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Medical-legal service costs for workers comp claims up in California

Posted On: Feb. 2, 2016 12:00 AM CST

Average medical-legal service costs increased 66% between 2007 and 2014 for California workers compensation claims following a change in the state's med-legal fee schedule structure, according to the California Workers' Compensation Institute.

The Oakland, California-based institute said in a report Monday that medical-legal service costs averaged $1,628 per California comp claim in 2014, up from $979 in 2007.

California enacted a revised fee schedule in 2007 for medical-legal services related to workers comp claims, the CWCI said. While the older fee schedule included a flat fee payment system for medical-legal services, the newer fee schedule began providing payments based on the length of time it took to perform services such as follow-up exams for injured workers and supplemental reports for workers comp claims.

The study found that there was a significant jump in costs related to services billed in 15-minute increments. For instance, there was a 136.4% increase in the average cost of workers comp follow-up evaluations provided within nine months of an injured worker's prior evaluation.

The average payment for supplemental evaluations increased 86.1% from 2007 to 2014, while the average payment for comprehensive evaluations involving extraordinary circumstances increased 66.2% during that time, the CWCI said.