We at Mullen and Filippi hope you gathered around friends and family for a safe and healthy Independence Day Weekend. With the cookouts and festivities behind us, we hope that you get some rest away from your desks and enjoy the summer months with longer days and warmer weather, before we enter fall.
DWC ISSUES NOTICE TO READOPT PANEL QME EMERGENCY TELEHEALTH REGULATION
On July 7, 2022, the Department of Industrial Relations (DIR) announced that the Division of Workers’ Compensation (DWC) issued a notice of intent to readopt and extend emergency regulation Section 46.3 beyond the current expiration date of July 18, 2022.
Emergency regulation 46.3 allows medical-legal evaluations to be performed via telemedicine by electronic means, where the physician and the injured worker are not in the same physical space during the examination.
In its announcement, the DIR noted that the regulation “addresses the ongoing need for telehealth medical-legal evaluations and office location flexibility resulting from various state and local public health safety measures related to COVID-19” and that the regulation will assist injured workers and their employers to avoid delays and move claims toward resolution.
Assuming the state Office of Administrative Law (OAL) approves and files The Notice, Finding of Emergency, and text of the regulation, it will remain in effect for an additional 90 days.
MEDICAL-LEGAL COSTS RISE SHARPLY FOLLOWING NEW FEE SCHEDULE
According to the California Workers’ Compensation Institute (CWCI), medical-legal costs have increased “sharply” under the new medical-legal fee schedule, which changed the payment formula for medical-legal evaluations. The DWC implemented the new fee schedule in April 2021.
At the time the new fee schedule was implemented, the DWC predicted that it would increase medical-legal costs by no more than 25%.
Under the old fee schedule, medical-legal evaluators were paid a flat fee for basic and complex evaluations, with payments based on the time spent for evaluations that involved extraordinary circumstances. Under the new fee schedule, what had been three levels of service were combined into a single billing code. Under the new schedule, medical-legal evaluators are entitled to a flat rate fee of $2,025 for an initial evaluation, including review of up to 200 pages of medical records and an additional $3 per page for review of any additional records above the 200-page cap.
According to a recent article by WorkCompCentral, the CWCI compared data of medical-legal evaluation costs from 2015 through 2021 and determined that replacing the costs for the three levels of service with a flat fee “likely had the biggest impact on average payments.”
Basic medical-legal evaluations, which account for 40% of evaluations, have increased by 222%, whereas complex evaluations, which account for 18% of evaluations, have increased by 115%.
WorkCompCentral noted the following additional findings of the report:
- The average payment for a comprehensive evaluation that includes a face-to-face exam of the injured worker increased 52.9%, and the average payment for a supplemental evaluation increased 39.1%.
- The per-page record review fee added an average of $1,917 to the base fee for comprehensive evaluations, $1,410 to the base fee for follow-up evaluations and $1,437 to the base fee for supplemental evaluations.
- Physicians specializing in orthopedic surgery provided 53% of med-legal services in 2021, with internal medicine physicians, who were a distant second, providing 9% of services.
According to WorkCompCentral, the CWCI’s assessment of the increased costs for medical-legal evaluations is similar to the Workers’ Compensation Insurance Rating Bureau’s findings. The “WCIRB initially projected that the new fee schedule would increase med-legal costs by about 22%, but the actual increase was about 39%.” The WCIRB attributed the increased cost to the increased cost of record review.
Please click the link below to view Mullen & Filippi’s Updated Medical-Legal Fees chart.
Costs-for-Most-Med-Legal-Exams.pdf (mulfil.com)
CWCI: Med-Legal Costs Soar Following Changes
COVID-19 CLAIMS REPORTEDLY TRIPLE IN MAY
On July 6, 2022, the CWCI reported that the number of COVID-19 claims tripled in May.
In its bulletin, the CWCI said “[t]he latest figures show that after hitting a 10-month low of 1,303 claims in March of this year, the COVID claim tally increased nearly 83% to 2,381 claims in April, then jumped 182% in May to 6,704 claims, producing a fivefold increase in COVID claim volume during the spring surge”.
However, while the reported number of COVID-19 claims has been trending up since the March 2022, the number of COVID-19 claims is well below the all-time high from January of this year, when there were over 54,000 COVID-19 claims reported.
CWCI: COVID Claims Triple in May
FAREWELL CAROL POWELL!
The comp community has lost a veritable legend, as at the end of last month, Carol Powell, the Managing Senior Partner of our Oakland regional office, hung up her Rating Schedule and Money Chart and rode off into the sunset.
Carol was hired at the firm as an associate in 1987 and began managing the Oakland regional office in 2001. From 2010 to 2018, Carol assumed the role of Senior Administrative Managing Partner on Mullen & Filippi’s Management Committee.
One of the many highlights of Carol’s career came in 2017, when the State Bar of California’s Workers’ Compensation Section awarded her the 2017 Defense Attorney of the Year. She was the first woman to ever win this prestigious award.
Throughout her career, Carol was a fierce litigator. She was drawn to practice law because of her love for debate. Whatever the complexity of the legal or factual issue, we would frequently hear her say “I got this.” By knowing her files front to back, always knowing the right question to ask at trial, and with great creativity in how she approached a case, she elevated the practice and did her part in keeping the workers’ compensation system honest. She had the respect of her clients, attorneys representing injured workers, and her colleagues alike.
Well Carol, you do have this—a legacy that will live on! We here at Mullen and Filippi wish her nothing but the best in her future endeavors! Whatever they are, we know she’ll pursue them with inimitable style.
This Bulletin was written by Steve Rosendin, Associate Partner in our San Francisco office and James Cotter the Managing Senior Partner of our Oakland office. A copy of this Bulletin and the most current twelve months is available on our website at www.mulfil.com/bulletins.
