Connecticut Workers’ Compensation Commission Issues Important Update to Professional Guidelines Regarding One-Time Evaluations and Second Opinions

On August 29, 2019, Connecticut Workers’ Compensation Commission (WCC) Chairman Stephen M. Morelli issued Memorandum No. 2019-07 regarding updates to the Professional Guide for Attorneys, Physicians, and Other Health Care Practitioners Guidelines for Cooperation. Specifically, the memorandum highlights changes to the Professional Guide with respect to one-time medical evaluations and second opinions.

By way of background, the Professional Guide is a guidance document produced by the Workers’ Compensation Commission intended to improve the interaction between attorneys, physicians, and other health care professionals in the administration of workers’ compensation claims. The goal of the Professional Guide is to answer key questions, clarify duties and responsibilities, and help to avoid obstacles between workers’ compensation practitioners and medical professionals. See Professional Guide at p. 4. The Professional Guide is a valuable resource for claim professionals in that it not only provides useful guidance in addressing common issues in the workers’ compensation system, but also serves as a template for the critical interactions between medical professionals, claimants, and claim professionals/attorneys.

In September 2019, the WCC updated the Professional Guide in three key areas. First, effective September 1, 2019, the fee for Commissioner’s Medical Examinations has been raised from $750.00 to $900.00.

Second, effective September 15, 2019, the WCC updated the Professional Guide with respect to one-time medical evaluations. Specifically, the guide was changed to indicate that a one-time medical evaluation paid by the respondent is not the same as a Respondent’s Medical Examination (RME), and the physician is therefore not required to review outside medical records. Additionally, the WCC updated the guide to indicate that one-time evaluations should be reimbursed pursuant to the Official Connecticut Practitioner Fee Schedule rate for a Level 4 new patient consultation (CPT code 9924).

Finally, the WCC updated the Professional Guide with respect to second opinions. First, as was previously noted, the section on second opinions was updated to reflect the same changes made to one-time medical evaluations. Additionally, the updated Professional Guide indicates that when a respondent submits questions to the second opinion doctor that addresses legal issues, e.g., an opinion on causation, the visit then “enters the realm of an RME” and is no longer a second opinion. See Professional Guide at p. 20. This change was also effective on September 15, 2019.

It is important for any Connecticut claim professional to stay aware of any changes to the Professional Guide, especially with respect to issues that are so common in the Connecticut workers’ compensation system, such as one-time evaluations and second opinions. As noted above, the Professional Guide serves as an important tool relied upon by physicians, practitioners, and commissioners alike. Familiarity with the Professional Guide can not only help to avoid conflicts, but assist in decision-making with respect to common issues in the Connecticut workers’ compensation system.

A link to Memorandum 2019-17 and the Professional Guide can be found here.

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