Copy Service Bills as Medical-Legal Expenses (California)

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Copy Service Bills as Medical-Legal Expenses (California)

Postby ozzie on Mon Jan 14, 2019 7:10 pm

A copy service has claimed entitlement to very high charges for penalties, attorney's fees, and sanctions under CCR 10451.1 based on their claim that their records obtained are medical-legal services. However, none of the records subpoenaed by the AA appear to have ever been sent to either of the medical legal evaluators.

My position is that while they may have been used by the AA to analyze the case, they do not qualify as a "medical-legal expense" under LC 4620 because they were not used "for the purpose of proving or disproving a contested claim."

I am nevertheless told by the attorney representing the copy service that he has fought this battle and won in some Panel cases. I can't find them, however, and although he has promised to send me copies I have yet to see them.

Does anyone have some case law they can cite to me on this issue?
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Re: Copy Service Bills as Medical-Legal Expenses (California)

Postby steve appell on Tue Jan 15, 2019 8:29 am

I am unaware of any statute or case law that requires SDT docs to be sent to an AME as a precursor to valid med legal charges. All I know is SDT DOCS must be "reasonably calculated to lead to admissible evidence" to be compensable.

I'm sure this is nothing new to you OZZIE.
Steve

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Van Nuys, Ca 91401
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Re: Copy Service Bills as Medical-Legal Expenses (California)

Postby lacompfun on Wed Jan 16, 2019 1:00 pm

Interesting... let us know if he sends you any cases directly on point.

What kind of records?
Medical
Employment file
WCIRB
Other

AA if he gets the records should serve them upon defense.

The procedural problem is 10451.1.
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Re: Copy Service Bills as Medical-Legal Expenses (California)

Postby jpod on Wed Jan 16, 2019 1:59 pm

Well what about the plain language of the statute?
==========================================
4620. (a) For purposes of this article, a medical-legal expense means any costs and expenses incurred by or on behalf of any party, the administrative director, the board, or a referee for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and, as needed, interpreter's fees, for the purpose of proving or disproving a contested claim.

(b) A contested claim exists when the employer knows or reasonably should know that the employee is claiming entitlement to any benefit arising out of a claimed industrial injury and one of the following conditions exists:
(1) The employer rejects liability for a claimed benefit.
(2) The employer fails to accept liability for benefits after the expiration of a reasonable period of time within which to decide if it will contest the claim.
(3) The employer fails to respond to a demand for payment of benefits after the expiration of any time period fixed by statute for the payment of indemnity.
===========================================

Were ALL of the requirements found in LC 4620 (a)(b) met? What benefit was demanded and denied that the SDT records were/are capable of overcoming the denial of that demanded benefit? What date was the benefit denied; snd, WHEN were the records SDT'd?

I can't provide any case law but I would start with requiring A/A to prove all of the elements of the ML definition.
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Re: Copy Service Bills as Medical-Legal Expenses (California)

Postby vampireinthenight on Thu Jan 17, 2019 10:00 am

Not sure of the case law but, regardless, they are going to be so fact specific as to be useless anyway. You have to look at what the state of the case was when ordered. While the fact that the records were never used is an indication that they were useless, it would not be dispositive on the reasonableness of the order itself. For instance, a certificate of no records is almost totally useless to prove anything medically, it would still represent a valid med-legal expense when ordered if it was done in good faith.

Of course, I would bet if you dug deep enough, you would find out that attorney never specifically ordered the records at all. Likely they simply authorized the copy company to get whatever they could find. At least that is the typical MO I have seen.
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Re: Copy Service Bills as Medical-Legal Expenses (California)

Postby anon2013 on Thu Jan 17, 2019 4:11 pm

Copy services tend to ignore the new laws despite the passage of time. Check out labor code 5307 and reg 9982.
First the applicant has to ask the defendant for the records. Once that hurdle is reached, you can discuss fee schedule, SBR and IBR.
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