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Effective April 1, 2021, CA Code of Regulations section 9793-9795 will change the existing fee schedule for medical-legal evaluations and create additional procedures that parties to the cause of action will be required to follow by Michael Costello

2021-03-31

Effective April 1, 2021, California Code of Regulations section 9793-9795 will change the existing fee schedule for medical-legal evaluations and create additional procedures that parties to the cause of action will be required to follow. This will have a significant increase in the cost of the medical legal evaluations.

The biggest change concerns record review by a physician.  California Code of Regulations section 9793(n) requires a party who intends on submitting records for a physician to review concerning a disputed or contested medical issue to attest to total page numbers of the records or reports to be reviewed and compliance with California labor code section 4062.3  concerning communication with an opposing party.  As it relates to California Code of Regulations section 9793(n), Testan Law attorneys have been apprised of the changes and on our client's behalf we will be preparing a declaration supporting compliance with Labor Code section 4062.3 and attesting to total page numbers of records that are to be reviewed. 

California Code of Regulations section 9794 is not significantly changed or altered.  California Code of Regulations section 9795 outlines the official medical fee schedule for comprehensive medical-legal evaluations.  Some of the highlights are as follows:

  • $503.75 charge, if the medical-legal evaluation appointment is missed. However, "if the fees for failed appointments and for late cancellations are incurred through the fault or neglect of the injured worker or his/her representative, the employer may seek to credit those charges against the injured worker's award."
  • $2015.00 for initial comprehensive medical-legal evaluation which includes review of 200 pages of records. Each additional page is to be reimbursed at the rate of $3.00 per page.
  • $1316.25 for a follow-up medical-legal evaluation, this evaluation is to occur within 18 months of the initial evaluation and includes review of 200 pages of records that were not previously provided noting $3.00 per page thereafter.
  • $650.00 for review of supplemental records and writing a report regarding said review. The fee concerning supplemental review of records is based upon 50 pages or less of records and if you exceed 50 pages the charge will be $3.00 per page.
  • Medical-legal testimony shall be paid out at $455.00 per hour with a minimum of two hours for a deposition and the right to be reimbursed for time spent relating to preparation and travel. If the deposition is cancelled within eight calendar days or less, the physician should be compensated for one hour of the scheduled deposition, $455.00
  • $325.00 per hour for review of sub-rosa recordings.
  • Additional modifiers exist within the fee schedule regarding evaluations for psychiatric, toxicology, and oncology.

In summary, the rule changes require more attention and legal analysis as to the records being offered for use in a medical-legal report, an increase in process including declaration under penalty of perjury as to the records being provided, and as to communication with opposing counsel and different fees for various tasks and issues.  
 

For more information, click here.
 

As usual, Testan Law will be there to assist, to advise and to guide. If you require separate training or wish to discuss specific facts relating to the changes to the regulations please feel free to contact the firm by phone or email address below.

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