Grinberg: The New Med-Authorized Payment Schedule| Employees Compensation Information

By Gregory Grinberg

Thursday, April 8, 2021 | 64 | 0

This or our swampland is full of the new fee schedule issued by the Workers’ Compensation Department, and I would like to share some of the highlights with you.

Gregory Grinberg

The rules went into effect on the unfortunate April 1, which resulted in them being largely dismissed as a joke. That was, of course, until the sun rose on April 2nd and they were still in effect.

Note that the new rules will apply to assessments, certificates and reports requested after April 1st. This means that any pending additional reports requested before that date should follow the old schedule.

The new fee schedule for medical legal developments covers many areas, and there is more to discuss than one blog post will cover. So get in touch with me as I hand out this topic throughout the week.

First, let me point out that subsection 9793 (c) provides some new definitions to work with. Now an “assessment” must include an actual examination of an employee. This will have a significant impact on various disputes that arise with the Compensation Appellate Body. Two immediately come to mind.

Suppose an unrepresented applicant plans a PQME assessment with a panel doctor. The injured worker does not cancel the appointment but does not attend, and the qualified medical examiner, after reviewing the records, will report and provide a preliminary opinion pending a personal examination. Has the applicant received a “Comprehensive Medical Legal Assessment” under Section 4062.1 of the Labor Code?

Before April 1, the California Code of Regulations Section 9793 (c) did not require an exam, but it does now. It is conceivable that one party could argue that there is no right to a Romero replacement panel in the above circumstances, but the new section 9793 (c) seems to cut off just such an argument.

Another area that will apply is billing with the attending physician. How many times have you seen $ 625 ML-102 bills from a PTP to write a report to the usage verification provider contesting a UR denial? Well, without an exam, that claim is now even more absurd than it was before, as a medical exam is required to settle under ML102 (now ML202).

Another interesting definition that was added is 9793 (l), which now includes “any correspondence received by the doctor from the parties to the action” as part of the term “reports and documents requested by the Administrative Director”.

Why is that important? Well, it appears that legal medical reports sent to the parties should now include reproductions of the correspondence sent by the parties to the QME and the agreed Section 9794 (h) medical examiner.

I am paranoid and cynical, so I can imagine an applicant attorney sending him a “proposed” QME letter that reads “Dear Dr. Dolittle, please rate my client’s paper cut. It really, really hurts, and he lost the Superman patches his doctor gave him. “Then he sent another letter to the QME saying,” Dear Dr. Dolittle, humble blogger, eats puppies and hates you for not being a real “doctor, since you’ve never mastered scalpel throwing self-defense.”

Reminder, dear readers, you are here to blog so as not to judge me.

Presumably now, if the QME wants their bills to be paid, they will also include in the report copies of the letters sent to the parties.

Gregory Grinberg is the managing partner of Gale, Sutow & Associates’ SF Bay South office and a certified employee compensation law specialist. This post was reprinted with permission from Grinberg’s WCDefenseCA blog.