PTP report service requirements (California)

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PTP report service requirements (California)

Postby wcscout on Tue Nov 28, 2017 10:49 am

Is there any code governing a PTP serving medical reports on both the carrier and defense counsel, is there any remedy for a PTP that refuses to serve on Counsel?
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Re: PTP report service requirements (California) (California)

Postby LawAdvocate on Tue Nov 28, 2017 12:15 pm

Nope to PTP serving to Defense Counsel. In fact the code explicitly states that the PTP only need serve a copy to the claims administrator, CCR 9795(c).

"The primary treating physician, or a physician designated by the primary treating physician, shall make reports to the claims administrator as required in this section. A primary treating physician has fulfilled his or her reporting duties under this section by sending one copy of a required report to the claims administrator. A claims administrator may designate any person or entity to be the recipient of its copy of the required report. "

Be careful asking to be designated as the recipient of the required reporting, as it usually contains a bill and the time frames for payment start. This is why you don't demand it.

Yep, related to remedy for getting the PTP to serve, you pay for it. CCR 9783.14 (d) allows the PTP to bill for any requested copies of reports, so make sure your client is willing to pay for it, if you demand it from the PTP and your demand letter should include a letter from the claims administrator on their letterhead allowing authorization to bill for same, in my experience most claims administrators will not incur this cost.

"Duplicate Reports. A primary treating physician has fulfilled his or her reporting duties by sending one copy of a required report to the claims administrator or to a person designated by the claims administrator to be the recipient of the required report. Requests for duplicate reports related to billings shall be made only by the claims administrator and shall be in writing. Duplicate reports are separately reimbursable. Use Code WC009 to bill for duplicate reports “By Report”."

Why Claims administrators do not give their defense attorneys access to the medical file and pay the cost for the defense secretaries to go in once every 60 days is beyond me. I am sure it has something to do with potential HIPPA violations, but there has to be a way. Since Claims Adjusters rarely are involved in the "meat and potatoes" of a claim, most claims adjusters are up against a wall in getting the medical reporting to the defense counsel on a periodic basis. It is impossible to do all you are supposed to do in caseload, once it spikes over 100 semi-complex claims. There is not enough time in the day and employers/insurance carriers are running a calculated risk as to what does not get done.
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Re: PTP report service requirements (California)

Postby vampireinthenight on Wed Nov 29, 2017 9:13 am

Agree with LA. It is really important for a claims unit to have a solid report service process.

I also agree it is problematic when the adjuster is expected to serve medicals and also subpoena all needed records and serve all records to the QMEs. The reality is that the adjusters simply do not have the time to get all this done.
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