As many of you know, Title 8 CCR Section 9793(n) is scheduled to go into effect, April 01, 2021.

What is Title 8 CCR Section 9793(n)? Short answer, an annoying regulation that has been amended to make obtaining a final Med-Legal report that much more difficult and more expensive. Long answer, Title 8 CCR Section 9793(n) will do the following for Med-Legal evaluations and testimony beginning on April 01, 2021:

  1. Requires a declaration under penalty of perjury that the provider has complied with the provisions of Labor Code Section 4062.3 and includes a total page count of records provided. Absent this declaration, a physician will not review any records sent.
  2. Increase the total cost for medical reports as follows:
    • (ML200) $503.75 for:
      • Missed/ No-Show appointment (by the applicant or interpreter),
      • if applicant is 30 minutes later for an examination,
      • If the applicant leaves before the evaluation is complete
      • if an examination is cancelled within six (6) business days of the scheduled evaluation.
    • (ML201) $2,015.00 for a Comprehensive Medical-legal Evaluation and Report that includes a complementary record review of up to 200 pages.
      • (ML-PRR) $3.00 per page for any pages over the included 200 pages
      • Physician must include a total number of pages they reviewed.
    • (ML202) $1,316.25 for Re-evaluations that occur within 18 months of the initial evaluation. This total includes a complementary record review of up to 200 pages.
      • But only $3.00 per page for any pages over the included 200 pages
      • Physician must include a total number of pages they reviewed.
      • So what happens if an evaluation is scheduled after the allotted 18 months? I’m glad you asked. The new regulation does not specify but the evaluation will likely be charges as an initial evaluation.
    • (ML203) $650.00 for Supplemental Reports but only a record review of up to 50 pages is included.
      • Can you guess what happens after 50 pages? YES – $3.00 per page for any page over 50.
    • (ML204) $455.00 per hour for Med-Legal Testimony with a minimum of two hours unless the deposition is cancelled less than 8 days prior to the scheduled date then only one hour minimum.
    • (ML205) $81.25 per quarter hour or $325.00 per hour for reviewing sub-rosa footage. (Yup they get this too…)
      • If the physician receives the sub rosa video prior to the issuance of a pending Med-Legal report, the physician may not also bill for a supplemental report in connection with the review of the materials.

These amendments appear to address the ever-growing concerns for the med-legal physician’s not getting their due rewards. However, they also leave one scratching their head in an attempt to balance the scales of having the doctor review all the records related to the claim and making sure you don’t have to raise your reserves on a file just for a medical-legal report. We understand your concern. Here is list of some tips that can help:

  1. Make sure to count the pages being sent to the physician and include it in your declaration being sent to the physician. Perhaps a bates stamp of all pages being sent so the number is not in dispute.
  2. Only send records that are relevant to that physician. (ie: only send dental records to a dental QME)
  3. Try to avoid sending duplicate records. If you have a set of records under one location that is essentially the same as another, only send one of them.
  4. If applicant is represented, make sure applicant’s attorney is not sending the same records you are, if so, list in your cover letter that applicant’s attorney is providing those records.

However, these tips will not lower the amount in all cases. Sometimes you will have no choice but to send those 5,000 pages of records. So, you may get hit with a huge bill in this instance, but overall, what else is new.

Another big question is what happens with all the evaluations that are scheduled on or after April 01, 2021? Well, the DWC understands … and states “parties to these evaluations should communicate with each other to reach agreement on the handling of these evaluations.” Basically, they did their part and amended the regulations. The rest is up to us.