AMENDMENTS TO THE WORKER'S COMPENSATION ACT

PLAIN LANGUAGE SUMMARY 2003 Wisconsin Act 144

EFFECTIVE MARCH 30, 2004

  1. Physician Assistants and Advance Practice Nurse Prescribers. Physician Assistants and Advance Practice Nurse Prescribers are included as practitioners who employers and insurance carriers can select to conduct examinations on employees. s.102.13(1)(a), (b)&(d), Wis. Stats.
  2. Access to information or Written Material. This amendment includes Physician Assistants and Advanced Practice Nurse Prescribers as practitioners who must provide reports reasonably related to worker's compensation claims upon request. s.102.13(2)(a)(b), Wis. Stats.
  3. Minimum Threshold for Reasonableness of Fee Disputes. This amendment creates a minimum $25.00 threshold amount for utilizing the Reasonableness of Fee Dispute Resolution process. The minimum $25.00 amount may be based on a single charge or a combination of charges for one or more dates of service. There is no minimum threshold amount after treatment provided to the employee for the injury by the health service provider has ended. s.102.16(2)(a)(am), Wis. Stats.
  4. Standard Deviation for Determining Reasonableness of Fee Disputes. The Standard Deviation is reduced from 1.5 to 1.4 for determining Reasonableness of Fee Disputes. s.102.16(2)(d), Wis. Stats.
  5. Extension of Time for Modifying Reasonableness of Fee Decisions. This amendment will give the Department an additional 30 days (60 total days) to set aside, reverse or modify a Reasonableness of Health Service Fee Determination on the grounds of mistake. s.102.16(2)(f), Wis. Stats.
  6. Minimum Threshold for Necessity of Treatment Disputes. This amendment creates a minimum $25.00 threshold amount of utilizing the Necessity of Treatment Dispute Resolution process. The minimum $25.00 amount may be based on a single charge or a combination of charges for one or more dates of service. There is no minimum threshold amount after treatment to the employee for the injury by the health service provider has ended. s.102.16(2)(m)(a)(am), Wis. Stats.
  7. Extended Time for Modifying Necessity of Treatment Determination. This amendment provides an additional 30 days (60 days total) for the Department to set aside, reverse or modify a necessity of treatment determination on grounds of mistake. s.102.16(2m)(e), Wis. Stats.
  8. Certified Reports. This amendment adds physician assistants and advance practice nurse prescribers as practitioners who can complete certified medical reports. Physician assistants and advanced practice nurse prescribers are given the same status as dentists to prepare certified reports. Certified reports by dentists, physicians assistants and advance practice nurse prescribers are admissible as evidence of the diagnosis and necessity of treatment but not of the cause and extent of disability. s.102.17(1)(d), Wis. Stats.
  9. Uniform 21-Day Payment Standard. This amendment clarifies that in cases where orders awarding a portion of the benefits claimed, and the order is appealed by the employee, and the order is appealed by the employee, the insurance carrier or self-insured employer is required to pay the undisputed/uncontested amount within 21 days rather than after the appeal is resolved. s.102.18(1)(b), Wis. Stats.
  10. Examination Autopsy or Opinion. This is a technical amendment by the drafter to modernize the language in this section. s.102.17(1)(g), Wis. Stats.
  11. Malpractice Actions. This amendment ads physician assistants and advance practice nurse prescribers as practitioners employees may maintain a civil action against for malpractice. s.102.29(3), Wis. Stats.
  12. Notice of Cancellation or Termination. This amendment permits insurance carriers to give notice of cancellation or termination of a policy to the Wisconsin Compensation Rating Bureau by certified mail, facsimile machine transmission, electronic mail or any other medium approved by the Department. s.102.31(2)(a), Wis. Stats.
  13. Payment of Permanent Partial Disability. This amendment clarifies the requirements for the prompt payment of compensation for permanent partial disability. Where permanent partial disability is based on a minimum rating set by Department rule payment is to begin within 30 days after the end of the employee's healing period. In situations where the extent of permanent partial disability cannot be determined without a medical report that provides the basis for a minimum permanent disability rating, payment shall begin within 30 days after the employer or insurance carrier receives a medical report that provides a basis for a permanent partial disability rating. The Department shall promulgate a rule for determining when compensation for permanent disability shall begin in cases where the employer or insurance carrier concedes liability but disputes the extent of permanent partial disability. s.102.32(6), Wis. Stats.
  14. Advance Payment. This amendment clarifies that the Department may direct advance payment of death benefits or of unaccrued compensation for permanent partial disability. s.102.32(6m), Wis. Stats.
  15. Waiver or Reduction of Forfeitures.  The Department by this amendment may waive or reduce a forfeiture on the grounds that it was imposed due to a mistake or an absence of information if the employer or worker's compensation insurance carrier a waiver or reduction within 45 days after notice of the forfeiture is mailed by the Department. s.102.35(1), Wis. Stats.
  16. The Employee Choice of Treating Practitioner. This amendment permits employee's to select physician assistants and advance practice nurse prescribers licensed to practice and practicing in Wisconsin to provide treatment for injuries. s.102.42(2)(a), Wis. Stats.
  17. Supplemental Benefits. The maximum supplemental benefit rate is increased by this amendment from $202.00 per week to $233.00 per week for injuries occurring before May 13, 1980 and payable for weeks of disability beginning March 30, 2004. s.102.44(1), Wis. Stats.
  18. Payment to State Fund-Death Claim. The payment (assessment) to the Work Injury Supplemental Benefit Fund by employers and worker's compensation insurance carriers for injuries resulting in death is increased from $5,000.00 to $10,000.00. s.102.49(5)(a), Wis. Stats.
  19. Payments to State Fund-Injuries resulting in dismemberment. The payment (assessment) to the Work Injury Supplemental Benefit Fund by employers and worker's compensation insurance carriers is increased from $7,000.00 to $10,000.00. s. 102.59(2), Wis. Stats.
  20. Uninsured Employers Fund. This is a technical amendment which included a reference to payments on behalf of the injured employee or to the employees dependents. s. 102.81(1)(a), Wis. Stats.
  21. Reimbursement by Uninsured Employer. This amendment authorizes the Department to claim reimbursement from uninsured employers for claims administration expenses paid by the Department in addition to all payments made to or on behalf of employees or to employee's dependents. s.102.82(1), Wis. Stats.