What Happens If the Claims Administrator Doesn’t Pay Your QME Invoice?
California law gives Qualified Medical Evaluators powerful tools to secure payment. If a claims administrator fails to pay within the statutory window—60 calendar days from receipt of your complete billing packet (Labor Code §4622)—you may add penalties, charge interest, and, ultimately, file a lien with the Workers’ Compensation Appeals Board (WCAB).
Step-by-Step Collection Process
- Verify Service Date
Double-check proof of service. The 60-day clock starts when the claims administrator receives both the report and a compliant invoice. - Send a Courtesy Reminder (Day 61–70)
A brief e-mail or certified letter often prompts payment; many late checks result from adjuster turnover or clerical backlog. - Assess Penalty and Interest (After Day 60)
• Penalty: 10 % of the unpaid amount.
• Interest: 7 % simple interest, calculated from the original due date.
Cite Labor Code §4622(c) in your demand letter and include a revised invoice. - File a Second Bill Review (SBR) Petition (Optional)
If the administrator disputes the fee—claiming, for example, that modifiers are unsupported—you must file SBR within 90 days of receiving the Explanation of Review (EOR). - File a WCAB Lien
When penalties and SBR fail, e-file a lien in EAMS. Attach the report, invoices, service proofs, and correspondence. A status or lien conference will be set; judges routinely award statutory penalties and interest when documentation is airtight. - Pursue Civil Collection (Rare)
Some evaluators turn stubborn accounts over to collection firms, but the lien process usually resolves the debt without court.
Best Practices to Avoid Non-Payment
- Serve invoices electronically and by first-class mail; retain read receipts.
- Include record-review logs and modifier rationales—pre-empts fee disputes.
- Calendar Day 60 and Day 75 reminders in your billing software.
Helpful Regulatory Reference
For the official penalty provisions, see Labor Code §4622(c) on the DWC website: Payment of Medical-Legal Expenses (§4622).
By following these steps—and maintaining meticulous proof of service—you transform late payments from a revenue risk into a recoverable, penalty-enhanced receivable.