Alert: ESIS has failed to pay at least 7 bills for workers’ comp Medical-Legal services, despite acknowledging receipt of the bills in question. Further, attempting to call ESIS is a painful and futile undertaking.

We are compelled to publish the information below, in order to hold ESIS to account for its refusal to timely reimburse physician evaluators as required by California law.

Publicly shaming ESIS is an unfortunate necessity, as California workers’ comp regulations impose no real repercussions on payers that choose to ignore payment requirements. Essentially, California creates a consequence-free environment which actively encourages payers to withhold reimbursement from providers — including the failure to enforce penalty and interest payments due for exactly this kind of negligence.

We also share this data to warn medical-legal physician evaluators billing ESIS.

Obtaining reimbursement from ESIS may be difficult or impossible, unless the physician is willing to endure the expense and administrative burden of retaining attorney services to pursue reimbursement.

Medical-Legal Bills Accepted - No Excuses

daisyCollect agents confirmed with ESIS’s bill review service that each of the bills in question were accepted, reviewed, and forwarded to an ESIS adjuster for final processing and payment. daisyBill agents have taken all appropriate action to demand reimbursement from ESIS on behalf of our provider clients….and ESIS continues to refuse to pay the evaluators.

Med-legal evaluators, be advised that ESIS is currently ignoring California laws, regulations, and rules mandating timely payment and delivery of Explanations of Review (EORs) in response to Medical-Legal bills.

Furthermore, be advised that penalty and interest payments are due for the delayed payments, in addition to the amounts billed. Below is a table listing the bills that remain unpaid by ESIS as of this writing, as well as the penalties and interest currently due to affected physicians.

ESIS Unpaid Med-Legal Bills, Penalties & Interest Owed

Below is a complete list, as of this writing, of the bills for which ESIS has remitted no payment to daisyBill providers. For each of the bills below, daisyCollect agents contacted ESIS’s bill review to confirm receipt of the bill.

Medical-Legal Payment Deadlines, Penalty and Interest Rates

California Labor Code Section (LAB) 4622 mandates that claims administrators have 60 days from receipt of the physician’s bill to remit payment and the EOR for Medical-Legal services:

All medical-legal expenses for which the employer is liable shall, upon receipt by the employer of all reports and documents required by the administrative director incident to the services, be paid to whom the funds and expenses are due, as follows:

(a) (1) Except as provided in subdivision (b) [which outlines the provider’s appeal process to dispute incorrect reimbursements], within 60 days after receipt by the employer of each separate, written billing and report…” [emphasis added]

After 60 days from receipt of the bill, the claims administrator incurs a 10% and 7% accrued interest per annum. LAB § 4622 continues:

…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]

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