Wisconsin Employers for Equitable Worker’s Compensation

A coalition in support of an equitable workers’ compensation system

WEEWC Outlines 2017-18 Agreed Bill Goals

The 2017-2018 agreed bill cycle is shaping up to be one of the most pivotal in Wisconsin’s pioneering worker’s compensation history. A fee schedule to bring medical charges in line with the rest of the nation is a real possibility, along with controls on treatment that will ensure quality care without runaway bills or unnecessary disability. Disability rates, the statute of limitations, and which injured workers are eligible for permanent disability compensation are all on the table for potential changes.

It has never been more important for employers to get involved.

Medical Cost Containment and Treatment Guidelines

Wisconsin Employers for Equitable Worker’s Compensation (WEEWC) supports a four-part proposal for cost containment and medical treatment guidelines. The proposal will be presented to the Worker’s Compensation Advisory Council by the management caucus at the May meeting.

The proposal establishes a medical fee schedule tied to established Medicaid rates, creating a fair, predictable mechanism for controlling the cost of medical care. The fee schedule would include a 50-percent “upper,” a percentage markup above the Medicaid rate to fairly compensate medical providers for quality care.

Current law allows for disputes of medical fees, defining “reasonable” fees as those that are no more than .8 standard deviations above the mean fee for the service or procedure being billed. That mean is determined using one of several state-certified databases, which rely on actual billing practices of medical providers. According to the Worker’s Compensation Research Institute (WCRI), this process results in medical fees for worker’s compensation claims in Wisconsin that are as much as 300 percent greater than most other states. Wisconsin’s medical costs are greater than other states studied, and have consistently increased more dramatically, according to the WCRI.

Wisconsin is one of just six states that do not have a medical fee schedule for worker’s compensation.

Along with the fee schedule, the proposal establishes meaningful treatment guidelines that give employers and medical providers a consistent set of best practices for handling worker’s compensation injuries. These guidelines would be based on nationally-recognized best practices established by occupational health providers.

Employers gain another level of certainty under a directed care element of the proposal. This would establish a system of identifying effective occupational health providers, and allowing employers to direct injured workers to providers in this pool. Directed care may be limited to the first 90 days following an injury, or another period yet to be determined.

Finally, the proposal calls for administrative efficiencies aimed at expediting communication and saving costs for employers and medical providers alike. These efficiencies may include bill payment timeframes, electronic records and reduced fee disputes.

Statute of Limitations

In 2016, the worker’s compensation act was changed to include a carve-out of the 12-year statute of limitations for “traumatic” injuries, reducing the statute for those injuries to six years. However, the statute of limitations remains 12 years for “occupational” injuries and diseases. The bar for proving an occupational injury is low – requiring that an employee show only that the work exposure was a causative factor in the condition. The shortened statute is so easily defeated, the change is effectively meaningless.

WEEWC supports a true reduction in the statute of limitations to two years, with a carve-out only for true toxic exposures. Diseases like silicosis and mesothelioma can certainly be due to workplace exposures, and take years to incubate. Allowing these claims years after the end of employment is the right thing to do. Paying for treatment of degenerative joint disorders years after the end of any work exposure is unfair.

Wisconsin employers interested in the agreed bill cycle, and in a fair worker’s compensation environment in our state, have a voice through WEEWC.

For more information on WEEWC contact John Tindall at jtindall@intrisksolutions.com.