How 6 Minutes Could Have Saved $58,000 

Introduction

In California’s Workers’ Compensation system, each page submitted to a Qualified Medical Evaluator (QME) carries a fixed financial weight. Under the state’s Medical-Legal Payment and Reimbursement Rules (MLPRR), providers are entitled to $3 per page, regardless of whether the content is relevant, redundant, or even blank.

Medical record overload is not new, but the scale of its financial impact is coming into focus. An analysis by Effingo Technology LLC, based on more than 2 million pages of med-legal documents, revealed a concerning trend:

• The average case file contains 20 percent duplicated content
• Some cases reached up to 49 percent duplication
• Of those duplicates, only 38 percent were exact matches, meaning 62 percent would not be flagged by basic software like Adobe or standard PDF scanners

This means the majority of waste is currently undetected, and the cost of irrelevance is quietly compounding.

The Cost of Redundant Records

The MLPRR mandates payment at a per-page level. That structure introduces a serious issue:

• Carriers and adjusters do not have the tools available to instantly remove duplicate documents prior to evaluation.
• Providers receive payment even for filler content or administrative duplicates
• Duplicated surgeries, prescriptions, and histories within records introduce clinical confusion
• Overloaded files delay QME assessments and risk recommendation inaccuracy

Beyond billing concerns, the clinical consequences of record duplication can affect outcomes. Repeated entries in slightly different formats force evaluators to navigate unnecessary complexity, slowing case resolution and creating downstream risk.

Case Studies: When Duplication Becomes a Liability

Case A: One-Third of Total Cost Was Waste

In one case, a total of 6,426 pages were submitted. Deduplication analysis found 3,213 duplicates, equating to $9,639 in unnecessary spend. The med-legal report value was $17,000, meaning over one-third of the payout was tied to duplicative documentation.

Case B: Duplicates Drove the Med-legal Review Cost

In another file, 4,486 pages were submitted. 2,200 were duplicates, resulting in $6,600 in unjustified cost. The records were submitted without the opposing counsel’s review. The med-legal report review, valued at $12,858, was heavily based on duplicated pages.

Case C: Litigation Due to Duplicate Charges

A defense firm reported that its client paid $58,000 in duplicate page charges on a case that advanced to trial.  The medical records were submitted multiple times through the litigation process, the payer was billed for the same content again and again. The use of a med-legal specific deduplication tool could have identified the redundancies and prevented escalation.

Duplicate Pages Cause Delays

Repetitive documents affect more than the balance sheet. They also slow the resolution process.

In a case involving more than 18,500 pages, post-review analysis found that 8,100 were duplicates. This translated into $24,300 in duplication waste. The provider had already received $28,700 in reimbursement, meaning nearly half the compensation was paid for irrelevant content.

As one defense attorney noted:

“Applicant attorneys flood us with files at the last minute. We do not have the time or the bandwidth to manually remove all these duplicate records.”

Manual review is time-consuming and introduces risk. Human reviewers may miss non-identical duplicates, and the process itself often cannot keep up with case deadlines. As long as this remains the industry norm, overpayment will persist.

Conclusion

The cost of duplicated records is measurable, immediate, and avoidable. The use of generic tools or manual cleanup is no longer sufficient to meet the demands of today’s Workers Compensation environment. With per-page costs climbing and litigation risks tied to irrelevant documents, a smarter approach is required.

A Technical Solution Designed for Med-Legal Work

Effingo Tech is one option who offers a solution designed specifically for the unique challenges of Workers’ Compensation documentation.

Effingo is not a general-purpose file scanner. It combines Artificial Intelligence (AI) with Human Intelligence (HI) to detect both exact and partial duplication. This hybrid approach allows Effingo to capture up to 99% of duplicity and unnecessary pages.

Unlike conventional systems, Effingo:

• Removes irrelevant pages, blanks, and partial duplicates instantly
• Identifies pattern-based duplicity that software alone cannot catch
• Reduces file size and complexity before records ever reach the QME
• Operates with guidance from med-legal experts who understand how records are used in litigation
• All documents are also converted into Optical Character Recognition (OCR)
• Analytics and customizable reports are also provided 

Effingo was developed by seasoned med-legal professionals, including co-founders Jonathan Norzagaray, CEO, Joseph Farran, CTO, and Tiffany Amber, EVP, whose combined expertise spans technology, operations, and Workers’ Compensation. The team is further strengthened by former DWC Judge Nikki Mehrpoo, who serves as Chief Legal Strategist. Effingo is already trusted by leading defense firms, carriers, and administrative service organizations focused on achieving greater efficiency and cost control.

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