The workers’ compensation system has a vast multitude of rules and regulations. These can seem overwhelming to those not heavily involved in workers’ compensation cases on a regular basis. Even if you are not regularly involved in the system, you are expected to know and go by the rules if you do become involved. This is true for everyone from the largest insurance company to a solo interpreter service business. If you own or operate an interpreter service business, you have likely run into the problem of getting the employer or insurance company to timely pay your invoices. It is important to know when an interpreter charge is a medical-legal charge, and how that interacts with some other essential provisions in the law.
California Labor Code 4620 contains the definition of a medical-legal expense in the context of workers’ compensation. The statute states that a medical-legal expense is “any costs any expenses incurred by or on behalf of any party, the administrative director, or the board . . . for the purpose of providing or disproving a contested claim.” The statute goes on to list some allowable types of medical-legal expenses, including X-rays, laboratory fees, medical reports, and, “if needed”, interpreter fees. Subsection (d) of the statute provides that an injured employee is entitled to an interpreter during the medical examination if the employee is not able to effectively communicate with the medical professional during the exam. Medical-Legal charges for Interpreters typically only occur within Agreed and Qualified Medical Evaluations. Treatment and Cost provisions cover the remainder of services.
California Labor Code 4622 provides the framework regarding timelines for the insurance company or employer to actually pay the invoice. The code provides that if the service is not contested, payment on the invoice is due within sixty days of receipt by the employer. If the bill is not paid within that timeframe, the balance will be increased by 10% plus interest at the rate of 7%. This will be retroactive to the date the employer received the bill.
It is possible, however, for the provider to contest the amount paid. If the provider wants to contest the amount, the provider may request a second review. This request must be submitted to the employer and must include specific information contained in the statute, such as who requested the service, the claim number, and the amount in dispute. If the Interpreter does not file a request for a second review within ninety days, then the invoice will be deemed “satisfied.”
These are not the only rules and regulations addressing these issues. One must also look to WCAB Rule § 10786, “Determination of Medical-Legal Dispute.” The statute provides that within sixty days of service to a provider of an employer or insurance company’s objection or denial of part or all of an invoice, the defendant “shall file and serve a petition for determination of medical-legal expenses and a Declaration of Readiness to Proceed.” If the defendant fails to file the petition within the time stated in the rule, then the medical-legal provider (such as the interpreter) may file a petition for reimbursement. The matter may then be set for either a status conference or a mandatory settlement conference. It is important to understand that failure to file the correct documents at the same time could end up meaning the defendant has waived objections to medical-legal provider billing. Finally, if the WCAB determines that the objections, refusal to pay, and/or failure to adhere to the timelines was a result of bad faith, they could be ordered to pay the attorney’s fees, as well as monetary sanctions.
We have extensive experience with the collection process. Call us today to talk about your interpreter business and how we can help you. Our services are generally free to you, as we collect our fees from the insurance company. Call today for a free consultation.