Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 17 - Health Care Liability Insurance Patients Compensation Fund
Section Ins 17.26 - Payments for future medical expenses
Universal Citation: WI Admin Code ยง Ins 17.26
Current through August 26, 2024
(1) PURPOSE. This section implements s. 655.015, Stats.
(3) DEFINITIONS. In this section:
(a) "Account" means a portion of the
fund allocated specifically for the medical expenses of an injured
person.
(b) "Claimant" means the
injured person, the individual legally responsible for the injured person's
medical expenses or the injured person's legal representative.
(c) "Medical expenses" means charges for
medical services, nursing services, medical supplies, drugs and rehabilitation
services that are incurred after the date of a settlement, panel award or
judgment.
(4) ADMINISTRATION.
(a) If a settlement or
judgment is subject to s.
655.015,
Stats., the insurer or other person responsible for payment shall, within 30
days after the date of the settlement or judgment, pay the fund the amount in
excess of $100,000 and shall provide the fund with an executed copy of the
document setting forth the terms under which payments for medical expenses are
to be made.
(b) The fund shall
credit each account with a proportional share of any interest earned by the
fund, based on the remaining value of the account at the time the investment
board declares the interest earnings. The fund shall maintain an individual
record of each account as provided in s.
16.41,
Stats.
(c) Upon receipt of a
claimant's request for reimbursement of medical expenses, the fund, after
determining that the supplies or services provided were necessary and
incidental to the injury sustained by the injured person and that the provider
of the supplies or services has actually been paid, shall pay the claim from
the appropriate account.
(d)
1. If the fund is not satisfied that a
provider has actually been paid for services or supplies provided to an injured
person, the fund may make payments jointly to the claimant and the
provider.
2. A claimant may, in
writing, authorize direct payment to a provider.
(e) The fund shall at least annually report
to each claimant the status of the injured person's account, including the
original amount, payments made since the last report and the balance
remaining.
(f) If an injured person
dies and there is a balance in his or her account, the balance shall revert to
the insurer or other person responsible for establishing the account.
See the table of Appellate Court Citations for Wisconsin appellate cases citing s. Ins 17.26.
Disclaimer: These regulations may not be the most recent version. Wisconsin may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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