A well written cover letter to the med-legal evaluator has always been important to the effective handling of a case. However, many of us tend to send the “generic” cover letter providing a very brief summary of the relevant facts and asking the doctor to respond to the same questions about MMI/P&S, periods of Temporary Total Disability, Temporary Partial Disability, Permanent Disability, Apportionment, Future Medical Care, Work Restrictions and entitlement to the Supplemental Job Displacement Benefit Voucher. In addition, every medical report, set of subpoenaed records, etc. is sent for the doctor to review.
With the implementation of the new Medical Legal Fee Schedule on April 1, 2021, an efficient and effective cover letter is more important than ever, to avoid any unnecessary costs that may result from the doctor addressing items that are not at issue, reviewing records that are not relevant to body parts that are the focus of the examination, or the need for a supplemental report.
When preparing the cover letter to the med-legal evaluator, the first thing you should do is identify what body parts/systems the doctor is evaluating. If the applicant has alleged/sustained injuries that require evaluations by other specialties, provide the doctor with this information. For example:
Dr. Green you will be evaluating applicant as it pertains ONLY to the orthopedic injuries. Applicant is scheduled to be evaluated by Dr. Black who will address the alleged psyche injury and Dr. Blue who will evaluate the internal complaints.
Provide the doctor with a brief summary of the mechanism of injury alleged. If the applicant provided different descriptions of how the injury occurred, point this out. Identify to who and when the applicant made the initial report of injury and what was reported. Then note to whom the subsequent descriptions were provided, and how far removed from the initial report. Specifically identify what body parts/systems are being evaluated, what body parts/systems are accepted and what body parts/systems are denied. If a discussion on causation is NOT needed, state this.
Provide a brief statement regarding treatment and the status of treatment. Do not summarize the medical reports, or provide your own interpretation of the reports; the doctor will review them as part of the evaluation. A brief statement of the facts, such as “treatment has been provided for the neck, back and right knee” is sufficient. If the applicant has been discharged from care, without impairment or need for further medical treatment, point this out.
Now, the party submitting the records to the med-legal examiner is required to provide a declaration under penalty of perjury that he/she has complied with the provisions of Labor Code 4062.3 before providing the documents to the doctor. The declaration must also contain an attestation as to the total page count of the documents provided. If the declaration and attestation are not provided, the doctor will not review the records.
This becomes important when determining what records to send to the doctor. For the initial evaluation and any re-evaluation, pages in excess of 200 are billed at $3.00 per page. Therefore, you must be discerning of the records that you are sending to the doctor, particularly in cases that involve injuries that will involve multiple body systems and specialties. Provide the doctor only relevant medical records – if orthopedic, do not send psyche or internal, etc.
If records are voluminous and consist of duplicates, blank pages, etc., ie Kaiser, you may consider having an informal conference with the applicant attorney to seek an agreement to send only the relevant records and-provide him/her with an excerpted copy of the records that you are proposing to send to the doctor. You want to avoid having the doctor review records that are not relevant and/or duplicative. If applicant attorney is not agreeable, a more formal conference may be needed to reach an agreement; however, should he/she fail to agree, you may be left with no other choice but to send all the records.
Finally, provide the doctor with the questions that you would like him/her to address. These are often the same questions in every case, however, in some cases, they can be drafted specifically to address the facts of that case. If the doctor does not need to address causation, then do not ask him to. If the injury is orthopedic, do not ask the doctor questions related to psyche injuries.
These are only suggestions and are by no means hard and fast guidelines. Ultimately, what we want to do is provide the evaluator with all the relevant information he/she needs to complete the evaluation and avoid any unnecessary fees that are due to the doctor addressing items that are non-issues or providing a report that does not address all issues because the cover letter was not clear.