Let’s take a look at the current med-legal fee schedule. In a supreme bit of irony, the fee schedule went into effect on April Fools’ Day in 2021. Now that we’ve had it for over a year, what results can we see from this new system?

Gregory Grinberg

Did the extra money attract the top physicians to write excellent reports and minimize the need for more med-legal services? Are cases now resolved more expeditiously with an accurate level of benefits and lower costs for employers?

Come on, people, it’s been over a year! Certainly, there are now lots more qualified medical evaluators so that the wait times are lower and the reporting is more consistent, right?

Well, the California Workers' Compensation Institute has prepared a study reflecting that compared to 2019, there’s been more than a 50% increase in payments for face-to-face exams and almost 40% for supplemental reports. Three dollars per page in review as per the fee schedule has also drastically increased the cost of an initial exam by almost $2,000. 

According to the CWCI, the fee schedule resulted in a 3% increase of QMEs in the active evaluator pool as compared to 2022, and 1% less than 2019! In other words, the new fee schedule has enriched existing QMEs with huge fees but has not attracted more QMEs to the industry. 

The new regulations have also failed to provide recourse for employers when reports are not substantial medical evidence or to recoup costs. There is practically no disincentive to produce intentionally vague or incoherent reports to entice parties to depose the doctor or seek a supplemental report, generating more fees for the doctor and more costs for the defense. We all recognize those doctors on our panels that will force at least three evaluations, four depositions and seven supplemental reports before there’s enough in the record that you can get a ruling other than “develop the record.”

Of course, this is great for the applicant bar: The more expensive the claims process is due to med-legal fees, the more inflated the “nuisance” value of each claim is.

Gregory Grinberg is managing partner of Gale, Sutow & Associates’ S.F. Bay South office and a certified specialist in workers’ compensation law. This post is reprinted with permission from Grinberg’s WCDefenseCA blog.