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MEMORANDUM NO. 2024-05
Establishment of Maximum Fee for Causation Opinion or PPD Rating on a Denied Claim - Effective July 1, 2024
| TO: | WCC Administrative Law Judges, District Administrators, Advisory Board Members, Legal Advisory Panel, Medical Advisory Panel, Medical Practitioners, Insurance Carriers, Self-Insureds, Medical Care Plans, Claimants, Attorneys and Unions. |
| FROM: | Stephen M. Morelli, Chairperson |
| DATE: | June 27, 2024 |
| RE: | Establishment of Maximum Fee for Causation Opinion or PPD Rating on a Denied Claim - Effective July 1, 2024 |
Effective July 1, 2024, a treating physician who is asked to provide a causation opinion or a Permanent Partial Disability (PPD) rating on a denied claim may charge up to $400 for this report. The report must be affirmatively requested by the patient or their representative, and the patient would be responsible for payment. As with standard special report fees, if a physician feels that an additional fee is warranted, they may seek permission to charge that higher rate from an administrative law judge. However, physicians considering requesting additional fees should keep in mind that the patient bears the responsibility for payment and should proceed accordingly.
The Professional Guide for Attorneys, Physicians, and Other Health Care Practitioners and the Payor and Medical Provider Guidelines to Improve the Coordination of Medical Services will be updated to reflect this change.