Tola: Navigating Interpreter Liens for Medical Treatment

Thursday, November 2, 2023 | 0

Interpreters play a prominent role in the multilingual realm of the California workers’ compensation system, and determining the rate of compensation for interpreting services remains a highly litigated issue.

Maya M. Tola

In this blog post, we will explore factors to consider when defending against interpreter liens, beginning with whether the services were reasonable and necessary.

Reasonable and necessary

When an applicant receives reasonable and necessary medical treatment under Labor Code 4600, the employer is liable not only for the cost of the treatment, but also certain expenses incurred as a result of it, including interpreter services.

In Guitron v. Santa Fe Extruders (2011), the Workers' Compensation Appeals Board issued an en banc decision holding that an employer is required to pay for an interpreter at medical treatment appointments, but the interpreter lien claimant has the burden of proving the reasonableness and necessity of the services. This right subsequently was codified under Labor Code 4600(g).

The board elucidated that in assessing the reasonableness of an interpreter’s services, the criteria outlined in Kunz v. Patterson Floor Coverings Inc. (2002) should be considered. The Kunz factors encompass:

• The customary fee accepted (not charged) by the provider.
• The typical fee accepted by other medical providers in the same geographical area.
• Pertinent aspects of the economics of the medical provider’s practice.
• Any exceptional circumstances pertaining to the case.

Interpreters, akin to other lien claimants, must show that their services were both reasonable and necessary. For example, if an interpreter was used during the deposition of the worker or at an agreed or qualified medical evaluation, it might be reasonable to infer that the worker needed interpreting services during medical treatment. Conversely, if the applicant spoke English during his deposition or if the medical, employment or prior claim records show a history of fluency in the English language, it can be argued that the interpreter's services were not reasonable or necessary.

Further, if the underlying medical service was improper or would not have been compensable, interpreting services are arguably not compensable. For instance, if there were more than 24 dates of service (DOS) for a chiropractor, a carrier may refuse payment for DOS in excess of 24. (Unless, of course, the chiropractor was reimbursed in excess of 24 DOS, which can occur if, for example, the applicant underwent surgery.)

Original invoice and proof of service

Invoices must be submitted in a timely manner to the correct address of the insurance carrier and within 12 months of the date of service. The proof of service may be reviewed in assessing the timeliness of the submission.

As per Labor Code 4603.2(b)(1)(B), for services rendered on or after Jan. 1, 2017, the request for payment, including an itemized list of services and their respective charges, must be forwarded to the employer within 12 months of the DOS. In most cases, no payment is owed if the provider fails to submit a bill within this 12-month window, even if the lien was timely filed.

It’s important to distinguish that the 12-month window for invoice submission is distinct from the statute of limitations for filing a lien, as outlined in Labor Code 4903.5.

Sign-in sheets

Interpreters may not consistently furnish sign-in sheets as substantiating evidence for their lien claim; occasionally, they may even offer receipts or work orders instead of sign-in sheets. It is advisable to insist on sign-in sheets for every date of service for cross-referencing with the interpreter’s invoices. Additionally, PR-2s or chart notes from the medical treatment appointments may also indicate the interpreter’s presence, and in some cases, their name and certification.

Interpreter certification

Remuneration of interpreter services hinges on whether the interpreter possessed valid certification at the time of service. There are four online sources to check an interpreter’s certification credentials:

• Certified Medical Interpreters Registry.
• California Courts Certification Search.
• CCHI Public Registry.
• California Department of Human Resources Interpreter Search.

Notably, certifications that have lapsed do not appear in these databases after expiration. The onus is, however, on the lien claimant to support the lien, and if required, to furnish evidence of prior certification, affirming the credentials at the time that services were rendered.

Certified interpreters often include their certification number on invoices and sign-in sheets. If a certification number is absent from the invoices and sign-in sheet, often (though not always) these interpreters are uncertified. In practice, uncertified interpreters are relatively uncommon.

Carriers are not obligated to compensate noncertified interpreters for their services. While provisionally certified interpreters may be reimbursed, this scenario is rarely encountered in practice.

Statutory rate of reimbursement

According to 8 CCR § 9795.3 (b)(2), interpreter fees are billed and paid at a rate of $11.25 per quarter hour or any part thereof (equivalent to $45 per hour), with a minimum payment of two hours or the prevailing market rate, whichever is greater.

This rate is applicable specifically for services rendered at medical treatment appointments. For activities such as hearings, deposition preparation, depositions, transcript review or the examination of settlement documents, interpreters receive compensation at the Superior Court rate of $228 for a half day.

Additionally, it’s important to note that when interpreting services involve exotic languages, the applicable rate may be considerably higher. That topic is complex and requires another blog entry, but please note that exotic languages may warrant significantly higher rates.

Market rate evidence

Market rate refers to the standard price commonly exchanged for services or goods within an open market. In this context, it pertains specifically to the actual compensation received by an interpreter for the recent services related to claim preparation and resolution.

To ascertain this rate, interpreters must furnish comprehensive documentation to the claims administrator, outlining a record of comparable services rendered and the corresponding remunerations received.

It is within our purview to contest market rate evidence by scrutinizing the nature, timing (year) and duration of services covered in the data, as well as the associated hourly rates. Notably, collections alone are not indicative of the market rate.

Interpreters often provide data that fails to serve as a reliable gauge for evaluating the prevailing charges or rates. Most market rate evidence that is proffered presents “cherry-picked” or selective data that is not a comprehensive representation of the market. Evidence provided by interpreters omits, overlooks or does not represent potential reductions, penalties and interest, or payments stemming from lien trials, or payments charged and received by other interpreters in the same geographical location.

To be deemed valid market rate evidence, the documentation must encompass all invoices recently settled for akin services, not exclusively those that support full payment.

In the absence of an established market rate, reimbursement per DOS should be pursuant to the statutory rate.

Using EOBS/EORS

When paying interpreters, we highly recommend using explanations of review or explanations of benefits, which are also known as EORs or EOBs. While this may be common knowledge for some defendants, not everybody is aware of this. The benefit of using EORs or EOBs is that it sets up the “second bill review” defense, which we previously covered here.

Maya M. Tola is an associate attorney at Bradford and Barthel’s Los Angeles office. This entry from Bradford & Barthel's blog appears with permission.