What Is California Labor Code §4622: Medical-Legal Bill Payment?

If the provider does not request a second review within 90 days, the bill will be deemed satisfied and neither the employer nor the employee shall be liable for any further payment.

What Does Labor Code 4622 Require?

Section 4622 sets the payment timeline, the penalty for paying late, and the steps a provider follows to dispute the amount billed.

Medical-legal expenses are the cost of an evaluation, test, report, or certified interpreter used to settle a disputed part of your claim, as Labor Code 4620 defines them. A qualified medical evaluator (QME) or an agreed medical evaluator usually writes the report; our guide on what a QME is explains that role. Once the report and bill reach your employer, Labor Code 4622 takes over: a 60-day clock to pay, a penalty for paying late, and a path for either side to challenge the amount.

This section applies mainly to your employer, its insurer, and the provider who submitted the bill. It is not a bill you pay yourself. A slow or disputed bill can still hold up the evaluation your claim depends on. The version of the law in effect today took effect January 1, 2013, under the SB 863 reform.

How Does the 60-Day Payment Deadline Work?

Your employer has 60 days after receiving the written billing and report to pay it, or a 10 percent increase plus 7 percent yearly interest applies.

The clock starts when your employer receives a separate, written billing and report from the provider. A late payment raises the unpaid part by 10 percent. Interest then runs too, at 7 percent a year from the day the bill and report arrived.

Your employer can avoid that increase on part of a disputed bill. It must pay the share it believes reasonable within 60 days, then later win the dispute over the rest.

A separate 20-day deadline runs from when the appeals board files an order directing payment. If you, or a deceased worker's dependents, ask for that payment within the 20 days and your employer still does not pay within that window, the same 10 percent increase and 7 percent interest apply, counted back to the date the board filed the order.

What Happens if the Employer Disputes the Bill?

Your employer has to explain a dispute in a written explanation of review, often called an EOR, and the provider can ask for a second review within 90 days of that notice.

Labor Code 4603.3 requires your employer to send a written explanation of review (EOR) whenever it disputes a medical-legal bill. The EOR must state why your employer is paying less than the full amount billed.

A provider that disagrees has 90 days from service of the EOR to ask for a second review, on the administrative director's form, listing the disputed items, the amount sought, and the reason. Missing that window settles the bill; neither your employer nor you owe anything further.

Your employer then has 14 days to send a final written decision on every item still in dispute. If the provider still disagrees, it can request an independent bill review under Labor Code 4603.6 within 30 days of the second review. That review is neutral and sits outside the regular claims process; missing its 30-day window also forfeits the balance.

What if the Employer Denies the Whole Bill?

A full denial for a reason other than the fee schedule works differently: the provider has 90 days to object, and your employer then has to take the dispute to the appeals board.

A full denial for a reason other than the fee schedule works differently than an ordinary dispute over the amount paid. The provider then has 90 days from the explanation of review to object. Skipping that window gives up the denied amount for good.

When the provider objects on time, your employer must file a petition and a declaration of readiness to proceed with the Workers' Compensation Appeals Board (WCAB), within 60 days. The WCAB then decides who is right. If your employer prevails, the board can order the provider to repay any part it finds unreasonable.

How Does Labor Code 4622 Connect to Other Medical-Legal Rules?

4622 governs the bill itself; nearby sections decide who owes it in the first place, and two general penalty laws do not reach it at all.

Labor Code 4620 defines a medical-legal expense and the contested claim that has to exist before one is owed. Labor Code 4064 puts the cost of a panel evaluation under sections 4060 through 4062 on your employer. Labor Code 4621 covers a different case: it pays you back when you, not your employer, cover that expense yourself. Section 4622 applies once a provider bills your employer directly, whichever path the bill came from.

Two general penalty laws do not reach this bill. Subdivision (e) excludes Sections 5800 and 5814. Labor Code 5800 adds interest to an unpaid appeals board award. Labor Code 5814 adds up to a 25 percent penalty, or $10,000, whichever is less, for an unreasonably delayed benefit. A late medical-legal bill uses only the 10 percent increase and 7 percent interest built into section 4622 instead. A related law, Labor Code 4603.2, runs a similar second-review process for ordinary medical treatment bills, a separate category from medical-legal expenses.

What Should I Keep for a Medical-Legal Billing Dispute?

Keep every date tied to the bill, and ask the claims administrator in writing if a payment or a response runs late.

Keep the provider's report, the itemized bill, and proof of when your employer received both; that date starts the 60-day clock. Keep the EOR, the second review request, and the final decision too. Each date decides whether a penalty or a deadline applies.

If a bill sits unpaid past 60 days with no EOR on file, ask the claims administrator why, in writing. A pattern of late or disputed bills can slow the evaluation your claim depends on. A licensed attorney can review the dates if a delay does not clear up.

Is your claim stuck behind an unpaid medical-legal bill, or an evaluation held up by a billing dispute you do not follow? Yazdchi Law P.C. can review the dates and the explanation of review with you. Call (661) 273-1780 or use our contact form for a free initial review. The firm reviews each matter's own facts before deciding whether to take a case.