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'Duplicate Record Dilemma' Could Drive Up Med-Legal Costs, DWC Attorney Says

  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  23 shares
If California workers’ comp stakeholders don’t do their part in rooting out irrelevant o…

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Ron Perelman Apr 21, 2021 a 2:42 pm PDT

Of course Med legal expenses will go up. It is called a raise. The last one was in 2006. The PTP P&S issue needs to be addressed head on. If all parties are satisfied with a PR4 type report, then that is what we should write. If the case is complex then a QME could deal with it. But don’t ask a PTP to do a complex report unless he/she is properly paid. I have not been successful getting a carrier to pay ML rates for a PTP final. Mr West says the new Regs don’t deal with this issue, so we need clear cut guidance. I will be happy to do whatever is decided, but it can’t be do a complex report for minimal payment

Anne Bazel Apr 21, 2021 a 2:55 pm PDT

Regs imply, if requested, you should be able to produce ML as PTP at any time, just talk to the parties, including the patient.

Lawrence Whiting Apr 22, 2021 a 5:53 pm PDT

The Brower v. David Jones Construction (2014) 79 CCC 550 WCAB (en banc) states that if there is a dispute, the applicant is entitled to a medical-legal report from the PTP to be paid as a medical-legal expense. So, it the applicant (or presumably the employer) asks for a narrative report addressing a dispute (WPI, apportionment, TTD status), the PTP should bill for and be paid at med-legal rates.

Jacob Rosenberg Apr 21, 2021 a 3:59 pm PDT

the auditor recommended a 30% increase in 2019; here we are 2 years later with a 22% increase?
The defense should pay note

As for med-legal reports vs PR-4s by a treating physician the determining factor is whether a party has requested that the treater address a contested med-legal issue. Mr West responded that a claims adjustor could definitely make such a request but he was unsure if an applicant attorney could.

Steve Cattolica Apr 21, 2021 a 5:33 pm PDT

The declaration and attestation includes a signature under "penalty of perjury." This nuance is meant to keep folks accountable. However, if the individual who signs under penalty of perjury, but found to have lied, is never prosecuted, there's no effect. And yes, that must work both ways. Dr. Feinberg is absolutely correct. The burden of paying for all submitted records is squarely on the submitter(s) - not the evaluator. Regarding the projected 22% raise, as Dr. Rosenberg and the Auditor point out, if there had been provision for a COLA in the former fee schedule, reimbursement under this new schedule would still be behind equivalency. Notwithstanding the news attributable to the new MLFS, it is now time to move on to other major issues that undermine California's comp system.

Shawn King Apr 21, 2021 a 7:20 pm PDT

The notion that there is some cost explosion pending connected to records is simply untrue. Carriers have been using doctors as $250 or $312 an hour clerks for years by submitting massive duplicate stacks of records under the prior ML system and being billed by the hour for the effort. One could actually argue that as AME modifiers, and all modifiers actually, don't apply to the records review portion, there isn't much of a difference in cost at all. Historically, one of the common concepts employed for record review was that 100 pages = one hour. If true, then that would be $300 per hour. A decline in the rate for AMEs. While a raise for QMEs, as others have noted, a raise was a long time in coming.

If the carriers want to cut costs connected to records, use the regs to extend the time for records collection. Then have a bonded service cull duplicates at a much lesser cost before sending the clean file on to the doctors.

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