How many ways can an insurer violate workers’ comp payment laws, regulations, and rules on a single bill?

Travelers may have set the benchmark by refusing to correctly pay a Qualified Medical Evaluator (QME) for Medical-Legal services, despite Independent Bill Review (IBR) overturning Travelers’ nonsensical payment denials.

In a “hold my beer” moment of serial non-compliance, Travelers:

• Denied a $4,453.14 Medical-Legal bill by erroneously claiming the services were “non-compensable”
• Denied the QME’s Second Review appeal without providing a denial reason
• Defied an IBR ruling and paid the QME $90.46 less than the amount ordered by improperly applying a Preferred Provider Organization (PPO) discount
• Violated California law by failing to reimburse the QME the $180 IBR filing fee

To receive payment for a single Medical-Legal bill, this QME submitted three different bills (an original bill, a Second Review appeal, and an IBR request) for a combined total of 261 pages and paid $180 to file the IBR request—and Travelers still refuses to properly pay the QME despite a final and definitive IBR decision.

We can’t be surprised, because this is California.

Laws and regulations are only as effective as the Division of Workers’ Compensation (DWC)’s commitment to enforcing them. As we see daily, enforcement is a low priority for the DWC, whose continued refusal to impose consequences has…well, consequences like the egregious abuse Travelers inflicted on this QME.