Third-party claims administrator (TPA) ESIS systematically refuses to pay bills for Medical-Legal services. Full stop.

Below, we list 9 Medical-Legal bills — some more than half a year overdue — that ESIS has simply, flat-out failed to pay. Since publication of our recent article, ESIS Refuses to Answer Phone or Pay Med-Legal Doctor, ESIS has added three more overdue bills to their shameful total.

This begs many questions. Below are just a few:

• WHEN will ESIS pay these bills?

• WHAT are Medical-Legal evaluators supposed to do when confronted with behavior like this from claims administrators?

• WHO is supposed to help Medical-Legal evaluators in this situation? Attorneys?

• WHY do California legislators allow claims administrators to ignore the laws they enact?

• HOW does California allow this payment abuse?

In all 9 instances listed below, the evaluator submitted a compliant bill for Medical-Legal services, which California Code of Regulations Section 9794(b) dictates ESIS must pay within 60 calendar days:

All medical-legal expenses shall be paid within 60 days after receipt by the employer of the reports and documents required by the administrative director unless the claims administrator, within this period, contests its liability for such payment. [emphasis added]

The table below shows that ESIS is overdue to pay by anywhere between 62 and 223 days (and counting) for various Medical-Legal bills. California Labor Code Section 4622(a)(1) outlines the penalty and interest rates for failure to adhere to the 60-day time frame:

…within 60 days after receipt by the employer of each separate, written billing and report, and if payment is not made within this period, that portion of the billed sum then unreasonably unpaid shall be increased by 10 percent, together with interest thereon at the rate of 7 percent per annum retroactive to the date of receipt of the bill and report by the employer. [emphasis added]

The table includes penalty and interest ESIS owes as of this writing.

ESIS Paid a Single Medical-Legal Bill

Since publishing our previous article decrying ESIS’ failure to pay Medical-Legal bills, ESIS managed to send a single payment. However, ESIS failed to include in that payment the mandated self-executing penalty and interest owed due to ESIS’ untimely payment.  

Copious Documentation of ESIS Noncompliance

daisyBill has posted multiple articles reporting ESIS’ repeated, persistent non-compliance:

• 3/29/2022: ESIS Unpaid Medical-Legal Bills 
• 2/9/2022: ESIS Refuses to Answer Phone or Pay Med-Legal Doctor 
• 8/23/2021: ESIS Fails to Pay IBR Fee on Behalf of ABM Industries 
• 1/28/2021: ESIS & ABM Industries: IBR Hall of Shame 

In addition to the above articles, daisyBill has filed Audit Complaints with the DWC to report ESIS non-compliance.

We urge the Division of Workers’ Compensation (DWC) to address ESIS’ habit of disregarding payment deadlines and requirements, and impose appropriate consequences. Otherwise, we can expect more of the same from ESIS, and other claims administrators inclined to act as phantom regulators that choose for themselves which workers’ comp laws are truly mandatory.

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