A Closer Look at the New Med-legal Fee Schedule

• Publication year: 2021
• Author: John P. Kamin, Esq.

A Closer Look at the New Med-Legal Fee Schedule

John P. Kamin, Esq.

Woodland Hills, California

California's Office of Administrative Law recently approved a controversial set of amendments to the med-legal fee schedule that pays physicians higher fees for med-legal evaluations, effective April 1, 2021.

The Division of Workers' Compensation (DWC) created the regulations after state auditor Elaine Howle determined in a November 2019 audit report that there was a shortage of qualified medical evaluators in the California workers' compensation system. She also concluded that the DWC was not doing enough to ensure that QMEs are producing high-quality reports.

Based on industry observations, the DWC has at least partially complied with the auditor's suggestions. Of the recommendations, an update to the 13-year rates in the fee schedule is perhaps the most notable.

Like most fee schedule changes, this one increases costs for defendants in the California workers' compensation system. The new fee schedule:

• Increases reimbursement for comprehensive med-legal evaluations up to $2,015, including review of up to 200 pages
• Raises the fee for supplemental reports to $650, including review of up to 50 pages
• Pays $1,315 for reevaluations, including review of up to 200 pages of new records
• Requires a declaration and an attestation to QMEs stating exactly how many pages of documents were submitted to them for review
• For any reviews above the page counts listed above, pays $3 a page
• Increases the rate for med-legal testimony to $455 an hour, with a minimum of two hours per deposition; depositions canceled within eight calendar days of the deposition date incur a late cancellation fee of at least $455
• Reimburses sub rosa surveillance at $325 an hour
• Pays AMEs various multipliers times the QME rate
• Uses various multipliers to increase evaluation reimbursements for psychiatrists and psychologists, internal medicine specialists, and oncologists

Declarations with Attestations

From a practical standpoint, the fee schedule's new requirement of declarations has caused an immediate change to the workers' compensation industry. To comply with the new regulations when they became effective in early April, QMEs immediately began requesting attestations of the number of pages submitted to them. As a result, law firms, carriers, and administrators had to adjust and began submitting declarations with every letter to a QME.

What happens if a party doesn't include a signed declaration and attestation? The...