With the passage of SB863, fewer doctors are treating patients on a lien. Some injured workers who had been treating with a doctor, who had been providing services on a lien, are abruptly being cut-off from care. The appointment clerk tells the patient, “I’m sorry but we cannot schedule a follow-up appointment for you. We received a ‘letter’ from the insurance company.”
What happened? The new subsection (b) of Labor Code § 4903.1 is what happened. SB863 replaced former LC § 4903.1(b) which permitted liens to be filed with the WCAB for medical services, among other things, that were provided to the applicant. Medical providers were able to seek recovery of their costs by showing that the services were reasonable. Medical providers were able to recover a portion of their bill even on denied claims.
The new LC § 4903.1(b) prohibits payment of medical providers’ liens, unless one of three conditions are met: (1) The defendant authorized the services; (2) The defendant failed or refused to provide medical treatment (up to $10,000) during the 90-day time period that the defendant had to decide if it will accept or deny the claim; (3) The medical expense was necessarily incurred for an emergency medical condition.
There are still a limited number of other ways medical providers can get paid or reimbursed for their services, such as after an award for medical treatment or a WCJ finding that the injured worker is permissibly treating outside the MPN. Nevertheless, with the new restrictions of LC § 4903.1(b) medical providers will find it harder to get paid for their services on denied claims or when the treatment is not authorized. This means that applicant attorneys will have to seek litigation of such thresholds issues early in the case to protect the interests of these treating physicians and to ensure that injured workers will continue to have a choice of medical doctors who will treat on a lien.
