DWD 80.73(7)(e) (e) The provider, insurer or self-insurer shall have 30 days from the date the expert’s opinion is received by the department under par. (d) to present written evidence to the department that the expert’s opinion is in error. Unless the department receives clear and convincing written evidence that the opinion is in error, the department shall adopt the written opinion of the expert as the department’s determination on the issues covered in the written opinion.

DWD 80.73(7)(f) (f) If the necessity of treatment dispute involves a claim for which an application for hearing is filed under s. 102.17, Stats., or an injury for which the insurer or self-insurer disputes the cause of the injury, the extent of the disability, or other issues which could result in an application for hearing being filed, the department may delay resolution of the necessity of treatment dispute until a hearing is held or an order is issued resolving the dispute between the injured employee and the insurer or self-insurer.

DWD 80.73(8) (8) Payment of costs.

DWD 80.73(8)(a) (a) The department shall charge the insurer or self-insurer the full cost of obtaining the written opinion of the expert for the first dispute involving the necessity of treatment rendered by an individual provider, unless the department determines the provider’s position in the dispute is frivolous or based on fraudulent representations.

DWD 80.73(8)(b) (b) In a subsequent dispute involving the same provider, the department shall charge the full cost of obtaining the expert’s opinion to the losing party.

DWD 80.73(8)(c) (c) Any time prior to the department’s order determining the necessity of treatment, the department shall dismiss the application if the provider and insurer or self-insurer mutually agree on the necessity of treatment and the payment of any costs incurred by the department related to obtaining the expert opinion.

DWD 80.73(9) (9) Department initiative. In addition to the provider’s right to submit a dispute to the department under sub. (6), the department may initiate resolution of a dispute on necessity of treatment when requested to do so by an injured worker, an insurer or a self-insurer. The department shall notify the insurer or self-insurer of its intention to initiate the dispute resolution process and shall direct them to provide information necessary to resolve the dispute. The department shall allow up to 60 days for the parties to respond, but may extend the response period at the request of either party.

DWD 80.73(10) (10) Expert panels. The department may establish one or more panels of experts in one or more treating disciplines, and may set the terms and conditions for membership on any panel. In making appointments to a panel the department shall consider:

DWD 80.73(10)(a) (a) An individual’s training and experience, including:

DWD 80.73(10)(a)1. 1. The number of years of practice in a particular discipline;

DWD 80.73(10)(a)2. 2. The extent to which the individual currently derives his or her income from an active practice in a particular discipline; and,

DWD 80.73(10)(a)3. 3. Certification by boards or other organizations;

DWD 80.73(10)(b) (b) The recommendation of organizations that regulate or promote professional standards in the discipline for which the panel is being created; and,

DWD 80.73(10)(c) (c) Any other factors that the department may determine are relevant to an individual’s ability to serve fairly and impartially as a member of an expert panel.

DWD 80.73(11) (11) Applicability. This section first applies to health services provided on January 1, 1992, and shall take effect on July 1, 1992.

DWD 80.73 History History: Emerg. cr. eff. 1-1-92; cr. Register, June, 1992, No. 438, eff. 7-1-92; CR 03-125: am. (3) (a) (intro.) Register June 2004 No. 582, eff. 7-1-04; CR 07-019: am. (2) (d), Register October 2007 No. 622, eff. 11-1-07; CR 15-030: am. (3) (a) 1. to 7., (6) (f) Register October 2015 No. 718, eff. 11-1-15.