Workers’ compensation: medical-legal expenses: fee schedule.
One of the significant changes proposed by SB668 is the authorization for the medical director to recalibrate the fee schedule every two years. This adjustment would consider various factors, including increases in conversion factors and the per-page costs linked to reviewing medical records. By consistently updating the fee schedule, the bill aims to ensure that the fees remain reflective of actual medical expenses and facilitate fair compensation for healthcare providers involved in the workers' compensation process.
Senate Bill No. 668, introduced by Senator Hurtado on February 20, 2025, aims to amend Section 5307.6 of the Labor Code, specifically addressing the fee schedule for medical-legal expenses within the workers' compensation system. This system provides comprehensive medical-legal evaluations to aid in resolving contested workers' compensation claims. Currently, fees for these evaluations are capped at a physician’s regular fee or a state-established fee schedule, whichever is lower. The bill seeks to streamline this process by allowing the administrative director to adjust the fee schedule biennially based on a comprehensive evaluation of certain medical practice costs.
However, the bill is not without contention. Critics may argue that the provisions granting the administrative director broad powers to adjust fees could lead to inconsistencies or perceived unfairness in how medical-legal expenses are reimbursed. Concerns may also arise regarding the potential imposition of higher fees, which could impact both employers and employees involved in workers' compensation claims. The bill includes safeguards whereby fees in excess of the established schedule must be justified as reasonable, but this aspect may lead to disputes over cost justification and procedural transparency in individual cases.