DWD 80.61(1)(b)(b) “Partial-insurance” means self-insurance of a part of the liability and consent to the issuance of one or more policies on the remainder of the liability, as provided in ss. 102.28 (2) (b) and 102.31 (1), Stats. DWD 80.61(2)(a)(a) The requirements for partial-insurance and divided-insurance by 2 or more insurance companies are as follows: DWD 80.61(2)(a)1.1. Submission of an application on department forms available from the department. If the application is approved, the department shall permit partial-insurance or divided-insurance by written order. In the application, the employer shall agree to assume full responsibility to immediately make all payments of compensation and medical expense as the department may require, pending a final determination as to liability between the insurance carriers under divided-insurance or between the employer and the insurance carrier under partial-insurance, if a dispute should arise as to which insurance company or whether the employer or insurance company is responsible for a particular injury or illness sustained during the time the written order is in effect. DWD 80.61(2)(a)2.2. If the applicant is a political subdivision of the state, it shall submit a certified statement by an officer or the attorney for the political subdivision which cites the legal authority for executing the application and agreement when the initial application is submitted. DWD 80.61(2)(a)3.3. If the employer is a corporation, it shall submit a certified copy of the resolution adopted by the board of directors authorizing the execution of the initial application. Applications by organizations other than corporations shall be signed by person(s) possessing authority to execute such application. Partnerships must submit a consent by all the partners that the individual(s) executing the application has the authority to act for the applicant partnership. DWD 80.61(2)(a)4.4. Partial-insurance or divided insurance shall not be permitted when the portion of the entity to be insured is unable to obtain coverage under voluntary markets. Otherwise, DWD 80.61(2)(a)4.a.a. The department shall permit divided-insurance to municipalities which have ownership of nursing homes in order that the nursing homes may be separately insured and develop a separate experience rate. DWD 80.61(2)(b)(b) Renewal applications shall be submitted to the department on a department form no later than 3 months prior to the expiration date of the department’s order. Partial-insurance and divided-insurance shall expire on the date specified in the order unless continued in force by further order, as the department deems necessary. DWD 80.61 NoteNote: To obtain a renewal application form, contact the Department of Workforce Development, Worker’s Compensation Division, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin 53707 or call (608) 266-1340.
DWD 80.61(3)(3) Divided-insurance for designated carrier wrap-up construction projects. DWD 80.61(3)(a)2.2. “Designated wrap-up carrier” means the designated carrier or insurance company which insures the wrap-up project under ch. 102, Stats. DWD 80.61(3)(a)3.3. “Job site” means the premises and vicinity upon which the operations covered under the contract with the contractor or subcontractor are to be performed. DWD 80.61(3)(a)4.4. “Material supplier” means vendors, suppliers, material dealers, and others whose function is solely to supply or transport material, equipment, or parts to or from the construction site. DWD 80.61(3)(a)5.5. “Owner” means the person, firm, corporation or municipality having lawful possession of the construction project. DWD 80.61(3)(a)6.6. “Regular carrier” means the insurance company which insures all operations of a contractor or subcontractor under ch. 102, Stats., except for work done on the wrap-up project. DWD 80.61(3)(a)7.7. “Subcontractor” means a person who contracts with a contractor and also includes any subcontractor of a subcontractor. DWD 80.61(3)(a)8.8. “Wrap-up project” means a construction project wherein the owner selects a carrier, and this carrier issues a separate worker’s compensation policy to each contractor and subcontractor scheduled to work on the project for work which will be done on the project, and where the owner pays for each such policy. DWD 80.61(3)(b)(b) Minimum wrap-up project requirements. Wrap-up projects shall comply with the following: DWD 80.61(3)(b)1.1. The estimated project cost of completion shall be equal to at least $25 million. The estimated project cost of completion shall be the estimate of the costs of the total construction contracts to be awarded by the owner on the wrap-up project. DWD 80.61(3)(b)2.2. The estimated standard worker’s compensation manual premium shall be equal to $250,000 or more. DWD 80.61(3)(b)3.3. The project shall be confined to a single location except that in connection with the building of a road, bridge, pipeline, tunnel, waterway, or 2 or more concurrent wrap-up projects involving the same owner and the same insurance carrier the entire job or the concurrent projects are considered as a single project location. DWD 80.61(3)(b)4.4. The project shall have a definite completion date involving work to be performed continuously until completion and may not be extended to include maintenance work following completion. DWD 80.61(3)(b)5.5. All contractors and subcontractors shall be included under the wrap-up program. DWD 80.61(3)(b)6.6. All material suppliers shall be included in the safety program on the job site while unloading and handling material and performing other work, but material suppliers shall be excluded from the rest of the wrap-up program. DWD 80.61(3)(b)7.7. The submission of all bids and the letting of all contracts shall be on an ex-insurance basis. DWD 80.61(3)(c)(c) Minimum requirements for owner. The owner shall comply with the following requirements on a wrap-up project: DWD 80.61(3)(c)1.1. The wrap-up plan and application shall be submitted on a form provided by the department. If the application is approved, the department shall permit divided-insurance on the wrap-up project. DWD 80.61 NoteNote: To obtain the form under this paragraph, contact the Department of Workforce Development, Worker’s Compensation Division, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin 53707 or call (608) 266-1340.
DWD 80.61(3)(c)2.2. The owner shall comply with all conditions and agreements in the application, including, but not limited to: DWD 80.61(3)(c)2.a.a. The reimbursement of the department’s costs incurred because of the wrap-up project. DWD 80.61(3)(c)2.b.b. The selection of a licensed and qualified designated wrap-up carrier having a record of compliance with the requirements of ch. 102, Stats., which is acceptable to the department. DWD 80.61(3)(c)2.c.c. Informing each contractor and subcontractor and each contractor’s and subcontractor’s insurance company either directly or through the bureau, at the bureau’s discretion, of each one’s responsibilities and the need for attaching a proper endorsement to the regular carrier’s policy to exclude coverage for the wrap-up job site. DWD 80.61(3)(c)2.d.d. The submission of each contractor’s and subcontractor’s application, on a form provided by the department, to the department prior to the time the contractor or subcontractor begins work on the wrap-up project. DWD 80.61 NoteNote: To obtain the form under this paragraph, contact the Department of Workforce Development, Worker’s Compensation Division, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin 53707 or call (608) 266-1340.
DWD 80.61(3)(c)2.e.e. The notification of department and bureau of any entity status change resulting from ensuing reorganization. DWD 80.61(3)(c)2.f.f. The assumption of responsibility for immediately making direct compensation payments if a dispute arises over coverage. DWD 80.61(3)(c)2.g.g. The payment of an employee’s attorney’s fees and lost wages resulting from a dispute. DWD 80.61(3)(c)3.3. If the owner is a corporation, it shall submit a certified copy of the resolution by the board of directors authorizing and directing the execution of the application and agreement. DWD 80.61(3)(c)4.4. If the owner is a subsidiary of a corporation, it shall submit a guaranty and agreement by the owner’s ultimate or top parent company agreeing to promptly satisfy all of the requirements and obligations assumed by the owner on the wrap-up project in case of default by the owner. DWD 80.61(3)(d)1.1. The designated wrap-up carrier shall submit an application on forms available from the department. If the application is approved, the department shall permit divided-insurance for each contractor and subcontractor scheduled to work on the wrap-up project. DWD 80.61 NoteNote: To obtain application forms, contact the Department of Workforce Development, Worker’s Compensation Division, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin 53707 or call (608) 266-1340.
DWD 80.61(3)(d)2.2. The designated wrap-up carrier shall comply with all conditions and agreements in the application, including, but not limited to: DWD 80.61(3)(d)2.a.a. Informing each contractor’s and subcontractor’s insurance company either directly or through the bureau, at the bureau’s discretion, of each one’s responsibilities and the need for attaching a proper endorsement to the regular carrier’s policy to exclude coverage for the wrap-up job site; DWD 80.61(3)(d)2.b.b. The issuance of each individual contractor’s and subcontractor’s wrap-up policy prior to the time the contractor and subcontractor begin work on the job site; DWD 80.61(3)(d)2.c.c. The notification of department and bureau of any entity status change resulting from ensuing reorganization; DWD 80.61(3)(d)2.d.d. Becoming the full risk insurer for any contractor or subcontractor not having purchased a worker’s compensation policy during the time the contractor or subcontractor is under contract on the wrap-up project, except as to an employer granted self-insurance; and DWD 80.61(3)(d)2.e.e. Becoming the full risk insurer for any contractor or subcontractor not insured or self-insured while working on the wrap-up project. DWD 80.61(3)(d)3.3. The designated wrap-up carrier shall submit a certified copy of a statement from an officer authorizing and directing the execution of the application and agreement. DWD 80.61(3)(e)(e) Application for contractors and subcontractors. The owner shall submit an application for divided insurance on forms available from the department for each contractor and subcontractor scheduled to work on the project. DWD 80.61(3)(em)(em) Waiver of requirements. The department may waive one or more requirements in pars. (b) to (e) if it determines that a waiver will not impair the construction owner’s ability to ensure minimum confusion about insurance coverage and maximum safety on the construction project site. DWD 80.61(3)(f)(f) Reimbursement for expenses incurred by department. The department shall be reimbursed for those expenses incurred because of the designated carrier wrap-up program. Where the department specifically consents to divided-insurance or partial-insurance on a wrap-up project, the owner shall reimburse the department, within 30 days after the date of a written request by the department, a sum determined by the department not to exceed 2% of the total audited worker’s compensation premium charged, with payment not to exceed 1% of the estimated worker’s compensation premium upon initial request. If an additional levy is determined to be necessary, a request shall be made for a sum that results in a total charge not to exceed 2% of the total audited worker’s compensation premium charged. DWD 80.61(3)(g)(g) Inapplicability to other employers. Subsection (3) does not apply to any group of employers other than those specified in this section on any other type of operations nor to any single contract or policy of insurance for any group or association of employers. DWD 80.61 HistoryHistory: Cr. Register, September, 1982, No. 321, eff. 10-1-82; am. (2) (a) 1., (3) (b) 3. and (3) (d) 3., r. and recr. (3) (e), Register, September, 1986, No. 369, eff. 10-1-86; am. (2) (a) 2. to (c), Register, April, 1990, No. 412, eff. 5-1-90; cr. (3) (em), Register, April, 1994, No. 460, eff. 5-1-94; CR 15-030: am. (3) (c) 1., 2. a. to f. Register October 2015 No. 718, eff. 11-1-15. DWD 80.62(1)(1) Purpose. The purpose of this section is to clarify the department’s procedures for handling claims for compensation to injured workers under s. 102.81 (1), Stats. This section also defines the financial standards and actuarial principles which the department will use to monitor the adequacy of the cash balance in the fund to pay both known claims and claims incurred but not reported under s. 102.81 (1), Stats. DWD 80.62(2)(a)(a) “Agent” means a third-party administrator or other person selected by the department to assist in the administration of the uninsured employers fund program. DWD 80.62(2)(b)(b) “Case reserve” means the best estimate documented in the claim-loss file of all liability to pay compensation on a claim under s. 102.81 (1), Stats. DWD 80.62(2)(c)(c) “Claim” means an injury suffered by an employee of an uninsured employer for which the uninsured employer is liable under s. 102.03, Stats., and which is reported to the department on a form approved by the department for reporting work-related injuries. DWD 80.62(2)(e)(e) “Incurred but not reported reserve” or “IBNR reserve” means the best actuarial estimate of liability to pay compensation under s. 102.81 (1), Stats., for injuries which occurred on or prior to the current accounting date, for which there is no claim yet reported to the department. DWD 80.62(2)(h)(h) “Ultimate reserve” means the best actuarial estimate of aggregate case reserves from all claims, the expected future development of claims that have been reported, and IBNR reserve. DWD 80.62(2)(i)(i) “Uninsured employer” means an employer who is subject to ch. 102, Stats., under s. 102.04 (1), Stats., and who has not complied with the duty to insure or to obtain an exemption from the duty to insure under s. 102.28 (2) or (3), Stats. DWD 80.62(3)(a)(a) In addition to the notice to an employer required under s. 102.12, Stats., an employee shall report a claim for compensation under s. 102.81, Stats., to the department on a form provided by the department within a reasonable time after the employee has reason to believe that an uninsured employer may be liable for the injury. DWD 80.62 NoteNote: To obtain a form to report a claim for compensation, contact the Department of Workforce Development, Worker’s Compensation Division, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin 53707 or call (608) 266-1340.
DWD 80.62(3)(b)(b) After receiving a claim under par. (a), the department shall determine whether the employer is an uninsured employer by reviewing its own records and the records maintained by the Wisconsin compensation rating bureau. Within 14 days after receiving a claim under par. (a), the department shall send the employer written notice that a claim has been reported and that the department has made an initial determination that the employer is, or is not, an uninsured employer with respect to the claimed injury. The department shall send a copy of the notice to the employee who filed the claim. If the department later modifies its initial determination regarding the employer’s insurance status with respect to a claim reported under this section, it shall promptly notify the employer and the employee of the reason for the modification and the likely impact of this change on the claim, if any. The employer shall notify its insurance carrier of any modification if the department determines that the employer is an insured employer. DWD 80.62(3)(c)(c) If the department determines that the employer is an uninsured employer it shall promptly seek reimbursement as provided in s. 102.82 (1), Stats., and additional payments to the fund as provided in s. 102.82 (2), Stats. The department may also initiate penalty proceedings under s. 102.85, Stats. If the department determines that the employer is not an uninsured employer it shall notify the parties and close the claim. Nothing in this section shall prevent the department from taking other appropriate action on a claim including penalties and interest due under ss. 102.16 (3), 102.18 (1) (b) and (bp), 102.22 (1), 102.35 (3), 102.57 and 102.60, Stats. DWD 80.62(4)(4) Paying a claim. Within 14 days after a claim is reported to the department, the department or its agent shall mail the first indemnity payment to the injured employee, deny the claim or explain to the employee who filed a claim the reason that the claim is still under review. The department or its agent shall report to the employee regarding the status of the claim at least once every 30 days from the date of the first notification that the claim is under review until the first indemnity payment is made or the claim is denied. DWD 80.62(5)(a)(a) An employee who makes a claim shall cooperate with the department or its agent in the investigation or payment of a claim. DWD 80.62(5)(b)(b) The department or its agent may deny compensation on a claim if an employee fails to provide reasonable assistance to the department or its agent, including recorded interviews, questionnaire responses, medical and other releases, copies of relevant payroll checks, check stubs, bank records, wage statements, tax returns or other similar documentation to identify the employer who may be liable for the injury under s. 102.03, Stats. The department or its agent may also require the employee to document any medical treatment, vocational rehabilitation services or other bills or expenses related to a claim. To verify information submitted in support of a claim for compensation the department or its agent may share information related to a claim with other governmental agencies, including those responsible for tax collection, unemployment insurance, medical assistance, vocational rehabilitation, family support or general relief. Any information obtained from a patient health care record or that may constitute a patient health care record will be shared only to the extent authorized by ss. 146.81 to 146.84, Stats. DWD 80.62(5)(c)(c) If an employee fails to cooperate as required by par. (b), the department may suspend action upon an application filed under s. 102.17 (1), Stats., or may issue an order to dismiss the application with or without prejudice. DWD 80.62(6)(6) Employer cooperation. An employer who is alleged to be uninsured shall cooperate with the department or its agent in the investigation of a claim by providing any records related to payroll, personnel, taxes, ownership of the business or its assets or other documents which the department or its agent request from the employer to determine the employer’s liability under s. 102.03, Stats. If an employer fails to provide information requested under this subsection, the department may presume the employer is an uninsured employer. DWD 80.62(7)(a)(a) The department may select one or more agents to assist the department in its administration of the uninsured employers program, including agents selected for any of the following: DWD 80.62(7)(a)2.2. To represent the legal interests of the uninsured employers fund and to make appearances on behalf of the uninsured employers fund in proceedings under ss. 102.16 to 102.29, Stats. DWD 80.62(7)(a)3.3. To seek reimbursement from employers under s. 102.82 (1), Stats., for payments made from the fund to or on behalf of employees or their dependents and for claims administration expenses. DWD 80.62(7)(a)5.5. To prepare reports, audits or other summary information related to the program. DWD 80.62(7)(a)6.6. To collect overpayments from employees or their dependents or from those to whom overpayments were made on behalf of employees or their dependents where benefits were improperly paid.
