The Division of Workers’ Compensation (DWC) will hold a public meeting on Wednesday, October 17 to discuss the structure of a new medical-legal fee schedule for the workers’ compensation system. This fee schedule is used to compensate physicians for examinations and reports that decide issues of compensability for work-related injuries.

DWC posted a notice of pre-rulemaking proposed amendments to the current medical-legal fee schedule in an open forum on May 3 and says it received an overwhelming response by the workers’ compensation community, with most respondents requesting an overhaul of the entire medical-legal fee schedule.

There were no changes to the amount of fee schedule payments in the May proposed amendments to section 9794 and 9795 of the regulations. It did clarify the use of the complexity factors relating to causation, medical research, record review and apportionment. The factors that indicate the presence of extraordinary circumstances in a medical -legal evaluation were more clearly defined. The language required in a report to define extraordinary circumstances is explained. Realistic limits on certain areas of billing are implemented.

The characterization of the responses as “overwhelming” is an understatement. The file containing the written responses is 520 pages.  For the most part, physicians claim they are not paid enough for QME medical legal work.

The October meeting is intended to respond to this input and develop next steps for revising the fee schedule. DWC seeks input from stakeholders who will be affected by the final version of the medical-legal fee schedule. The Division is particularly interested in:

– Determining the best format for the new fee schedule to offer optimum benefit for QMEs, AMEs, Injured Workers, Employers, Medical Management Organizations and Carriers;
– Identifying any possible obstacles to that process; and
– Identifying representatives to participate in small pre-rulemaking meetings to further develop the best format for the new medical-legal fee schedule.

The public meeting is scheduled for Wednesday, October 17 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland.

Meeting attendees will be allowed up to three minutes to express their ideas on changes to the fee schedule. Written comments can also be submitted at the public meeting, emailed to DWCRules@dir.ca.gov, or mailed to: Division of Workers’ Compensation, P.O. Box 420603, San Francisco, CA 94142 – Attn: Medical-Legal Fee Schedule Forum