California Workers' Compensation Division Changes How Physicians Calculate Fees for Medical-Legal Evaluations
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California Workers' Compensation Division Changes How Physicians Calculate Fees for Medical-Legal Evaluations

Key Takeaways

  • Physicians can now charge $3 per page for every page over 200 when reviewing records during a medical-legal evaluation

  • Litigation strategies will have to change to save cost

 

The California Department of Industrial Relations’ Division of Workers’ Compensation’s new Medical-Legal Fee Schedule became effective on April 1, 2021. This fee schedule has changed how physicians calculate fees and adds additional requirements to medical-legal evaluations. These changes apply to every evaluation after the effective date.

WHAT CHANGES WERE MADE IN REGARDS TO RECORDS PRODUCTION?

As of now, when records are produced for a physician’s review, they must be accompanied by a declaration that states the attorney has complied with Labor Code § 4062.3. To comply with § 4062.3, the records produced must be relevant to the determination of the medical issue and the parties must have come together to decide what documents are produced. In addition, the declaration must contain an attestation as to the total page count of the documents provided. The number of pages matters due to the new fee schedule limiting the number of pages that can be produced without additional charges up to 200 pages. Now physicians can charge $3 per page for every page reviewed over 200 pages. Additionally, if a declaration and attestation are not presented with the records, the physician will not review the records.

WHY WERE THE CHANGES MADE?

The Division sees a flat-rate system of billing as an easy system to follow. It believes that attorneys can figure out how much record review will cost simply based on the amount of pages that are produced.

WHAT DOES THIS MEAN?

Attorneys need to be more concerned about what documents are sent to physicians to review. As cost can easily rise with the new $3 per page over 200 rule. Huge voluminous records should no longer be sent for review. Clients should not have to foot the bill for excessive record review fees, especially if records include documents not relevant to the examination at issue.

Attorneys will have to tailor the records to only documents that are deemed relevant. To comply with §  4062.3, applicant and defense attorneys will need to collaborate to ensure they both sign off on the records that are produced. They both need to be conscious of the amount of pages to avoid excessive fees. Neither should dump a large volume of records on the physician at the medical-legal evaluation without suffering fees. This may lead to a more conservative approach to record production at medical-legal evaluations. Having a signed and/or written agreement with opposing counsel on what will be provided to selected physicians will be cost effective, and help reduce the litigation over what does and does not get sent to doctors.

As new regulations become effective and the legal market changes, we will continue to stay knowledgeable on new developments.

If you have any questions about these changes or how they impact your business, please contact: