Workers’ compensation law allows certain claims for payment for services or benefits provided to or on behalf of injured workers to be filed as a lien against an the employee’s claim for workers ‘compensation benefits. Payment of those claims can only be allowed by order of the Workers’ Compensation Appeals Board (WCAB).
Requests that can be filed as a lien against the injured employee’s claim include:
- Attorney fees
- Burial expenses
- Living expenses of the employee’s spouse or minor children.
- The amount of unemployment compensation disability benefits paid pending a determination of a work-related injury.
- The amount of unemployment compensation benefits and extended benefits or family temporary disability insurance benefits to the extent such benefits duplicate period of the injured employee’s entitlement to temporary total disability.
- The amount of indemnification granted by the State’s Victims of Crime Program.
- The reasonable expense incurred by or on behalf of the injured employee for reasonable medical treatment to cure or relieve the effects of the industrial injury except medical treatment disputes subject to independent medical review or independent bill review.
What is independent bill review (IBR)
IBR is an efficient, non-judicial process for resolving medical treatment and medical-legal billing disputes where the medical provider disagrees with the amount paid by a claims administrator on a properly documented bill after a second review.
* When will IBR begin?
* IBR is effective Jan. 1, 2013 for all dates of service on or after Jan. 1, 2013.
* How does IBR work?
Upon referral by the administrative director (AD), the independent bill review organization (IBRO) notifies the parties of the assignment and provide them with an IBR case or identification number.
The IBRO assigns an independent bill reviewer to examine all documents submitted, apply the appropriate fee schedule (i.e., Official Medical Fee Schedule, Medical Legal Fee Schedule, Contract Reimbursement Rates per Labor Code 5307.11), and issue a written determination within 60 days of the assignment to IBR.
If the determination finds any additional amount of money is owed to the provider, the determination shall also order the claims administrator to pay the additional sum owed and reimburse the provider the amount of the filing fee.
The IBR determination is deemed the determination of the AD and it is binding on all parties.
What type of medical bill is eligible for IBR?
Any medical service bill where the fee is determined by a fee schedule established by the DWC can be resolved through IBR.