Amendments To DWD 80 of the Wisconsin Administrative Code

PLAIN LANGUAGE SUMMARY 

EFFECTIVE July, 2004

  1. Supplementary Reports by Employers and Insurance Companies. Under the current rule self-insured employers and insurance carriers are required to submit supplemental reports only if the reported injury meets the definition of lost time under DWD 80.02(1)(a). This amendment will require self-insured employers and insurance companies to submit supplemental reports for all claims reported whether or not they meet the lost-time definition. The amendment will not require the reporting of no lost time or denied claims but will require the filing of supplemental reports for all claims that are reported. DWD 80.02(2)(b) of the Wisconsin Administrative Code.

  2. Written Notice by Employers and Insurance Carriers. This amendment will require self-insured employers and insurance carriers to provide notice of denial to the Worker's Compensation Division and employees for claims which are initially reported and paid but later denied. The current rule is inconsistent with the requirement to report only compensable claims. DWD 80.02(g)2 of the Wisconsin Administrative Code.

  3. Written Notice by Employers and Insurance Carriers. DWD 80.02(2)(h) of the Wisconsin Administrative Code is repealed. Under the current rule self-insured employers and insurance carriers are required to provide the Worker's Compensation Division with written notice related to denial or continued investigation of claims with copies of the report provided to employees. A new subsection will be created to cover this situation.

  4. Notice by Employers and Insurance Carriers to Employees. DWD 80.02(2M) of the Wisconsin Administrative Code is created. This amendment will clarify that notice of denial or investigation of claims is to be sent to the employee along with a statement advising the employee of the right to a hearing before the department. The notice of investigation will specify if additional medical or other information is needed to complete the investigation. This notice must be sent to the employee and is not required to be sent to the Worker's Compensation Division.

  5. Electronic Reporting. This amendment will permit the Worker's Compensation Division to require self-insured employers and insurance carriers to submit all or selected information in reports or amendments to reports to be filed via electronic, magnetic or other media satisfactory to the Worker's Compensation Division. Under the current rule self-insured employers and insurance carriers may request to submit required reports electronically but are not required to do so. This amendment will allow the Worker's Compensation Division discretion to require electronic reporting to help the self-insured employer or insurance carrier to meet reporting requirements. DWD 80.02(3m) of the Wisconsin Administrative Code.

  6. Payment of Permanent Disability. DWD 80.52 of the Wisconsin Administrative Code will be created to establish when a payment for compensation for permanent disability must begin in cases in which the self-insured employer or insurance carrier concedes liability but disputes the extent of permanent disability. Under this rule payment is to begin (1) within 30 days after the self-insured employer or insurance carrier receives a report which provides a permanent disability rating or, (2) within 30 days after receiving a report from an examination performed under s. 102.13(1)(a), Wis. Stats., in the amount of permanent disability found as a result of the examination and, (3) if no examination was previously performed the self-insured employer or insurance carrier must give notice of a request for an examination within 30 days of receiving a report which establishes permanent disability and payment must begin within 90 days of the request for the examination in the event the examining practitioner’s report is not available by that date.

  7. Uninsured Employers Fund. This amendment includes the right of the Worker's Compensation Division to seek reimbursement from a legally uninsured employers for payments made by the Uninsured Employers Fund for claims administration expenses. DWD 80.62(7)(a)3 of the Wisconsin Administrative Code.

  8. Notice of Cancellation or Termination. This amendment permits insurance carriers to give notice of cancellation or termination of insurance policies to the Wisconsin Compensation Rating Bureau by facsimile machine transmission, electronic mail or any electronic, magnetic or other medium approved by the Worker's Compensation Division. The current rule permits notice only by certified mail or personal service. The rule is amended to authorize notice by different means to comply with the amendment to s. 102.31(2)(a), Wis. Stats. DWD 80.65 of the Wisconsin Administrative Code.

  9. Reasonableness of Fee Disputes. This amendment requires self-insured employers and insurance carriers to raise disputes over liability or the extent of disability and give notice within 30 days after receiving a completed bill from a healthcare provider unless there is good cause for the delay in providing this notice. DWD 80.72(3)(a) of the Wisconsin Administrative Code.

  10. Necessity of Treatment. This amendment requires self-insured employers and insurance carriers to raise disputes over liability or the extent of liability and give notice within 60 days after receiving a bill from the healthcare provider unless there is good cause for the delay in providing this notice. DWD 80.73(3)(a) of the Wisconsin Administrative Code.