Ins 17.26(4)(a) (a) If a settlement or judgment is subject to s. 655.015, Stats., the insurer or other person responsible for payment shall, within 30 days after the date of the settlement or judgment, pay the fund the amount in excess of $100,000 and shall provide the fund with an executed copy of the document setting forth the terms under which payments for medical expenses are to be made.

Ins 17.26(4)(b) (b) The fund shall credit each account with a proportional share of any interest earned by the fund, based on the remaining value of the account at the time the investment board declares the interest earnings. The fund shall maintain an individual record of each account as provided in s. 16.41, Stats.

Ins 17.26(4)(c) (c) Upon receipt of a claimant’s request for reimbursement of medical expenses, the fund, after determining that the supplies or services provided were necessary and incidental to the injury sustained by the injured person and that the provider of the supplies or services has actually been paid, shall pay the claim from the appropriate account.

Ins 17.26(4)(d) (d)

Ins 17.26(4)(d)1. 1. If the fund is not satisfied that a provider has actually been paid for services or supplies provided to an injured person, the fund may make payments jointly to the claimant and the provider.

Ins 17.26(4)(d)2. 2. A claimant may, in writing, authorize direct payment to a provider.

Ins 17.26(4)(e) (e) The fund shall at least annually report to each claimant the status of the injured person’s account, including the original amount, payments made since the last report and the balance remaining.

Ins 17.26(4)(f) (f) If an injured person dies and there is a balance in his or her account, the balance shall revert to the insurer or other person responsible for establishing the account.

Ins 17.26 History History: Cr. Register, November, 1976, No. 251, eff. 12-1-76; renum. from Ins 3.37, Register, July, 1979, No. 283, eff. 8-1-79; am. (3), r. (4) (b) and (f), renum. (4) (d), (e), (g) and (h) to be (4) (e) (b), (d) and (f) and am., Register, April, 1984, No. 340, eff. 5-1-84; am. (1), (3) (a) to (c) and (4), r. (2), Register, June, 1990, No. 414, eff. 7-1-90; emerg. am. (4) (a), eff. 5-28-96; am. (4) (a), Register, September, 1996, No. 489, eff. 10-1-96.

Ins 17.26 Note Note: See the table of Appellate Court Citations for Wisconsin appellate cases citing s. Ins 17.26.

Ins 17.27 Ins 17.27 Filing of financial report.

Ins 17.27(1) (1) Purpose. This section implements s. 655.27 (3) (b), (4) (d) and (5) (e), Stats., for the purpose of setting standards and techniques for accounting, valuing, reserving and reporting of data relating to the financial transactions of the fund.

Ins 17.27(2) (2) Definitions. In this section:

Ins 17.27(2)(a) (a) “Amounts in the fund,” as used in s. 655.27 (5) (e), Stats., means the sum of cash and invested assets as reported in a financial report under sub. (3).

Ins 17.27(2)(b) (b) “Fiscal year,” as used in s. 655.27 (4) (d), Stats., means a year commencing July 1 and ending June 30.

Ins 17.27(3) (3) Financial reports. The board shall furnish the commissioner with the financial report required by s. 655.27 (4) (d), Stats., within 60 days after the close of each fiscal year. In addition, the board shall furnish the commissioner with quarterly financial reports prepared as of September 30, December 31 and March 31 of each year within 60 days after the close of each reporting period. The board shall prescribe the format for preparing financial reports in accordance with statutory accounting principles for fire and casualty companies. Reserves for reported claims and reserves for incurred but not reported claims shall be maintained on a present value basis with the difference from full value being reported as a contra account to the loss reserve liability. Mediation fund fees collected under s. Ins 17.01 shall be indicated in the financial reports but shall not be regarded as assets or liabilities or otherwise taken into consideration in determining assessment levels to pay claims.

Ins 17.27(4) (4) Selection of actuaries. The board shall select one or more actuaries to assist in determining reserves and setting fees under s. 655.27 (3) (b), Stats. If more than one actuary is selected, the board members named by the Wisconsin medical society and the Wisconsin hospital association shall jointly select the 2nd actuary.

Ins 17.27 History History: Cr. Register, June, 1980, No. 294, eff. 7-1-80; am. (1), (2) (a) and (b) to (4), cr. (2) (intro.), Register, June, 1990, No. 414, eff. 7-1-90.

Ins 17.275 Ins 17.275 Claims information; confidentiality.

Ins 17.275(1) (1) Purpose. This section interprets ss. 19.35 (1) (a), 19.85 (1) (f), 146.82, 655.26 and 655.27 (4) (b), Stats.

Ins 17.275(2) (2) Open records; privileged or confidential fund records. Except as provided in s. 601.427 (7), Stats., records of the fund are subject to subch. II of ch. 19, Stats., and are open to inspection as required under subch. II of ch. 19, Stats. The fund may withhold and retain as confidential any record which may be withheld and retained as confidential under subch. II of ch. 19, Stats., including, but not limited to, a record which may be withheld or which is privileged under any law or the rules of evidence, as attorney work product under the rules of civil procedure, as attorney-client privileged material under s. 905.03, Stats., as a medical record under ss. 146.81 to 146.84, Stats., or as privileged under s. 601.465, Stats.

Ins 17.275(3) (3) Definition. In this section, “confidential claims information” means any document or information relating to a claim against a plan-insured health care provider in the possession of the commissioner, the board or an agent thereof, including claims records of the plan.

Ins 17.275(4) (4) Disclosure. Confidential claims information may be disclosed only as follows:

Ins 17.275(4)(a) (a) To the medical examining board as provided under s. 655.26, Stats.

Ins 17.275(4)(b) (b) As needed by the peer review council, consultants and the board under s. 655.275, Stats., and rules promulgated under that section.

Ins 17.275(4)(c) (c) As provided under s. 804.01, Stats.

Ins 17.275(4)(d) (d) To an individual, organization or agency required by law or designated by the commissioner or board to conduct a management or financial audit.

Ins 17.275(4)(e) (e) With a written authorization from the plan-insured health care provider on whose behalf the claim was defended or paid.

Ins 17.275(4)(f) (f) To the risk manager for the fund, as needed to perform the duties specified in its contract. The risk manager may not disclose confidential claims information to any 3rd party, unless the board expressly authorizes the disclosure. The board may authorize disclosure of patient health care records subject to ss. 146.81 to 146.84, Stats., only as provided in those sections.