation training program developed under
9s. 102.61 (1) or (1m).
AB56,1159
10Section
1159. 102.18 (1) (b) 3. of the statutes is amended to read:
AB56,709,1511
102.18
(1) (b) 3. If the
division department finds that the employer or insurer
12has not paid any amount that the employer or insurer was directed to pay in any
13interlocutory order or award and that the nonpayment was not in good faith, the
14division department may include in its final award a penalty not exceeding 25
15percent of each amount that was not paid as directed.
AB56,1160
16Section
1160. 102.18 (1) (bg) 1. of the statutes is amended to read:
AB56,709,2517
102.18
(1) (bg) 1. If the
division department finds under par. (b) that an insurer
18or self-insured employer is liable under this chapter for any health services provided
19to an injured employee by a health service provider, but that the reasonableness of
20the fee charged by the health service provider is in dispute, the
division department 21may include in its order under par. (b) a determination made by the department
22under s. 102.16 (2) as to the reasonableness of the fee or, if such a determination has
23not yet been made, the
division department may notify, or direct the insurer or
24self-insured employer to notify, the health service provider under s. 102.16 (2) (b)
25that the reasonableness of the fee is in dispute.
AB56,1161
1Section
1161. 102.18 (1) (bg) 2. of the statutes is amended to read:
AB56,710,102
102.18
(1) (bg) 2. If the
division department finds under par. (b) that an
3employer or insurance carrier is liable under this chapter for any treatment provided
4to an injured employee by a health service provider, but that the necessity of the
5treatment is in dispute, the
division department may include in its order under par.
6(b) a determination made by the department under s. 102.16 (2m) as to the necessity
7of the treatment or, if such a determination has not yet been made, the
division 8department may notify, or direct the employer or insurance carrier to notify, the
9health service provider under s. 102.16 (2m) (b) that the necessity of the treatment
10is in dispute.
AB56,1162
11Section
1162. 102.18 (1) (bg) 3. of the statutes is amended to read:
AB56,710,2212
102.18
(1) (bg) 3. If the
division department finds under par. (b) that an insurer
13or self-insured employer is liable under this chapter for the cost of a prescription
14drug dispensed under s. 102.425 (2) for outpatient use by an injured employee, but
15that the reasonableness of the amount charged for that prescription drug is in
16dispute, the
division department may include in its order under par. (b) a
17determination made by the department under s. 102.425 (4m) as to the
18reasonableness of the prescription drug charge or, if such a determination has not
19yet been made, the
division department may notify, or direct the insurer or
20self-insured employer to notify, the pharmacist or practitioner dispensing the
21prescription drug under s. 102.425 (4m) (b) that the reasonableness of the
22prescription drug charge is in dispute.
AB56,1163
23Section
1163. 102.18 (1) (bp) of the statutes is amended to read:
AB56,711,1424
102.18
(1) (bp) If the
division
department determines that the employer or
25insurance carrier suspended, terminated, or failed to make payments or failed to
1report an injury as a result of malice or bad faith, the
division department may
2include a penalty in an award to an employee for each event or occurrence of malice
3or bad faith. That penalty is the exclusive remedy against an employer or insurance
4carrier for malice or bad faith. If the penalty is imposed for an event or occurrence
5of malice or bad faith that causes a payment that is due an injured employee to be
6delayed in violation of s. 102.22 (1) or overdue in violation of s. 628.46 (1), the
division 7department may not also order an increased payment under s. 102.22 (1) or the
8payment of interest under s. 628.46 (1). The
division department may award an
9amount that the
division department considers just, not to exceed the lesser of 200
10percent of total compensation due or $30,000 for each event or occurrence of malice
11or bad faith. The
division department may assess the penalty against the employer,
12the insurance carrier, or both. Neither the employer nor the insurance carrier is
13liable to reimburse the other for the penalty amount. The
division department may,
14by rule, define actions that demonstrate malice or bad faith.
AB56,1164
15Section
1164. 102.18 (1) (bw) of the statutes is amended to read:
AB56,711,2216
102.18
(1) (bw) If an insurer, a self-insured employer, or, if applicable, the
17uninsured employers fund pays compensation to an employee in excess of its liability
18and another insurer or self-insured employer is liable for all or part of the excess
19payment, the department
or the division may order the insurer or self-insured
20employer that is liable for that excess payment to reimburse the insurer or
21self-insured employer that made the excess payment or, if applicable, the uninsured
22employers fund.
AB56,1165
23Section
1165. 102.18 (1) (c) of the statutes is amended to read:
AB56,712,524
102.18
(1) (c) If 2 or more examiners have conducted a formal hearing on a claim
25and are unable to agree on the order or award to be issued, the decision shall be the
1decision of the majority. If the examiners are equally divided on the decision, the
2division department may appoint an additional examiner who shall review the
3record and consult with the other examiners concerning their impressions of the
4credibility of the evidence. Findings of fact and an order or award may then be issued
5by a majority of the examiners.
AB56,1166
6Section
1166. 102.18 (1) (e) of the statutes is amended to read:
AB56,712,137
102.18
(1) (e) Except as provided in s. 102.21, if the department
or the division 8orders a party to pay an award of compensation, the party shall pay the award no
9later than 21 days after the date on which the order is mailed to the last-known
10address of the party, unless the party files a petition for review under sub. (3). This
11paragraph applies to all awards of compensation ordered by the department
or the
12division, whether the award results from a hearing, the default of a party, or a
13compromise or stipulation confirmed by the department
or the division.
AB56,1167
14Section
1167. 102.18 (2) of the statutes is repealed and recreated to read:
AB56,712,2015
102.18
(2) The department shall have and maintain on its staff such examiners
16as are necessary to hear and decide claims and to assist in the effective
17administration of this chapter. Those examiners shall be attorneys and may be
18designated as administrative law judges. Those examiners may make findings and
19orders and may approve, review, set aside, modify, or confirm stipulations of
20settlement or compromises of claims for compensation.
AB56,1168
21Section
1168. 102.18 (3) of the statutes is amended to read:
AB56,713,1322
102.18
(3) A party in interest may petition the commission for review of an
23examiner's decision awarding or denying compensation if the department,
the
24division, or the commission receives the petition within 21 days after the department
25or the division mailed a copy of the examiner's findings and order to the last-known
1addresses of the parties in interest. The commission shall dismiss a petition that is
2not filed within those 21 days unless the petitioner shows that the petition was filed
3late for a reason that was beyond the petitioner's control. If no petition is filed within
4those 21 days, the findings or order shall be considered final unless set aside,
5reversed, or modified by the examiner within that time. If the findings or order are
6set aside by the examiner, the status shall be the same as prior to
the setting aside
7of the findings or order
that were set aside. If the findings or order are reversed or
8modified by the examiner, the time for filing a petition commences on the date on
9which notice of the reversal or modification is mailed to the last-known addresses
10of the parties in interest. The commission shall either affirm, reverse, set aside, or
11modify the findings or order, in whole or in part, or direct the taking of additional
12evidence. The commission's action shall be based on a review of the evidence
13submitted.
AB56,1169
14Section
1169. 102.18 (4) (c) 3. of the statutes is amended to read:
AB56,713,1615
102.18
(4) (c) 3. Remand the case to the department
or the division for further
16proceedings.
AB56,1170
17Section
1170. 102.18 (4) (d) of the statutes is amended to read:
AB56,713,2418
102.18
(4) (d) While a petition for review by the commission is pending or after
19entry of an order or award by the commission but before commencement of an action
20for judicial review or expiration of the period in which to commence an action for
21judicial review, the commission shall remand any compromise presented to it to the
22department
or the division for consideration and approval or rejection under s.
23102.16 (1). Presentation of a compromise does not affect the period in which to
24commence an action for judicial review.
AB56,1171
25Section
1171. 102.18 (5) of the statutes is amended to read:
AB56,714,10
1102.18
(5) If it appears to the
division department that a mistake may have
2been made as to cause of injury in the findings, order, or award upon an alleged injury
3based on accident, when in fact the employee was suffering from an occupational
4disease, within 3 years after the date of the findings, order, or award the
division 5department may, upon its own motion, with or without hearing, set aside the
6findings, order or award, or the
division department may take that action upon
7application made within those 3 years. After an opportunity for hearing, the
division 8department may, if in fact the employee is suffering from disease arising out of the
9employment, make new findings, and a new order or award, or the
division 10department may reinstate the previous findings, order, or award.