California OMFS: Yet Another Death of the Extraordinary Circumstances Exception Post-2004

A third WCAB panel finds that the extraordinary circumstances exception in the OMFS has died post-2004

In Murphy v. County of Fresno, 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB rescinded the WCJ’s finding that the lien claimant Cedar-Sinai Medical Center was entitled to payment of fees in excess of the inpatient fee schedule set forth in the 2004 OMFS pursuant to 8 Cal. Code Reg. § 9792(c)(2) [R 9792] due to the applicant’s urgent injury and extraordinary nature of services provided by lien claimant, and held instead that the lien claimant was only entitled to payment pursuant to the 2004 OMFS and nothing further.

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The WCAB reasoned that the provision in Labor Code § 5307.1 [LC 5307.1], which allows payment in excess of the OMFS for medical treatment related to extraordinary services, was deleted in 2004 as part of SB 228, and that, concurrently, Labor Code § 5307.1(e)(1) was amended to provide for adoption of a new OMFS after 12/31/2003. Although WCAB panels have previously reached different conclusions as to whether fees in excess of the 2004 OMFS are allowed when there are extraordinary circumstances regarding medical services, the recent amendment to 8 Cal. Code Reg. § 9790 [R 9790] now expressly states that 8 Cal. Code Reg. §§ 9790.1 through 9792.1 [R 9790.1-9792.1] are not applicable for medical and inpatient hospital services for discharges after 1/1/2004 unless otherwise specified. Since services in this case were provided in 2011, the exception to the OMFS for extraordinary services does not apply. Reimbursement for inpatient services is now governed by 8 Cal. Code Reg. § 9789.22(a) [R 9789.22].

Read the Murphy noteworthy panel decision.

To read similar noteworthy panel decisions, see our reports of Torres Tavera and Garcia.

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