Ins 17.28(6s)(a) (a) This subsection implements s. 655.27 (3) (bg) 1., Stats., requiring the establishment of an automatic increase in a provider’s fund fee based on loss and expense experience.

Ins 17.28(6s)(b) (b) In this subsection:

Ins 17.28(6s)(b)1. 1. “Aggregate indemnity” has the meaning given under s. Ins 17.285 (2) (a).

Ins 17.28(6s)(b)2. 2. “Closed claim” has the meaning given under s. Ins 17.285 (2) (b).

Ins 17.28(6s)(b)3. 3. “Provider” has the meaning given under s. Ins 17.285 (2) (d).

Ins 17.28(6s)(b)4. 4. “Review period” has the meaning given under s. Ins 17.285 (2) (e).

Ins 17.28(6s)(c) (c) The following tables shall be used in making the determinations required under s. Ins 17.285 as to the percentage increase in a provider’s fund fee:

Ins 17.28(6s)(c)1. 1. For a class 1 physician or a nurse anesthetist:

Ins 17.28(6s)(c)2. 2. For a class 2 physician:

Ins 17.28(6s)(c)3. 3. For a class 3 physician:

Ins 17.28(6s)(c)4. 4. For a class 4 physician:

Ins 17.28 Note Note: For a complete history of s. Ins 17.28 from June 1980 through August 31, 2000, see the History note following s. Ins 17.28 published in Register August 2000 No. 536.

Ins 17.28 History History: Cr. Register, June, 1980, No. 294, emerg. r. and recr. (6) and am. (6a), eff. 7-1-00; r. and recr. (6) and am. (6a), Register, August, 2000, No. 536, eff. 9-1-00; emerg. r. and recr. (6) and am. (6a), eff. 7-1-01; CR 01-035: r. and recr. (6) and am. (6a), Register September 2001 No. 549, eff. 10-1-01; emerg. r. and recr. (6), r. (6a), eff. 7-1-02; CR 02-035: r. and recr. (6), r. (6a), Register September 2002 No. 561, eff. 10-1-02; CR 03-039: r. and recr. (6) Register October 2003 No. 574, eff. 11-1-03; CR 04-032: r. and recr. (6) Register January 2005 No. 589, eff. 2-1-05; emerg. r. and recr. (6), eff. 7-1-05; CR 05-028: r. and recr. (6) Register October 2005 No. 598, eff. 11-1-05; CR 06-002: am. (3) (c) 1. and 2. and r. and recr. (6) Register June 2006 No. 606, eff. 7-1-06; CR 07-002: am. (6), Register June 2007 No. 618, eff. 7-1-07; CR 07-002: am. (6e), Register June 2007 No. 618, eff. 7-1-07; CR 08-006: am. (6) (intro.), (k) 2., (L) 2., (m) 2., (n) 3. and (q) 2. Register June 2008 No. 630, eff. 7-1-08; CR 09-004: am. (3) (c), r. and recr. (6) Register June 2009 No. 642, eff. 7-1-09; correction in (6) (o) made under s. 13.92 (4) (b) 7., Stats., Register June 2009 No. 642; CR 09-055: cr. (3h) Register March 2010 No. 651, eff. 4-1-10; EmR1020: emerg. r. and recr. eff. 6-15-10; CR 10-065: r. and recr. Register November 2010 No. 659, eff. 12-1-10; correction in (6) (o) made under s. 13.92 (4) (b) 7., Stats., Register November 2010 No. 659; EmR1108: emerg. am. (3) (c), r. and recr. (6) eff. 6-10-11; CR 11-015: am. (3) (c), r. and recr. (6) and Register August 2011 No. 668, eff. 9-1-11; EmR1306: emerg. am. (3) (c) 1. to 3., r. and recr. (6), eff. 6-3-13; CR 13-044: am. (3) (c) 1. to 3., r. and recr. (6) Register June 2014 No. 702, eff. 7-1-14; CR 19-119 am. (3) (c) 1. to 3., (4) (f) Register July 2020 No. 775, eff. 8-1-20.

Ins 17.285 Ins 17.285 Peer review council.

Ins 17.285(1) (1) Purpose. This section implements ss. 619.04 (5) (b) and (5m) (b), 655.27 (3) (a) 2m. and (bg) 2. and 655.275, Stats.

Ins 17.285(2) (2) Definitions. In this section:

Ins 17.285(2)(a) (a) “Aggregate indemnity” means the total amount attributable to an individual provider that is paid or owing to or on behalf of claimants for all closed claims arising out of one incident or course of conduct, including amounts held by the fund under s. 655.015, Stats. “Aggregate indemnity” does not include any expenses paid in the defense of the claim.

Ins 17.285(2)(b) (b) “Closed claim” means a medical malpractice claim against a provider, or a claim against an employee of a health care provider for which the provider is vicariously liable, for which there has been either of the following:

Ins 17.285(2)(b)1. 1. A final determination based on a settlement, award or judgment that indemnity will be paid to or on behalf of a claimant.

Ins 17.285(2)(b)2. 2. A payment to a claimant by the provider or another person on the provider’s behalf.

Ins 17.285(2)(c) (c) “Council” means the peer review council appointed under s. 655.275, Stats.

Ins 17.285(2)(cg) (cg) “Health care provider” has the meaning given in s. 146.81 (1), Stats.

Ins 17.285(2)(cr) (cr) “Patient health care records” has the meaning given in s. 146.81 (4), Stats.

Ins 17.285(2)(d) (d) “Provider,” when used without further qualification, means a health care provider subject to ch. 655, Stats., who is a natural person. “Provider” does not include a hospital or other facility or entity that provides health care services.

Ins 17.285(2)(e) (e) “Review period” means the 5-year period ending with the date of the first payment on the most recent closed claim reported under s. 655.26, Stats., for a specific provider.

Ins 17.285(2)(f) (f) “Surcharge” means the automatic increase in a provider’s plan premium or fund fee established under s. Ins 17.25 (12m) or 17.28 (6s) or both.

Ins 17.285(2m) (2m) Time for reporting. In reporting claims paid under s. 655.26, Stats., each insurer or self-insurer shall report the required information by the 15th day of the month following the date on which there has been a final determination of the aggregate indemnity to be paid to or on behalf of any claimant.

Ins 17.285(2s) (2s) Information for provider. Upon receipt of a report under sub. (2m), the council shall mail to the provider who is the subject of the report all of the following:

Ins 17.285(2s)(a) (a) A copy of the report, with a statement that the provider may contact the insurer that filed the report if the provider believes it contains inaccurate information.