Workers’ compensation: medical-legal expenses: fee schedule.

Senator Hurtado's workers' compensation reform proposal establishes a biennial review process for medical-legal evaluation fees, modifying how California compensates physicians who assess disputed claims. The legislation creates a mechanism for the Administrative Director of the Division of Workers' Compensation to adjust fee schedules every two years based on medical practice costs and the Medicare Economic Index.

The bill maintains the existing framework of procedure codes and relative values while adding specific criteria for fee adjustments. These include changes to the conversion factor and per-page costs for reviewing medical records. Under the proposed system, providers must continue operating within the established fee schedule unless they can document extraordinary circumstances related to a patient's medical condition. Both employers and employees retain the right to contest fees that exceed scheduled amounts.

The measure includes provisions governing compensation beyond standard fees. Medical providers cannot accept additional payments, rebates, or other forms of remuneration beyond authorized fees. Those who violate these restrictions face potential disciplinary action from both the Division of Workers' Compensation and their professional licensing boards. The bill preserves existing processes for resolving fee disputes, allowing providers to receive reasonable compensation for testimony when subpoenaed, subject to judicial review.