Magnifying Glass
Back to Sponsored Content

CA DWC Responds To Questions About Discounts

29 Apr, 2010 WorkersCompensation.com

                               Sacramento, CA (CompNewsNetwork) - The Division of Workers' Compensation (DWC) is responding to recent inquiries regarding discounted payments for medical-legal services. DWC advises that the Labor Code provisions for medical treatment do not apply to medical-legal services.

Claims administrators have asked whether medical provider networks (MPN) or preferred provider organization (PPO) contracted discounts apply to payments for medical-legal evaluations under the California official medical-legal fee schedule (MLFS). Payors applying these discounts are doing so citing the provisions of Labor Code section 5307.11 as their legal justification for using the contract rates.

Labor Code section 5307.11 addresses whether or not it is permissible to contract for reimbursement rates different from those in the fee schedule. This statute specifically indicates that health care providers and contracting agents, employers or carriers, may contract for rates different than those found in fee schedules adopted and revised pursuant to Labor Code section 5307.1, the official medical fee schedule (OMFS).

The MLFS is set forth in Labor Code section 5307.6, not 5307.1, and therefore services rendered under its provisions would not be subject to the contracting provisions described in section 5307.11.

Unless the medical-legal provider and the payor have made a specific written agreement regarding medical-legal service payment at rates different than the MLFS, a general MPN or PPO discount does not apply.

Claims administrators are also reminded to pay all undisputed amounts in a timely manner as required by Labor Code section 4622.

    • Read Also

    IOH Announces Appointment of Scott Strickland as Chief Operating Officer (COO) 

    SAN DIEGO, CA — July 1, 2024 — Institutes of Health (“IOH”), a leading transdisciplinary Workers’ Compensation treatment organization focused on patients suffering from complex and chronic conditions, is delighted to announce the appointment of […]
    Rising Medical Solutions Becomes Bronze Associate Partner of WorkCompCollege.com 

    Lakewood Ranch, FL (July 2, 2024) – WorkCompCollege.com, a division of Workers’ Compensation Educational Services, LLC, has announced a Bronze Associate Partnership with Rising Medical Solutions (Rising). Their mission to “make lives better” is consistent […]
    The Key Role of a Workers’ Comp Case Manager 

    Close attention through the claim lifecycle ensures the best claimant outcomes   In the world of workers’ compensation, where endless variables seem to be at play, Horizon Casualty Services, Inc., (HCS) acknowledges that having a clear […]

    About The Author

    • WorkersCompensation.com

    More by This Author

    Ametros’ Melissa Coleman Honored by the IAIABC as a 2024 NextGen Winner

    Wilmington, Mass. (June 24, 2024) – The IAIABC has recognized Melissa Coleman as a 2024 NextGen Award Winner. Coleman is the Senior Vice President of Marketing for Ametros, which helps people manage their medical funds following workers’ […]
    ReEmployAbility Announces Free Webinar: ‘Overcoming Jurisdictional Return-to-Work Challenges’

    ReEmployAbility, Inc.Contact: Rebecca Dearth(813) 261-3117 | news@reemployability.com Brandon, FL (May 10, 2023)- ReEmployAbility CEO and Founder Debra Livingston will be hosting a second free, live Work Comp Central webinar in their continued series to educate […]
    NCCI Annual Golf Event Tees Up $25,000 for Kids’ Chance of America

    (Orlando, FL–May 10, 2023)—The National Council on Compensation Insurance (NCCI) has given $25,000 to Kids’ Chance of America, supporting college scholarships for the children of injured workers. NCCI made the donation in conjunction with its Annual […]

    Read More

    IOH Announces Appointment of Scott Strickland as Chief Operating Officer (COO) 

    SAN DIEGO, CA — July 1, 2024 — Institutes of Health (“IOH”), a leading transdisciplinary Workers’ Compensation treatment organization focused on patients suffering from complex and chronic conditions, is delighted to announce the appointment of […]
    Rising Medical Solutions Becomes Bronze Associate Partner of WorkCompCollege.com 

    Lakewood Ranch, FL (July 2, 2024) – WorkCompCollege.com, a division of Workers’ Compensation Educational Services, LLC, has announced a Bronze Associate Partnership with Rising Medical Solutions (Rising). Their mission to “make lives better” is consistent […]
    The Key Role of a Workers’ Comp Case Manager 

    Close attention through the claim lifecycle ensures the best claimant outcomes   In the world of workers’ compensation, where endless variables seem to be at play, Horizon Casualty Services, Inc., (HCS) acknowledges that having a clear […]
    Ametros’ Melissa Coleman Honored by the IAIABC as a 2024 NextGen Winner

    Wilmington, Mass. (June 24, 2024) – The IAIABC has recognized Melissa Coleman as a 2024 NextGen Award Winner. Coleman is the Senior Vice President of Marketing for Ametros, which helps people manage their medical funds following workers’ […]
    PhysNet Achieves Fifth Consecutive Year of SOC 2 Type II Certification

    Jacksonville, FL, June 3, 2024 – PhysNet proudly announces its attainment of SOC 2 Type II compliance for the fifth consecutive year, reinforcing its commitment to providing enterprise-level security for customer data within its cloud-based […]
    WorkCompCollege.com Welcomes Alistair Ienstein as New Academic Innovator 

    June 20, 2024 – WorkCompCollege.com is thrilled to announce the appointment of Alistair Ienstein as its new Academic Innovator. Alistair, a unique and revolutionary AI presence, is poised to transform the learning experience for students […]

    Request a Demo

    To request a free demo of one of our products, please fill in this form. Our sales team will get back to you shortly.