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Thursday, October 11, 2018

Doctors at Gala Say Their Lien Days Are Over

  • By Jim Sams
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  8 shares
SAN DIEGO — Medical providers who treat California workers’ compensation applicants on a…

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2 Comments (10 Replies)

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Oct 11, 2018 a 1:36 pm PDT

All SB863 needed to do was address liens. Everything else it did was overkill in my opinion. Without the liens IMR most likely would not have been implemented, because it would not have been needed

WILLIAM YATTAW Oct 11, 2018 a 2:10 pm PDT

It certainly is a fool's game for Providers to roll the dice when they treat on a lien basis.

Steven Chandler Oct 11, 2018 a 3:10 pm PDT

Wait, what . . . ? Hinden states " nothing in the Labor Code prevents a treating physician from writing a medical-legal report". Read plainly, this may be true in that they can simply just write such a report; however, it will not be regarded as a medical-legal and neither will the charges associated with the report be subject to the medical-legal fee schedule. Generally, med-legals are issued by QME's and AME's. I would argue that any report offered by a provider who is neither a QME, AME, or WCAB appointed IME, is not considered substantial evidence on the basis that it is both incredibly misleading and lacks the authority to be regarded as a medical-legal report. I've reviewed submitted reports from lien-treaters purported to be medical-legal and billed both as medical-legal and OMFS/RBRVS. To provide a medical-legal report, there must be a standard to qualify the physician to do so. Either he or she must be a certified QME by the Medical Unit, or - the physician must be an AGREED medical examiner. It appears to me that what Hinden is suggesting constitutes fraud and I would certainly submit an FD-1 to the DOI and DA as I have in the past.

Robert Min Oct 11, 2018 a 3:10 pm PDT

Mr. Hinden says PTP's are allowed to lawfully write Med-Legal reports, while the experts at Daisybill say this is illegal per LC and only a QME can write Med-Legal reports. Who is write here??

John Don Oct 11, 2018 a 3:10 pm PDT

Daisybill?

Steven Chandler Oct 11, 2018 a 3:10 pm PDT

According to those I've spoken to our DA's office and others in the Department of Insurance, DaisyBill is correct. Unless you're a QME, AME, or WCJ-appointed IME specific to the case, you cannot write a report purporting to be medical-legal and subsequently bill under the medical-legal fee schedule as Hinden suggests they do.

William Berry Oct 11, 2018 a 4:10 pm PDT

See 8 CCR 9793(c)(2).

Oct 11, 2018 a 4:10 pm PDT

[deleted]

Robert Min Oct 11, 2018 a 6:10 pm PDT

The issue is that Labor Code, which overrules CCR, says no Med-Legal is allowed unless QME or AME, so PTP's who do so can be prosecuted for insurance billing fraud.

Anne Bazel Oct 11, 2018 a 8:10 pm PDT

Which Labor Code PTP cannot write Medical Legal report?

Charles Cleveland Oct 12, 2018 a 4:10 pm PDT

There's nothing in labor code 4620 that prevents PTP's from medical legal reports in contested cases. Daisybill is hardly citable legal authority.

Brenda Jones Oct 16, 2018 a 3:10 pm PDT

We have several cases in which the judge has ordered us to write med/legal reports as the PTP.

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