In a previous post, we saw how the Second Bill Review (SBR) / Independent Bill Review Process helps providers of medical-legal services dispute payments made by claims administrators.
However, the Independent Bill Review process applies only to disputes related to the amount to be paid to a medical-legal provider.
For all other medical-legal disputes it is necessary to file a non-IBR dispute.
These issues may include (without being limited to):
- Threshold issues (such as employment, statute of limitations, or insurance coverage).
- Whether the claimed medical-legal expense was incurred for the purpose of proving or disproving a contested claim.
- Whether the claimed medical-legal expense was reasonably, actually, and necessarily incurred.
- An assertion by the medical-legal provider that the defendant has waived any objection to the amount of the bill because the defendant failed to comply with the relevant requirements, timelines, and procedures set forth in Labor Code sections 4622, 4603.3, and 4603.6.
Non-IBR Petitions and Medical-Legal Providers
In the specific case of medical-legal expense providers, they may file a Petition for Determination of Non-IBR Medical-Legal Dispute with respect to any medical-legal expense dispute not subject to IBR if:
- A defendant fails to timely file a petition and/or Declaration of Readiness (DOR) as required by Labor Code section 4622(c) and Rule 10451.1(e)(2), that is, 60 days within the service of the provider’s objection to the Explanation of Review (EOR)
- A defendant breaches a duty under Labor Code section 4622(a) and/or (b) or the Rules of the Administrative Director at an earlier stage of the non-IBR dispute.
Medical-legal providers are not required to include a DOR, although they may choose to file one.
It’s important to note that a copy of the petition and any DOR must be concurrently served on:
- The defendant(s)
- The employee or dependent
- If any of these above is represented, service must also be made on the attorney(s) or hearing representative(s).
Practice IQ: Medical Billing Services in California
Need help filing a non-IBR petition? At Practice IQ, we have made it our mission to take care of the administrative side of medical-legal reports and billing so you can focus on what you do best.
We are located in Pomona, California, and serve clients all over the Golden State. Contact us today by telephone (424-433-5704) or email (piqusinfo@practiceiqusa.com), or fill out the contact form to learn more about our services.
