Late medical-legal payments: how Labor Code §4622 penalties and interest work

Short answer: If a claims administrator doesn’t pay a medical-legal bill within 60 days of receiving the bill and report, and hasn’t properly contested it, Labor Code §4622 increases the unpaid amount by 10% and adds interest at 7% a year, counted back to the date the bill and report were received.

When the 60-day clock starts

The clock starts when the employer or claims administrator receives each separate written bill together with the report and the documents the DWC requires. A missing document can delay the start, so a complete submission matters as much as the follow-up.

What the penalty and interest cover

• A 10% increase on the portion of the bill that is still unreasonably unpaid after 60 days.
• Interest at 7% a year on that amount, retroactive to the date of receipt, not from day 61.

When the penalty may not apply

If the payer contests the bill within 60 days with an explanation of review and pays the portion it considers reasonable, the disputed amount moves into bill review, and whether a penalty applies depends on how that dispute is resolved. You can request a second bill review within 90 days of service of the explanation of review, and independent bill review after that if money is still in dispute.

A worked example

How Full Service handles it

On Full Service, a bill 60 days past due is pursued for penalty and interest by our team, and followed up until it is paid. On Self-Managed, the built-in calculator gives you the number for your follow-up letter.