When a defendant objects to a bill for a medical-Legal expense, it must do so in compliance with LC 4622. Regulation 10451.1 is operative. Some defendants find the rules particularly onerous and want to tilt the process so that it will be more advantageous to insurers and defense interests.

Dr. Robert Weinmann

In recent months, reports have surfaced that the number of petitions for non-independent bill review disputes has increased. These petitions have been filed by providers of medical services, e.g., qualified medical examiners, treating physicians and diagnostic testing facilities. 

The key to this harmful and biased proposed regulatory change is that it will obliterate the right to be heard on a non-IBR petition if the defense simply does not file a declaration of readiness.

This proposed change is harmful to treating physicians and providers of diagnostic services, neither of whom will be able to go ahead with planned diagnostic or treatment protocols because of wrongfully denied QMEs. It will also harm QMEs, whose reports will be simply ignored.

It will reduce access of injured workers to all of these services — diagnostic studies and treatment not done or postponed, and QME analyses of opposing claims. The method will be short, simple and not sweet — arbitrary denials of bills, fake arguments proposing why approved bills should be paid at lesser amounts, and flat-out bill rejections.

The inevitable result will be decreased access to diagnostic services, further reduction of doctors willing to treat injured workers, and fewer doctors willing to stand up as QMEs to the slings and arrows of outrageous fortune, i.e, the clout of insurance companies. 

Ample examples of what the proposed changes in 10451.1 can get away with already exist, e.g., denying properly scheduled QME or agreed medical evaluator reports based on spurious claims, of which a favorite is that the QME or AME provider is "not in the medical provider network."

The proposed regulatory changes herein described are in bad faith and should be rejected. 

Dr. Robert Weinmann writes the Politics of Healthcare blog, from which this entry was taken with permission.