Costs for medical-legal evaluations and reports used to resolve medical disputes in California workplace injury claims have increased sharply, with the average payment for a comprehensive exam up 52%, the California Workers’ Compensation Institute reported Thursday.
The analysis of costs after the state in 2021 initiated a new fee schedule for med-legal evaluations found that the increase was “primarily due to new per-page fees for record review,” fees paid in addition to flat fees for med-legal evaluations services and which accounted for nearly 75% of the increase in payments, according to CWCI.
The changes also resulted in a 29% increase in costs for supplemental reports for med-legal evaluations.
The per-page record review payments added an average of $1,338 to the flat fee for follow-up evaluations with excess page review and $1,335 to the flat fee for supplemental reports with excess page review.
Additional charges for excess record review were found on 43.3% of the comprehensive evaluations, 24.9% of the follow-up evaluations, and 30.8% of the supplemental reports. For comprehensive evaluations, the new per-page record review fee added an average of $1,817 to the $2,015 flat fee payment for services with page review, CWCI reported.
Physicians specializing in orthopedic surgery provided 44% of the med-legal services in 2023, followed by chiropractors who provided 11% of the services.
When the California Division of Workers’ Compensation adopted the new schedule, it anticipated it would result in a 25% increase in payments for med-legal services.