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Stakeholders, Industry Watchers Say New MLFS Unlikely to Fix Med-Legal Issues

  • State: California
  • Topic: Top
  • -  1130 views
  • - Average time spent on item: 71 minutes
  • - Popular with: Legal
  • -  1 share
The California Division of Workers’ Compensation’s final Medical-Legal Fee Schedule prop…

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Ron Perelman Mar 2, 2021 a 7:03 am PST

I am a proponent of this simplified fee schedule. With the old one, we physicians were being harassed and prosecuted. All in clearer this way. I appreciate Sue’s concerns but most QMEs are orthopedic, so it’s ok to tinker with internal Med, psyche and toxicology, but focus on the big picture. Baby steps are ok. There will be payment problems, but let’s get it going and deal with each problem as it arises. That means the DWC needs an open dialog COA and CSISMS to solve these problems. Will this bring in new QMEs? Not sure, but if we don’t do this now, I promise you we will lose more and more. AB404 is needed

William Tappin Mar 2, 2021 a 11:03 am PST

The carriers and administrators are fully aware of the records they have previously sent to the medical legal evaluator. The WCAB is a Court of general equity and mandated to administer fundamental fairness and substantial justice as between all of the parties. In interpreting the regulations, the Judge’s are allowed to interpret the regulations and many Judges will feel if the defendant sends records, they should only send unreviewed records or risk the Court saying “if you sent records you already have had reviewed you pay the doctor for the number of records you send.” We sometimes forget that all regulations are subject to interpretation by the Court in any given case. I think we can assume Judges will determine what is fundamentally fair in any given case. This should be fair warning to any defendant that does a “document dump” on a Panel QME or an AME. They may very well be held accountable for their actions. We need to trust our Judges to do the right thing in dealing with these types of issues which I am sure will arise. Just my thoughts.

Cory Didion Mar 9, 2021 a 12:06 pm PST

I only have one question how many doctors actually review the records in my history they are all done by a historian who then condenses the records into bites of information for the doctor. So technically the doctor does evaluate all the records themselves.

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