California Workers' Compensation Medical-Legal Fee Schedule

In workers' compensation cases where there is disagreement over the primary physician's opinion on work-related issues, a medical expert is invited to provide an independent evaluation of the injured worker's condition to determine entitlement to workers' compensation (WC) benefits. The California Department of Industrial Relations (DIR) Division of Workers Compensation (DWC) requested that RAND review the California workers' compensation ML (ML) fee schedule, which has not been revised since 2007. We found that the $250 per hour rate used to determine the ML allowances is significantly higher than the 2017 allowances for evaluation and management services that consist of similar activities. We also found that the number of certain types of evaluations and the time per evaluation increased. Taken together, these findings suggest that consideration should be given to restructuring the allowances for extraordinarily complex evaluations. We also recommend consideration of policies providing incentives for completing high quality reports that address the issues outlined in the cover letter(s) from the parties requesting the evaluation.