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New California Med-Legal Fee Schedule For Review Of Records: Is It Really As Bad As We Thought It Would Be?

Eight months have passed since California’s new medical legal gee schedule has taken effect – that of which physicians, mostly PQMEs, are receiving $3 per page review after the first 200 pages. Well, where do we stand now?

We all may have shared the same thoughts: Are we going to be penniless paying $10,000.00 to $15,000.00 in review fees? Will these review fees be higher than what the Case-in-Chief will settle by way of Compromise and Release?

Generally speaking, we have not seen a tremendous impact as much as we thought! We also do not see a significant impact in the way of the applicant’s attorneys working to leverage the cost of a PQME report by requesting for additional money to settle the claim.

So, What Has Been The Result Of The New Med-Legal Fee Schedule?

Firstly, many clients have expressed their willingness to have us review and whittle down records over 200 pages. Usually, it is when the records reach a significant number, such as over 800 pages, clients request for us to go through and remove any unnecessary medical records. Certainly, we do not need the applicant’s treatment records regarding miniscule incidents like a hangnail from 2007 or a cut pinky toe from 2013.

As a result, the cost savings for clients have been quite positive. For data reference, on about 800 file reviews, the total cost savings was about $1,800.00 on average and a reduction of 600 pages. Comparing it to an average of approximately a cost of $300.00 for the defense attorney to having to review the same files, the net savings was $1,500.00!

What else can be done? Avoid duplications!

Sometimes, our files will have the same records albeit from different subpoena companies, different dates (we will have subpoenaed records up to 2019, for example, and then we have a new set going all the way up to 2021). However, once we get rid of those duplicate copies, the pages will be reduced and, in turn, the costs are lowered as well.

What Can We Expect In The Future?

Defense attorneys are working diligently to remove any unnecessary medical records. So far, the applicant’s attorneys seem to be cognizant of the fact that the $3.00 per page review is not something the carriers want to pay and have not been giving us much pushback when we want to eliminate records. Of course, if there is a real debate about what should be sent to the AME or PQME, a Declaration of Readiness (DOR) to Proceed in order to place this matter on calendar and discuss the matter with a Judge can always be done.

However, based on our “off the record” conversations with a few Judges, if in doubt, they will send it to the doctor for a review. Judges want to reiterate they are not doctors and will not make medical decisions or issue medical opinions – as that is the realm of the physician. In order to make a true and accurate record that will reflect substantial medical evidence, a Judge will defer to the doctor to review.

Therefore, before filing a DOR and spending litigation costs fighting what should or should not be a part of the medical record, you may want to reconsider and have a doctor review the records if there is a debate as to their importance.

Eliminate Additional PQMEs!

Eliminating the need for multiple PQMEs and multiple review of records is of the utmost importance. Make sure your defense attorney is working diligently in fighting any unnecessary PQMEs or simply settling the matter without the need for a PQME in additional specialties. If the carriers are willing to provide additional settlement authority rather than working with a doctor for medical reports, in the long run, we have seen many more settlements for a reasonable amount of money – which would have cost more had the applicant gone to additional PQMEs.

In closing, we are happy to report that the med-legal charges so far have not had as much of a negative impact as many may have thought when the law was passed.

However, as mentioned above, due diligence is required to make sure there are no unnecessary pages given to doctors. Carriers should also set a mark as to how much they are willing to pay or send to a doctor before deciding to move forward with having their attorney review and extract any unnecessary documentation and records. Likewise, the net savings by having your attorney do a good job in extracting these unnecessary pages have resulted in savings for carriers across the Board.

To keep up to date on the new regulations, visit California’s Division of Workers’ Compensation website.

Medical legal fees


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