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SELECTED INDICATORS IN WORKERS’ COMPENSATION:   A REPORT CARD FOR CALIFORNIANS

Since the mid-1990s, the average cost of a medical-legal report has increased by 38 percent, even though the reimbursement under the Official Medical Fee Schedule (OMFS) has remained unchanged since 1993.  The revised PD Survey by the WCIRB includes additional questions that reveal some of the potential causes of this increase in costs. The changes indicate various types of fee schedule classifications as well as geography.  However, issues for injury years before 1997 cannot be examined because the WCIRB survey revision of that year prevents comparisons.

The survey data show that, on average, medical-legal reports done in Southern California have always been substantially more expensive.  Increases in the average cost are being driven by claims in Southern California.

Further analysis indicates that the cost driver for California and its Southern region trends is not the price paid for specific types of examinations.  Rather, the mix of codes under which the reports are billed has changed to include a higher percentage of the most complex and expensive examinations and fewer of the least expensive type.  The following table shows the cost and description from the Medical-Legal Fee Schedule.

Evaluation Type

Amount Presumed Reasonable

ML-101 Follow-up/ Supplemental

$250

ML-102 Basic

$500

ML-103 Complex

$750

ML-104 Extraordinary

$200/hour

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