Working Days or Calender Days ? (California) (California)

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Working Days or Calender Days ? (California) (California)

Postby appliedpsych on Thu Nov 12, 2009 1:18 pm

My understanding is that LC 4622 now mandates QME payments 60 CALENDER days after receipt. One Claims Adjustor is disagreeing and says that it is still 60 WORKING days. I know the working days applied in the past, but I thought new changes clarified it.

The statute at present reads "...within 60 days...".

How do you all see it ? ? ?
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Re: Working Days or Calender Days ? (California) (California)

Postby mike@mikeslaw.com on Thu Mar 03, 2011 8:53 pm

The statute only says "days", not "working days". There are plenty of statues that use the term "working days". (I ran a word search on my book and came out with 25 different sectins using that term.) Absent that specificity, I see no reason that the idea of "working days" applies here. The adjuster just has sixty days.

Her's a quote from my book (Sullivan On Comp, section 14.65):

"Pursuant to LC 4622, the employer has 60 days after the receipt of each separate written billing and report to either issue payment or object to the billing. The purpose of LC 4622 is to ensure that bills of medical providers are paid promptly and that protests or objections to bills are promptly raised and adjudicated. It has been recognized that "medical providers not only render necessary services, they operate businesses which cannot be routinely dependent upon revenues subject to recovery by employer/carriers at some later unspecified time."[4]

If payment is not made within this period, or only a partial payment is made and the appeals board determines that additional payment is due, that portion of the billed sum will be increased by 10 percent plus interest at the rate of 7 percent per annum, retroactive to the date the employer received the bill and the report. The payment must be made within 20 days of the filing of an order of the appeals board directing payment (LC 4622(a)). If payment is not made within 20 days from the filing of an order of the appeals board directing payment, the employee may request that the unpaid portion be increased by 10 percent plus interest at the rate of 7 percent per annum, retroactive to the date of the filing of the order of the board directing payment (LC 4622(b)).

LC 4622 gives medical providers their sole remedy for delayed payment of medical-legal expenses.[5] That is, medical providers do not have a right to claim penalties under LC 5814 for unreasonable delays in payment of medical-legal expenses or interest under LC 5800 (LC 4622(c)). For more on this point, see Section 13.30 Unreasonable Delay –– Failure to Pay Medical-Legal Benefits."
Michael Sullivan
Michael Sullivan & Associates, P.C.
Author of "Sullivan on Comp," the clearest and most comprehensive treatise on California Workers' Compensation ever written. More info at http://www.workcompcentral.com/sullivan.
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Re: Working Days or Calender Days ? (California) (California)

Postby appliedpsych on Mon Apr 04, 2011 2:58 pm

Thank you Mikeslaw. That's the way I see it as well.

Given the clarity of LC 4622 and other related code sections, I wonder if you have an opinion on why some doctors have such trouble collecting from IC's. I have one such situation going on at present, but I am lucky I guess in that it has been a rarity that I have had to fight for QME payments.

Some psychiatrist QME's I have talked to describe multiple instances of IC's not paying their Panel QME bills, even when the QME opinion has been supportive of the IC position. It's not that the bill has been objected to, denied, etc. - but that the IC just passes blame as to why it has never been paid, then to add insult to injury, they claim that they are NOT required to pay interest and penalty per LC4622, just because they say so.

What do you suggest in cases like that?
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