In a recent November 19th Report from the DIR, auditors found failure to adequately administer the QME process may delay injured workers’ access to benefits. The recommendations by auditors included potential increases to the medical legal fee schedule, increased number of doctors on panels, and potential changes to the process for quicker access.
While the number of PQMEs able to write medical legal reports is absolutely a serious issue, we believe the more serious issue is access to doctors willing to work on denied cases on a lien basis. In some areas finding a doctor is hard or there are extremely limited options. Finding a specialist (like sleep, neuropsych, or internist) or surgeon on lien is near impossible even in populated areas. How are Applicants suppose to prove up their injuries with substantial medical evidence if no doctor will write a report?
Injury Compensation Law represents doctors that write medical-legal reports for collections and Petitions for Determination of Non-IBR Medical Legal Disputes. We have found that many doctors do not know that they can write medical-legal reports as PTPs under Title 8 CCR 9793(c)(2) (as well as other code sections and case law). We have also found that when the proper documentation such as PTP designations/proper billing and proofs of service/timely objections to EORs/etc are present we can get attorney fees under Title 8 CCR 10451.1(g)(1-2) and get the doctors their entire bill plus penalties and interest. We have one medical-legal provider group that has been using our services and has never paid a dime to our office since we get attorney fees every time due to their proper documentation and following the rules.
Judges are seeing these Petitions more and more nowadays as providers try to get paid. Some Judges have even started immediately issuing orders for payment of the full bill, 10% penalty + 7% interest per Labor Code 4622, and even attorney fees. Others have been setting Status Conferences/MSCs on the issue where we then set for trial.
If you are a Medical-Legal Provider (PTP, QME, AME, or even secondary physician) and are currently paying a collection agency with hearing representatives to take a cut – perhaps consider contacting InjuryCompLaw. Since we are attorneys, we get attorney rates/fees from the court. That means a better chance that you get your entire bill paid (plus P&I!), without having to give anyone a percent. You get better representation from a real attorney, advice from someone legally allowed to provide litigation answers/work, and you could pay less than what you are paying your current hearing representative/collection company.