Stacey Green — ADJ9060925

Panel QME Dr. David Doty (through cost petitioner William Tappin) billed $2,000.00 under the ML-104 complexity code for a February 16, 2017 evaluation that included a 5.5-hour record review. Zenith Insurance reduced the bill via Explanation of Review to ML-102 and paid $625.00, and the provider requested a second bill review but never requested Independent Bill Review (IBR). The provider argued the dispute over the reduction (and Zenith's alleged improper EOR addressing causation) was a legal/factual issue for the WCJ rather than an IBR amount-of-payment issue. The WCJ found the dispute was solely over the amount of reimbursement, subject to IBR, and that because the provider failed to request IBR within 30 days of the second review, the bill was deemed satisfied under Labor Code 4603.6(a). The WCAB adopted the WCJ's report and denied reconsideration.