Louisiana Workers’ Compensation Law Update

The Louisiana Workers’ Compensation Act was recently amended by the legislature to include Medical Treatment Guidelines. The new procedural rules for the Medical Treatment Guidelines were just passed and go into effect on April 20, 2012.

This is going to affect all medical treatment requests received from providers, effective April 20, 2012. The process begins with the medical provider sending a Form 1010 to the carrier with documentation to support his requested treatment. Insurers, self-insureds, and third party administrators will need to designate someone within the company to receive these forms. Many carriers are designating someone in their Utilization Review department to receive and process the claim.

The carrier must respond within 5 days with a Form 1010 or a Form 1010A. If the information is insufficient to make a decision, the carrier must reply with a Form 1010A explaining why the initial request was insufficient and what other information is necessary. If the information is sufficient or is supplemented to become sufficient, then within 5 days, the carrier must file a Form 1010 either approving the requested treatment or denying it.

If the carrier does not respond within 5 days, or timely denies the requested treatment, then the medical provider must file a Form 1009 with the OWC within 15 days to obtain an opinion from the OWC MD Review. This opinion shall carry great weight.

Any party aggrieved by the OWC MD opinion may file a Form 1008 within 30 days and place the matter into litigation. An expedited hearing shall occur within 15-30 days. The decision of the OWC MD may only be overturned when shown by clear and convincing evidence the decision was not in accordance with the published Medical Treatment Guidelines.

Plauché, Smith & Nieset, LLC is engaged in the insurance defense practice, concentrating on insurance defense litigation and business litigation in Calcasieu Parish, Cameron Parish, Jefferson Davis Parish, Allen Parish, and Beauregard Parish. Plauché, Smith & Nieset also engages in the insurance defense practice throughout the state of Louisiana.

Burden of Proof for Compensable Workers Compensation Accident

In an important insurance defense decision for Louisiana employers, the Louisiana Third Circuit Court of Appeal recently found that an employee who allegedly injured her neck, back and shoulders lifting 1 gallon cans of pain, failed to prove a work “accident” as defined by the Louisiana Workers’ Compensation Act. In Broussard v. Stine Lumber Company WCA 11-168 (attached), the court held that the claimant’s alleged accident was not unexpected or unforeseen and that there was no “event” that caused the claimant’s injuries. In reaching its decision, Court of Appeal, in Lake Charles, Louisiana, found that the WCJ was manifestly erroneous in determining that claimant met her burden of proving an accident by a preponderance of the evidence. The court reasoned that the claimant’s own inconsistent and unreliable testimony and the testimonies of physicians who were not privy to an accurate or complete medical history, failed to prove that her injuries were caused or exacerbated by the lifting of paint cans. The employer in this case, Stine Lumber, was represented by Christopher P. Ieyoub, Partner in the Lake Charles insurance defense firm of Plauché, Smith & Nieset, LLC.