DWD 80.39 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82; CR 07-019: am. (1), Register October 2007 No. 622, eff. 11-1-07. DWD 80.40DWD 80.40 Assessment for unpaid claims of insolvent self-insurer. If an employer currently or formerly exempted from the duty to insure by order of the department under s. 102.28 (7) (b), Stats., is unable to pay any award and if judgement against such employer is returned unsatisfied, the department shall determine payment into the fund established by s. 102.28 (8), Stats., as follows: DWD 80.40(1)(1) The department shall prepare an estimate of the payments that should be made by the insolvent exempt employer for a period of one year. If the department elects to retain an insurance carrier or insurance service organization under s. 102.28 (7), Stats., the department will prepare an estimate of the charges that will be made by such carrier or organization to process, investigate and pay such claims for the same one year period. The sum of these 2 amounts shall be divided by the total number of employers exempted under s. 102.28 (2), Stats. DWD 80.40(2)(2) The department shall assess and order payment within 30 days by each exempt employer the amount determined under sub. (1) to the state treasurer for deposit in the fund created by s. 102.28 (8), Stats. DWD 80.40(3)(3) The department shall prepare an estimate of the total remaining liability of the insolvent exempt employer and an estimate of the amount that may be recovered from that employer, its receiver or trustee in bankruptcy. Such estimates shall be communicated to all exempt employers. DWD 80.40(4)(4) At least annually following the original order the department shall estimate the amount due and payable during the following year and the charges expected from any insurance carrier or claims service for such year and assess and order payment by each exempt employer its pro rata share determined as provided by s. 102.28 (7) (b), Stats. DWD 80.40(5)(5) At the time orders are issued under sub. (4) the department shall prepare an estimate of the remaining liability of the insolvent exempt employer and the amount that may reasonably be expected to be recovered from such employer, its receiver or trustee in bankruptcy. Such estimates will be communicated to all exempt employers. DWD 80.40(6)(6) All money due and payable to injured employees which remain unpaid shall be considered money payable during the following year in making estimates. DWD 80.40(7)(7) All money recovered by the attorney general and paid into the fund shall be used in the payment of unpaid claims and shall be taken into account in making estimates and assessments. DWD 80.40 HistoryHistory: Cr. Register, September, 1986, No. 369, eff. 10-1-86. DWD 80.41DWD 80.41 Computation of monthly salary and reimbursement to retirement fund under s. 66.191, 1981 Stats. DWD 80.41(1)(1) Fringe benefits shall not be included in the computation of salary, earnings or wages under s. 66.191, 1981 Stats., unless such benefits are income for Wisconsin income tax purposes. DWD 80.41(2)(2) An eligible employee under s. 66.191, 1981 Stats., shall file with the department before an award is entered, as provided in s. 66.191, 1981 Stats., a waiver of disability annuity payments which may be due under s. 40.63, Stats., and further shall consent to reimbursement to the Wisconsin retirement fund of all disability benefits recovered under the provisions of s. 40.63, Stats. DWD 80.41 NoteNote: 1983 Wis. Act 191 repealed s. 66.191, 1981 Stats. However, people are still receiving benefits under this statute. DWD 80.41 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82; corrections in (title), (1), (2) made under s. 13.92 (4) (b) 7., Stats., Register March 2015 No. 711. DWD 80.42DWD 80.42 Vocational rehabilitation; reporting requirement. In order to determine whether or not an employee should be referred to the division of vocational rehabilitation for services, the self-insured employer or insurance carrier shall notify the department whenever temporary total disability will exceed 13 weeks. This report shall be made within 13 weeks from the date of the initial disability or when such disability can be determined, whichever is earlier, and shall include a current practitioner’s report. DWD 80.42 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82. DWD 80.43DWD 80.43 Fees and costs. Section 102.26, Stats., provides for a maximum attorney’s fee of 20% of the amount in dispute. Section 102.26 (3), Stats., places upon the department the responsibilities for fixing the fee and providing for the direct payment of the fee. In the exercise of this responsibility, the department shall take into account the following considerations: DWD 80.43(1)(1) The department shall balance the need to preserve the maximum amount of benefits for the injured employee and the need for fees which are sufficient to insure adequate representation for claimants under ch. 102, Stats. DWD 80.43(2)(2) Fees shall not be allowed on medical expenses to the extent that other sources, such as group insurance, are available to pay such expenses. DWD 80.43(3)(3) Fees for permanent total disability shall not be allowed on compensation awards due beyond 500 weeks. DWD 80.43(4)(4) The existence of a dispute under s. 102.26 (2), Stats., is dependent upon a disagreement after the employer or insurer has had adequate time and information to take a position on liability. Neither the holding of a hearing nor the filing of an application for a hearing alone may determine the existence of a dispute. However, a finding that a dispute exists shall not be precluded by an employer’s or insurer’s purposeful inactivity on the issue of liability. DWD 80.43(5)(5) Where representation is the result of the representative’s employment by an insurance carrier, an employer, a union, a social service agency or a public agency, the representative may not charge a fee on a contingency basis. DWD 80.43(6)(6) Where there has been successive representation by various representatives, the division of fees by the department shall take into account the relative value of the services performed by each representative, any concessions of disability, offers of settlement and other matters. DWD 80.43(7)(7) Where a claimant appears by an attorney of record any fee shall be payable to such attorney regardless of the cooperation or involvement of agents or other non-attorneys. The division of such fee with agents or other non-attorneys shall be at the discretion of the attorney of record. If there is disagreement among successive attorneys the department will make appropriate apportionment of any or all fees for services. DWD 80.43 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82; cr. (7), Register, September, 1986, No. 369, eff. 10-1-86. DWD 80.46DWD 80.46 Contribution to support of unestranged surviving parent. In assessing support under s. 102.48, Stats., the payment of room and board by a child to his or her parent shall not be considered as contribution to support of the parent. DWD 80.46 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82. DWD 80.47DWD 80.47 Medical release of employee for restricted work in the healing period. Even though an employee could return to a restricted type of work during the healing period, unless suitable employment within the physical and mental limitations of the employee is furnished by the employer or some other employer, compensation for temporary disability shall continue during the healing period. DWD 80.47 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82. DWD 80.48DWD 80.48 Reassignment of death benefits. When a spouse who is entitled to death benefits remarries, the department shall reassign the death benefits to the children designated in ss. 102.51 (1) and 102.49, Stats., unless a showing is made that undue hardship would result for the spouse because of the reassignment. DWD 80.48 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82. DWD 80.49DWD 80.49 Vocational rehabilitation benefits. DWD 80.49(1)(1) Purpose. The primary purpose of vocational rehabilitation benefits is to provide a method to restore an injured worker as nearly as possible to the worker’s preinjury earning capacity and potential. DWD 80.49(2)(2) Eligibility. The determination of eligibility for vocational rehabilitation training and whether a person is a suitable subject for training is the responsibility of the division of vocational rehabilitation. If the division of vocational rehabilitation determines that an employee is eligible to receive services under 29 USC 701 to 797b, but that the division of vocational rehabilitation cannot provide those services for the employee, the employee may select a private rehabilitation specialist certified by the department to determine whether the employee can return to suitable employment without rehabilitative training and whether rehabilitative training is necessary to develop a retraining program to restore as nearly as possible the employee to his or her preinjury earning capacity and potential. DWD 80.49(3)(3) 80-week rule. Extension of vocational rehabilitation benefits beyond 80 weeks may not be authorized pursuant to s. 102.61 (1) or (1m), Stats., if the primary purpose of further training is to improve upon preinjury earning capacity rather than restoring it. DWD 80.49(4)(a)(a) “IPE” means an individualized plan for employment developed by a specialist which identifies the vocational goal of a retraining program, the intermediate objectives to reach that goal and the methods by which progress will be measured. DWD 80.49(4)(b)(b) “Retraining program” means a course of instruction on a regular basis which provides an employee with marketable job skills or enhances existing job skills to make them marketable. DWD 80.49(4)(c)(c) “Specialist” means a person certified by the department to provide vocational rehabilitation services to injured employees under s. 102.61 (1m), Stats. DWD 80.49(4)(d)(d) Except as provided in sub. (5), “suitable employment” means a job within the employee’s permanent work restrictions for which the employee has the necessary physical capacity, knowledge, transferable skills and ability and which pays at least 85 percent of the employee’s preinjury average weekly wage. DWD 80.49(5)(a)(a) A job offer at or above 85% of the average weekly wage shall not constitute suitable employment if: DWD 80.49(5)(a)1.1. An employee’s education, training or employment experience demonstrates a career or vocational path; the average weekly wage on the date of injury does not reflect the earnings which the employee could reasonably have expected in the demonstrated career or vocational path; and the permanent work restrictions caused by the injury impede the employee’s ability to pursue the demonstrated career or vocational path; or, DWD 80.49(5)(a)2.2. The employee’s average weekly wage is calculated pursuant to the part-time wage rules in s. 102.11 (1) (f), Stats., or s. DWD 80.51 (4) or (5) and the employee’s average weekly wage for compensation purposes exceeds the gross average weekly wages of the part-time employment. DWD 80.49(5)(b)(b) The average weekly wage for purposes of determining suitable employment under par. (a) 1. shall be determined by expert vocational evidence regarding the average weekly wage that the employee may have reasonably expected in the demonstrated career or vocational path. DWD 80.49(5)(c)(c) The average weekly wage for purposes of determining suitable employment under par. (a) 2. shall be determined by expert vocational evidence regarding the employee’s age, educational potential, past job experience, aptitude, proven abilities, and ambitions on the date of injury. DWD 80.49(6)(a)(a) A person may apply to the department for certification as a specialist at any time. The department may require applicants to submit, and certified specialists to regularly report, information describing their services, including the geographic areas served by the specialist and the nature, cost and outcome of services provided to employees under this section. DWD 80.49(6)(b)(b) After evaluating the information submitted under par. (a), the department shall certify a person as a specialist if the person has a license or certificate which is current, valid and otherwise in good standing as one of the following, or may certify the person as provided in par. (c): DWD 80.49(6)(b)1.1. Certified professional counselor with specialty in vocational rehabilitation from the department of safety and professional services. DWD 80.49(6)(b)2.2. Certified disability management specialist from the certification of disability management specialist commission. DWD 80.49(6)(b)3.3. Certified rehabilitation counselor from the commission on rehabilitation counselor certification. DWD 80.49(6)(b)4.4. Certified vocational evaluator from the commission on certification of work adjustment and vocational evaluation specialists. DWD 80.49 NoteNote: The Commission on Rehabilitation Counselor Certification (CRCC) is located at 1699 E. Woodfield Road, Suite 300, Schaumburg, Illinois 60173. The Certification of Disability Management Specialist Commission (CDMS) is located at 8735 W. Higgins Road, Suite 300, Chicago, Illinois 60631. The Commission on Certification of Work Adjustment and Vocational Evaluation Specialists is located at 7910 Woodmont Avenue, Suite 1430, Bethesda, Maryland 20814-3015.
DWD 80.49(6)(c)(c) The department may certify a person as a specialist if the person has state or national certification, licensing or accreditation in vocational rehabilitation other than that required in par. (b) which is acceptable to the department. The department may require a specialist certified under this paragraph to serve a period of probation up to 3 years as a condition of certification. The department shall specify the conditions of the probationary certification. The department may revoke the probationary certification at any time without a hearing for conduct which violated the conditions of probation established by the department or conduct sufficient to decertify the specialist under par. (e). DWD 80.49(6)(d)(d) Unless certification is suspended or revoked under par. (e), certification by the department under par. (b) is valid for 3 years. If a specialist applies to the department to renew his or her certification before the expiration of the certification period, the certification shall remain in effect until the department renews or denies the application to renew. A renewal is valid for three years. DWD 80.49(6)(e)(e) Only the department may initiate a proceeding to suspend or revoke a specialist’s certification under this section. The department may suspend or revoke a specialist’s certification, after providing the specialist with a hearing, when the department determines that the specialist did not maintain a current, valid certificate or license specified in par. (b) or the specialist intentionally or repeatedly: DWD 80.49(6)(e)2.2. Fails to comply with the orders, rulings, reporting requirements or other instructions of the department or its representatives; DWD 80.49(6)(e)3.3. Charges excessive fees compared to the value of the services performed or ordered to be performed; or, DWD 80.49(6)(e)4.4. Misrepresents the employee’s work history, age, education, medical history or condition, diagnostic test results or other factors significantly related to an employee’s retraining program. DWD 80.49(6)(f)(f) The department shall maintain a current listing of all specialists certified by the department, including the areas they serve, and provide the list upon request. DWD 80.49(7)(a)(a) At the end of the medical healing period, the self-insured employer or insurance carrier shall notify the employee, on a form provided by the department, of the employee’s potential eligibility to receive rehabilitation services. DWD 80.49(7)(b)(b) The department shall arrange with the division of vocational rehabilitation to receive timely notice whenever the division of vocational rehabilitation determines under s. 102.61 (1m), Stats., that it cannot serve an eligible employee. When the division of vocational rehabilitation notifies the department that it cannot serve an eligible employee, the department shall mail to the employee and the self-insured employer or insurance carrier a list of certified specialists serving the area where the employee resides. DWD 80.49(7)(c)(c) The employee may choose any certified specialist. The employee may choose a second certified specialist only by mutual agreement with the self-insured employer or insurance carrier or with the permission of the department. Partners are deemed to be one specialist. DWD 80.49(7)(d)(d) A specialist selected by an employee under par. (c) shall notify the department and the self-insured employer or insurance carrier within 7 days of that selection. The department may develop a form for this purpose. DWD 80.49(7)(e)(e) The self-insured employer or insurance carrier is liable for the reasonable and necessary cost of the specialist’s services and the reasonable cost of the training program recommended by the specialist provided that the employee and the specialist substantially comply with the requirements in subs. (8) to (11). Except with the prior consent of the self-insured employer or insurance carrier, the reasonable cost of any specialist’s services to the employee shall not exceed $1,000 for each date of injury as defined in s. 102.01 (2) (g), Stats. Effective on the first day of January each year after 1995, the department shall adjust the $1,000 limit by the same percentage change as the average annual percentage change in the U.S. consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor, for the 12 months ending on September 30 of the prior year. The department shall notify insurance carriers, self-insured employers and specialists likely to be affected by the annual change in the limit. DWD 80.49 NoteNote: To obtain a copy of all forms under this subsection, contact the Department of Workforce Development, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin, 53707-7901 or access forms online at http://www.dwd.wisconsin.gov. DWD 80.49(8)(8) Employer’s duties upon receipt of permanent restrictions. Upon receiving notice that the division of vocational rehabilitation cannot serve the employee under s. 102.61 (1m), Stats., the employee or a person authorized to act on the employee’s behalf shall provide the employer with a written report from a physician, podiatrist, psychologist or chiropractor stating the employee’s permanent work restrictions. Within 60 days of receiving the practitioner’s work restrictions, the employer shall provide to the employee or the employee’s authorized representative, in writing: DWD 80.49(8)(b)(b) A statement that the employer has no suitable employment available for the employee; or, DWD 80.49(8)(c)(c) A medical report from a physician, podiatrist, psychologist or chiropractor showing that the permanent work restrictions provided by the employee’s practitioner are in dispute, and medical or vocational documentation that the difference in work restrictions would materially affect either the employer’s ability to provide suitable employment or a specialist’s ability to recommend a retraining program. If after 30 days the employee and employer cannot resolve the dispute, either party may request a hearing before the division of hearings and appeals to determine the employee’s work restrictions. Within 30 days after the division of hearings and appeals determines the restrictions, the employer shall provide the written notice required in par. (a) or (b). DWD 80.49(9)(a)(a) If the employer fails to respond as required in sub. (8), it shall be conclusively presumed for the purposes of s. 102.61 (1m), Stats., that the employer has no suitable employment available and the employee is entitled to receive vocational rehabilitation services from a specialist. DWD 80.49(9)(b)(b) If the employer does not make a written offer of suitable employment under sub. (8), the specialist shall determine whether there is suitable employment available for the employee in the general labor market without retraining. If suitable employment is reasonably likely to be available, the specialist shall attempt to place the employee in alternative suitable employment for at least 90 days prior to developing a retraining program. The employee shall cooperate fully in the specialist’s placement efforts and may not refuse an offer of suitable employment made within the 90-day period. In determining whether the offer is suitable the department shall consider age, education, training, previous work experience, previous earnings, present occupation and earnings, travel distance, goals of the employee, and the extent to which it would restore the employee’s preinjury earning capacity and potential. DWD 80.49(9)(c)(c) If the employee is placed in or refuses to accept suitable employment, the self-insured employer or insurance carrier is not liable for any further costs of the specialist’s services unless that suitable employment ends within the statute of limitations in s. 102.17 (4), Stats. DWD 80.49(10)(a)(a) If, after reasonably diligent effort by the employee and the specialist, the employee does not obtain suitable employment, then there is a rebuttable presumption that the employee needs retraining. The presumption is rebuttable by evidence that: DWD 80.49(10)(a)1.1. No retraining program can help restore as nearly as possible the employee’s wage earning capacity; DWD 80.49(10)(a)2.2. The employee or the specialist did not make a reasonably diligent effort under sub. (9) (b) to obtain suitable employment for the employee; or DWD 80.49(10)(a)3.3. The employee or specialist withheld or misrepresented highly material facts. DWD 80.49(10)(b)(b) A retraining program of 80 weeks or less is presumed to be reasonable and the employer shall pay the cost of the program, mileage and maintenance benefits, and temporary total disability benefits. DWD 80.49(10)(c)(c) A retraining program more than 80 weeks may be reasonable, but there is no presumption that training over 80 weeks is required. Extension of vocational rehabilitation benefits beyond 80 weeks may not be authorized if the primary purpose of further training is to improve upon preinjury earning capacity rather than restoring it. DWD 80.49(10)(d)(d) If the retraining program developed by the specialist is for more than 80 weeks, the self-insured employer or the insurance carrier may offer an alternative retraining program which will restore the employee’s preinjury earning capacity in less time than the retraining program developed by the specialist. An employee may not refuse a self-insured employer’s or insurance carrier’s timely, good-faith, written offer of an alternative retraining program without reasonable cause. DWD 80.49(11)(a)(a) A specialist shall develop an IPE for a retraining program for the employee, and may amend it to achieve suitable employment. DWD 80.49(11)(b)(b) A specialist shall make periodic written reports at reasonable intervals to the employee, employer and insurance carrier describing vocational rehabilitation activities which have occurred during that interval.
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Chs. DWD 80-81; Worker’s Compensation
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