California’s Division of Workers’ Compensation (DWC) has officially extended emergency regulations which add 15 days to the usual time frame for Medical-Legal reporting.

Enacted in response to the COVID-19 pandemic, the emergency measures were set to expire on October 12. Following recent approval of re-adoption by the Office of Administrative Law (OAL), the deadline extension will remain in place until January 11, 2022.

45 Days to Submit Medical-Legal Reports (Until January 11)

Normally, Qualified Medical Evaluators (QME) and Agreed Medical Evaluators (AME) must submit Medical-Legal evaluation reports within 30 days of the injured worker’s evaluation, with certain exceptions for unusual circumstances.

However, Section 46.2 was added to the California Code of Regulations (CCR), effective from March 14, 2020. This emergency regulation in response to the pandemic extends the 30-day time frame by 15 days, to 45 days.

After re-adoption by the DWC and approval by the OAL, §46.2 will remain in effect until January 11, 2022.

Appeal Improper Denials for Untimely Med-Legal Reports!

Sadly, claims administrators may fail to adhere to the emergency regulations, and deny payment on the grounds of untimely reporting — even when the physician submits the Medical-Legal report within the current 45-day time frame.

As we shared recently, we recommend including the following language with your report to help preclude such improper denials:

Per Governor Newsom’s stay-at-home order in response to COVID-19 issued on March 19, 2020, and the California Division of Workers’ Compensation’s emergency measures extending the deadline for submitting Medical-Legal reports found in California Code of Regulations Section 46.2(c), this Evaluation Report was delayed by 15 or fewer days in excess of the 30-day submission requirement.

Be sure to promptly dispute any improper timeliness-based denials by submitting a Second Review appeal within 90 days of receiving the Explanation of Review (EOR) from the claims administrator. Include the following language in your appeal:

California Code of Regulations Section 46.2, QME Emergency Regulation in Response to COVID-19, effective from 5/14/2020 to 1/10/2022, states that “During the time this regulation is in effect, all of the time periods enumerated in section 38 of title 8 of the California Code of Regulations are extended by a period of 15 days.” The evaluation report in question was submitted within 45 days, as allowed by this emergency regulation.

According to the DWC, this re-adoption will be the last time the emergency regulations are extended. After January 11, the usual 30-day time frame will apply to Medical-Legal reporting, barring the adoption of new emergency regulations.

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