Gould

Joseph Mayo and Christopher Allebe sustained industrial psychiatric injuries during their employment as police officers by the City of Los Angeles (City) and obtained psychiatric treatment from petitioner, Sam C. Gould, M.D., in West Los Angeles.

The issue presented is whether a physician who charges in excess of the official medical fee schedule must make a showing of “extraordinary circumstances” in order to justify that fee. We conclude that he does not and set forth factors which may be considered in determining whether fees in excess of the fee schedule are reasonable.

Pursuant to Labor Code section 5307.1, the Administrative Director of the Division of Industrial Accidents (now the Division of Workers’ Compensation) adopted an official medical fee schedule containing unit values for specified procedures. (Cal. Code Regs., tit. 8, ch. 4.5, § 9791.1 [rule 9791.1].) In California Code of Regulations, title 8, chapter 4.5, section 9792 (rule 9792), conversion factors are specified. When the unit values for a specified procedure, such as psychotherapy, are multiplied by the conversion factor for the pertinent section of the schedule, the administrative director’s…

I concur in the judgment. I write separately because I do not believe that it is necessary or appropriate in this case for the court to attempt a list of factors the Workers’ Compensation Appeals Board (WCAB) should *1073 consider in reaching a future determination about what are reasonable fees. Language in the decision appears to do that. (Maj. opn., ante, p. 1071.) I am particularly concerned about some of the factors in this list, such as “other aspects of the economics of the medical provider’s practice that are relevant” (my italics), which are open ended and may be subject to an expansive reading.

The WCAB has discretion in determining whether, and to what degree, fees in excess of the schedule are reasonable. It may, if it wishes, exercise its rule-making authority in this area. (Lab. Code, § 5307; see State Compensation Ins. Fund v. Workers’ Comp. Appeals Bd. (1979) 88 Cal.App.3d 43, 53 [ 152 Cal.Rptr. 153 ].) But a decision or a rule that disallows any fee over the schedule, unless justified by extraordinary circumstances related to exigencies of the treatment, cannot be reconciled with the reasonable fee provision of Labor Code section 5307.1.

That is what the board…

WOODS (A.M.), P.J.

Joseph Mayo and Christopher Allebe sustained industrial psychiatric injuries during their employment as police officers by the City of Los Angeles (City) and obtained psychiatric treatment from petitioner, Sam C. Gould, M.D., in West Los Angeles.

The issue presented is whether a physician who charges in excess of the official medical fee schedule must make a showing of "extraordinary circumstances" in order to justify that fee. We conclude that he does not and set forth factors which may be considered in determining whether fees in excess of the fee schedule are reasonable.

Pursuant to Labor Code section 5307.1, the Administrative Director of the Division of Industrial Accidents (now the Division of Workers' Compensation) adopted an official medical fee schedule containing unit values for specified procedures. (Cal. Code Regs., tit. 8, ch. 4.5, § 9791.1 [rule 9791.1].) In California Code of Regulations, title 8, chapter 4.5, section 9792 (rule 9792), conversion factors are specified. When the unit values for a specified procedure, such as psychotherapy, are multiplied by the conversion factor for the pertinent section of the schedule, the…