102.16 Submission of disputes, contributions by employees.

1,296 words·~6 min read·/wi/chapter-102/102-16

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)Any controversy concerning compensation or a violation of sub.

(3), including a controversy in which the state may be a party, shall be submitted to the department in the manner and with the effect provided in this chapter.

(b)A compromise of any claim for compensation may be reviewed and set aside, modified, or confirmed by the department within one year after the date on which the compromise is filed with the department, the date on which an award has been entered based on the compromise, or the date on which an application for the department to take any of those actions is filed with the department.

(d)Unless the word “compromise” appears in a stipulation of settlement, the settlement shall not be considered a compromise, and further claim is not barred except as provided in s. 102.17

(4)regardless of whether an award is made. The employer, insurer, or dependent under s. 102.51

(5)shall have equal rights with the employee to have a compromise or any other stipulation of settlement reviewed under this subsection. Upon petition filed with the department under this subsection, the department may set aside the award or otherwise determine the rights of the parties.

(e)A payment pursuant to a compromise agreement, including the full amount of any lump sum payment, may be made directly to the employee and need not be paid into an account at a credit union, savings bank, savings and loan association, bank, or trust company.

(a)If an insurer or self-insured employer concedes by compromise under sub.

(1)or stipulation under s. 102.18

(a)that the insurer or self-insured employer is liable under this chapter for any health services provided to an injured employee by a health service provider, but disputes the reasonableness of the fee charged by the health service provider, the department may include in its order confirming the compromise or stipulation a determination made by the department under sub.

(2)as to the reasonableness of the fee or, if such a determination has not yet been made, the department may notify, or direct the insurer or self-insured employer to notify, the health service provider under sub.

(b)that the reasonableness of the fee is in dispute. The department shall deny payment of a health service fee that the department determines under sub.

(2)to be unreasonable. A health service provider and an insurer or self-insured employer that are parties to a fee dispute under this paragraph are bound by the department’s determination under sub.

(2)on the reasonableness of the disputed fee, unless that determination is set aside, reversed, or modified by the department under sub.

(f)or is set aside on judicial review as provided in sub.

(f).

Effective date note NOTE: Par.

(a)is amended by 2025 Wis. Act 15 eff. on the day after the notice from the department of health services under 2025 Wis. Act 15 s. 9119

(b)1 . is published by the legislative reference bureau in the Wisconsin Administrative Register, except that, if the notice is not published before 8-1-27, the treatment of par.

(a)by 2025 Wis. Act 15 is void. As amended by 2025 Wis. Act 15 , par.

(a)reads:

Effective date text

(a)If an insurer or self-insured employer concedes by compromise under sub.

(1)or stipulation under s. 102.18

(a)that the insurer or self-insured employer is liable under this chapter for any health services provided to an injured employee by a health service provider, but disputes the fee charged by the health service provider, the department may include in its order confirming the compromise or stipulation a determination made by the department under sub.

(2)as to the fee or, if such a determination has not yet been made, the department may notify, or direct the insurer or self-insured employer to notify, the health service provider under sub.

(b)that the fee is in dispute. The department shall deny payment of a health service fee that the department determines is unreasonable or not allowable under sub. (2). A health service provider and an insurer or self-insured employer that are parties to a fee dispute under this paragraph are bound by the department’s determination under sub.

(2)on the fee, unless that determination is set aside, reversed, or modified by the department under sub.

(f)or is set aside on judicial review as provided in sub.

(2)(f).

(b)If an insurer or self-insured employer concedes by compromise under sub.

(1)or stipulation under s. 102.18

(a)that the insurer or self-insured employer is liable under this chapter for any treatment provided to an injured employee by a health service provider, but disputes the necessity of the treatment, the department may include in its order confirming the compromise or stipulation a determination made by the department under sub.

(2m)as to the necessity of the treatment or, if such a determination has not yet been made, the department may notify, or direct the insurer or self-insured employer to notify, the health service provider under sub.

(b)that the necessity of the treatment is in dispute. Before determining under sub.

(2m)the necessity of treatment provided to an injured employee, the department may, but is not required to, obtain the opinion of an expert selected by the department who is qualified as provided in sub.

(c). The standards promulgated under sub.

(g)shall be applied by an expert and by the department in rendering an opinion as to, and in determining, necessity of treatment under this paragraph. In cases in which no standards promulgated under sub.

(g)apply, the department shall find the facts regarding necessity of treatment. The department shall deny payment for any treatment that the department determines under sub.

(2m)to be unnecessary. A health service provider and an insurer or self-insured employer that are parties to a dispute under this paragraph over the necessity of treatment are bound by the department’s determination under sub.

(2m)on the necessity of the disputed treatment, unless that determination is set aside, reversed, or modified by the department under sub.

(e)or is set aside on judicial review as provided in sub.

(e).

(c)If an insurer or self-insured employer concedes by compromise under sub.

(1)or stipulation under s. 102.18

(a)that the insurer or self-insured employer is liable under this chapter for the cost of a prescription drug dispensed under s. 102.425

(2)for outpatient use by an injured employee, but disputes the reasonableness of the amount charged for the prescription drug, the department may include in its order confirming the compromise or stipulation a determination made by the department under s. 102.425

(4m)as to the reasonableness of the prescription drug charge or, if such a determination has not yet been made, the department may notify, or direct the insurer or self-insured employer to notify, the pharmacist or practitioner dispensing the prescription drug under s. 102.425

(b)that the reasonableness of the prescription drug charge is in dispute. The department shall deny payment of a prescription drug charge that the department determines under s. 102.425

(4m)to be unreasonable. A pharmacist or practitioner and an insurer or self-insured employer that are parties to a dispute under this paragraph over the reasonableness of a prescription drug charge are bound by the department’s determination under s. 102.425

(4m)on the reasonableness of the disputed prescription drug charge, unless that determination is set aside, reversed, or modified by the department under s. 102.425

(e)or is set aside on judicial review as provided in s. 102.425

(e).