QME No-Show Fees (California)

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QME No-Show Fees (California)

Postby Ron Castro on Sat Aug 07, 2010 2:09 pm

I have a claim that was on delay pending AOE/COE Investigation. The claimant filed for & was given a Q.M.E. panel. Upon receipt of the panel she scheduled the Q.M.E. appointment. I received the Q.M.E. appointment notice and attached to the notice was a letter from the Q.M.E. office that should the claimant not show up and/or not timely keep his/her appointment for the evaluation, they will charge no show charge $650.00. The end the letter stating the evaluation will not take place unless they have the signed authorization in their file prior to the claimant's appointment and ask that the claims examiner sign and fax the notice back to their office.

Question, is this legal? It's always been a practice that if a claimant not show up for a Q.M.E. examination, the Q.M.E. office was free to charge for the no-show, which they normally do and we normally process to our bill paying unit. I think the average amount they pay is $250.00 or $300.00. But I've never had a Q.M.E. demand a fee of $650.00 and state they unless the agreement is signed that they will not allow the appointment to take place. Especially since it's the claimant who made the appointment.

Any feedback is welcome. Thanks.
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Re: QME No-Show Fees (California)

Postby jonbrissman on Sun Aug 08, 2010 9:35 am

Sue Honor-Vangerov at DWC Headquarters is the person who can answer your question definitively, and who can take action to correct the situation if appropriate. Email her at shonor@dir.co.gov

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Re: QME No-Show Fees (California)

Postby calcala758 on Tue Aug 10, 2010 9:52 pm

As far as I know, the only provision in the Labor Code or Regs for no show appointments is for Interpreters pursuant to 9793.3(3)(ii)(c) which states:

(c) Unless notified of a cancellation at least 24 hours prior to the time the service is to be provided, the interpreter shall be paid no less than the minimum fee.

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Re: QME No-Show Fees (California)

Postby stewshe on Wed Aug 11, 2010 7:44 am

I agree with the prior responses, but would like to add there is another, similar situation where the EE becomes represented just before the PQME is scheduled to take place and the QME tries to collect from the EE. (Once the EE is represented the PQME cannot legally take place. PQMEs are only for un-represented EEs.)

Prior to my retirement last December I had 2 - 3 occasions where an EE was scheduled for an appointment in the near future and it was necessary to cancel the appointment on short notice. In 2 of these situations the QME's staff had told the EE the EE &/or the insurance co. would be responsible for their late cancellation. In one instance the appointment was at 11 a.m. and I was calling their office to cancel at 9 a.m.!

I explained the EE would not attend. (One doctor's office said he HAD to or pay, and the other said a late cancellation or no show for any reason would justify their charges and the EE would have to pay if the CA did not.)

I called the Medical Unit and ended up speaking to one of their supervisors. She was VERY professional, told me to please stay on the line, and she called the doctor's office! She tried to verify the EE and I had been told the EE would be charged. One office denied saying it, and the other protested. The latter was told to write a letter to the Medical Unit explaining their position, citing authority, and explaining why the advise they were receiving from the Medical Unit was incorrect. She then told the EE not to pay, because it was not his responsibility, nor the CA's'. It was part of the QME's cost of doing business and their attempting to collect from him was unlawful!

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Re: QME No-Show Fees (California)

Postby appliedpsych on Fri Aug 13, 2010 3:58 pm

Certainly the doctors office requiring a signed stipulation to pay for a no-show is out of line and not supported by any regulation that I know of. That’s like trying to catch flies with vinegar instead of honey. It would probably also get the doctor at least a nastygram from the Administrative Director if she heard about it.

In the rare instances where I have had no-shows, I have found that insurers typically will pay for at least one or two hours of QME time, since a psychological QME requires me to set aside at least a half day to accommodate the injured worker given the time needed for detailed intake plus psych testing. Most adjustors understand this, and pay up at a reasonable level. Usually if a re-schedule is made, and the applicant shows for that, then I don’t bother with a billing for the no-show.

I also have found IC’s are willing to pay for the time for review of records that they have sent me and asked me to review, even if there is a no-show. I don't think I have ever had a company refuse to pay for at least one hour, plus records review time, if any. When the adjustor has sent me 400 pages of records to review, it only makes sense that I am compensated for the review time, even if the injured worker does not show. Usually though by the time there are 400 pages to review, the applicant shows as they are quite dedicated to their case.

I have found that the larger the case file, the more certain the injured worker will present for the evaluation. It's those 30 pagers or no records that will be a no-show.

I did have an exception earlier this year, in case with a large case file. In an unrepped case, the Adjustor made the appointment. The injured worker kept calling my office late at night and saying that he had decided not to attend. This happened several times. Each time this happened, I faxed a notice of this to the Adjustor, asking if I should cancel the appointment. In the final fax, just days before the eval, I asked if she was sure I should not cancel, as the applicant seemed to clearly be stating they would not come. I stated in the fax that I would be glad to cancel with no billing to ensue, but that I would be billing for the 4 hours set aside for the appointment, plus the several hours of records review, if the adjustor kept the appointment in place and the client no-showed. The adjustor faxed back saying not to cancel, that they were telling the applicant to attend. The applicant no showed, and the adjustor paid up for 6 hours with no problems.
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Re: QME No-Show Fees (California)

Postby stewshe on Sat Aug 14, 2010 10:12 am

This should probably be posted under "War Stories," but it is somewhat relevant. It is possible to stress too firmly to an EE the necessity of attending a QME appointment.

I recall a number of years ago telling an EE in Fresno my firm represented how important it was the EE attend an exam in the L.A. area. The EE was a chronic complainer, much worse than most, and finally a day or two before the exam called to say he couldn't make it as his car broke down. The adjuster refused to advance money for a rental car and my firm would only advance gas money, not guarantee a rental, but his problem was the "repairs" his car needed.

I told him we could reschedule it, for 8 - 12 months in the future....and he said he'd find a way to get there. He hitch hiked, or tried to. Half way up the Grapevine a ride pulled over and stopped, beat him with a baseball bat, stole his wallet, and left him bleeding in a ditch.

The CA was shocked to learn his relatively simple torn medial meniscus claim now also involved a sub dural hematoma, a shoulder fracture, and internal organ damage as well as an ambulance bill and a couple of weeks in the hospital. Total charges would have paid for 1000 rental cars! Another example of "penny wise, pound foolish.!"

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Re: QME No-Show Fees (California)

Postby postscript2 on Sat Aug 14, 2010 6:23 pm

OUCH, Stew,

What a horrible story!!! No one should ever hitch hike on the "Grape-Vine..." That used to be part of my territory as a Field Rep C/A, praying the entire time that I didn't break down in a beat up 12 year old Ford Pinto with one of those antiquated cell phones that were the size of a large mans shoe!!! (with no reception!!!)

I used to provide bus or train travel, meals, etc==whatever I could do in my power. I was never one for rental cars due to dual liability, however this story is horrific!

Penny wise and pound foolish isn't the phrase! Pounds foolish and exponential pennies--a wise man would say.... ( I just made that up!)

Geez, don't some people "get it!" Congrat's on your retirement. Love to hear your stories, although this one is a bit on the "gory, but true side..."

Back to the original post: I would, as a C/A, sign an agreement for a no-show fee which varied in amounts. The Norm was about $250.00 if the PQME was "local;" however if the PQME had to travel to a satellite office miles and miles away, on occasions, I'd allow most of the amount. Along with that a letter to the I/W far prior to the appt., that if they were a no-show, the money would be deducted from any future award.

Just my 3 cents (I'm feeling generous tonight)...

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