Your Rights and Responsibilities
WHAT IS WORKERS’ COMPENSATION?
Workers’ compensation is a legal remedy whereby an employee who is injured on the job may be
entitled to certain benefits. The benefits can include medical care for the injury, indemnity wage
benefits, vocational rehabilitation services, and/or death benefits. These benefits are the obligation of
the employer and are paid directly to the employee by the employer or its workers’ compensation
insurer. Every employer, unless statutorily exempted, is responsible for the medical care and the
payment of indemnity wage benefits to any employee who is injured while in the course and scope of
his or her employment.
WHO IS COVERED BY THE WORKERS’ COMPENSATION LAW?
Most employees in Louisiana are covered from the day they start employment. Employees may be fulltime, part-time, seasonal, or minors. Subcontractors and certain independent contractors may be
considered employees if they are involved in the pursuit of the employer’s trade, business or occupation
or if they are performing substantial manual labor. The law does contain some limited exemptions.
Domestic employees, most real estate salespersons, uncompensated officers and directors of certain
non-profit organizations, and public officials are specifically exempted. Most volunteer workers would
not be entitled to benefits.
Employers are required to have workers’ compensation insurance or to be approved to self-insure. If
any employee has reason to believe that his or her employer is not covered or if the employer requires
an employee to pay for or purchase a workers’ compensation insurance policy, this violation should be
reported to the Office of Workers’ Compensation Administration (OWCA) Fraud & Compliance section at
toll free 1-800-201-3362.
Within 10 days of actual knowledge of an on the job injury resulting in death or lost time in excess of
one week, the employer must report the injury to their insurer on a Form LWC-WC IA-1 (First Report of
Injury or Illness). The insurer will then submit the report to the OWCA. Any employer that fails to
report such an injury to its workers’ compensation insurer or to the OWCA is subject to a penalty for
failure to do so.
THE OFFICE OF WORKERS’ COMPENSATION ADMINISTRATION
The Office of Workers’ Compensation Administration (OWCA) was created in 1983 within the Louisiana
Department of Labor (now the Louisiana Workforce Commission) to administer the provisions of the
Louisiana Workers’ Compensation Act. The OWCA investigates allegations of fraud; monitors
compliance with the requirement that employers insure their workers’ compensation obligation;
compiles information regarding workers’ compensation claims; resolves disputes over the necessity,
advisability, and cost of hospital care or services, as well as conflicts concerning medical, surgical and
non-medical treatment; provides Occupational Safety & Health Administration (OSHA) consultation
services; and assists Louisiana employers in the development and implementation of a safety
management plan in their workplace. The OWCA, however, does not pay any benefits to employees as
a result of a covered on the job injury.
The OWCA has exclusive original jurisdiction to resolve disputes in workers’ compensation matters.
There are ten district offices located throughout the state (see attached list) where disputed claims for
compensation are filed and which provide the framework for the resolution of disputes regarding claims
for benefits, the entitlement to benefits, or other relief under the Louisiana Workers’ Compensation Act.
WHAT INJURIES ARE COVERED BY THE WORKERS’ COMPENSATION LAW?
The law covers both mental and physical injuries from either accidents or occupational diseases.
However, a mental injury must be the result of a physical injury or of a sudden, unexpected and
extraordinary stress related to the employment and in either case must be proved by clear and
convincing evidence. An accident is defined by the Louisiana Workers’ Compensation Act as an
unexpected or unforeseen actual, identifiable, precipitous event happening suddenly or violently, with
or without human fault, and directly producing at the time objective findings of an injury which is more
than simply a gradual deterioration or progressive degeneration. An occupational disease is defined by
the Louisiana Workers’ Compensation Act as only that disease or illness which is due to causes and
conditions characteristic of and peculiar to the particular trade, occupation, process, or employment in
which the employee is exposed to such disease.
The event causing the injury must arise out of and be within the course and scope of the employee’s
employment. Generally, the fault of the employer or employees does not affect the compensability of
an injury. However, no compensation may be allowed if the injury was caused by the employee’s willful
intention to injure himself/herself or others; or by the injured employee’s intoxication at the time of the
injury, unless resulting from activities in pursuit of the employer’s interests or from activities in which
the employer procured and encouraged the use of the beverage or substance. An employee may not be
entitled to benefits if he is the aggressor in an unprovoked physical altercation. The employee may not
be entitled to benefits if it is determined that he/she was a participant in “horseplay” at the time that
the injury occurred.
HOW ARE INDEMNITY BENEFITS PAID?
An employee who suffers a covered injury may be entitled to weekly/monthly indemnity benefits if the
injury prevents the employee from returning to work for more than seven calendar days. The first
installment of benefits payable for Temporary Total Disability (TTD), Permanent Total Disability (PTD) or
death shall become due on the fourteenth day after the employer or insurer has knowledge of the injury
or death. No compensation shall be paid for the first week after the injury occurs unless the disability
from the injury continues for two weeks or longer after the date of the accident. This “waiting period”
indemnity payment shall be paid after the first two weeks have elapsed.
During the period of Temporary Total Disability (TTD), the employer or its workers’ compensation
insurer is responsible for the payment of indemnity benefits to the employee in an amount equal to
sixty-six and two-thirds percent of the employee’s average weekly wage, subject to a
maximum/minimum benefit amount set by the OWCA. Maximum/minimum indemnity benefits are
determined according to the date of the accident causing the injury and are not adjusted annually
for increases or decreases in the maximum/minimum benefit amount set by the OWCA.
An employee who suffers a covered injury may be entitled to Supplemental Earnings Benefits (SEB) if
that employee is able to return to work, but is unable to earn at least ninety percent of the pre-injury
wage. Supplemental Earnings Benefits are calculated as sixty-six and two-thirds percent of the
difference between the pre-injury average monthly wages and the average monthly wage the employee
is capable of earning, subject to the maximum/minimum benefit amount set by the OWCA.
Supplemental Earnings Benefits are payable on a monthly basis unless the employee is not receiving any
income from employment or self-employment and the employer has not established earning capacity.
In that case, the employee may be paid weekly SEB. In either case, SEB is payable for a maximum of 520
weeks including the time for which other indemnity benefits were paid.
If the employee dies within two years of the last treatment as the result of any job-related accident, his
or her surviving spouse and/or dependent child(ren) (or other dependents) may be entitled to weekly
indemnity benefits pursuant to the Louisiana Workers’ Compensation Act. If there are no surviving
dependents, the employee’s surviving parents are entitled to a one-time benefit of $75,000 each. The
employer or its workers’ compensation insurer shall also pay, in addition to any other benefits,
reasonable expenses of the burial of the employee, not to exceed $8,500.
An employee is entitled to a one-time payment of $50,000 if the injury is determined to be catastrophic.
Only the following injuries shall be considered injuries which are catastrophic: Paraplegia or
quadriplegia or the total anatomical loss of both hands, both arms, both feet, both legs, both eyes, or
one hand and one foot, or any two thereof. Functional loss or loss of use shall not constitute anatomical
loss.
If the employee applies for and subsequently receives Social Security disability benefits, employer provided disability plan benefits, or Social Security Old Age Retirement benefits, his or her workers’
compensation indemnity benefits may be reduced in accordance with the Louisiana Workers’
Compensation Act. This is not a simple dollar for dollar reduction and must be calculated individually
according to the employee’s circumstance. In addition, an employee is not entitled to receive workers’
compensation indemnity benefits and unemployment insurance benefits at the same time.
On the same day as the first payment of indemnity is made to the employee or on or before the
effective date of any modification (which may include a change from TTD to SEB benefits), suspension,
termination, or controversion of indemnity/medical benefits, a Form LWC-WC 1002 (Notice of Payment,
Modification, Suspension, Termination, or Controversion of Compensation or Medical Benefits/Notice of
Disagreement) shall be completed by the employer/payor and sent to the injured employee by certified
mail, and to the employee’s attorney, if applicable, by facsimile. The employer/payor shall also send a
copy of the Form LWC-WC 1002 to the OWCA within 10 days from the date the original Form LWC-WC
1002 was sent to the injured employee. Any subsequently completed Form LWC-WC 1002 shall be sent
to the OWCA on the same day as the original notice was sent to the injured employee and/or
employee’s representative.
Any injured employee or employee’s representative who disagrees with any information provided on
the Form LWC-WC 1002 (Notice of Payment, Modification, Suspension, Termination, or Controversion of
Compensation or Medical Benefits) shall notify the employer/payor of the basis for disagreement by
completing the Notice of Disagreement portion of the Form LWC-WC 1002 and returning it with the
original Form LWC-WC 1002 (Notice of Payment, Modification, Suspension, Termination, or
Controversion of Compensation or Medical Benefits) attached thereto, to the employer/payor via mail
or facsimile, or by a letter of amicable demand, stating the nature of benefits and amounts of
compensation asserted to be correct.
If the employer/payor does not provide the benefit that the employee and/or employee’s
representative claims is due within seven days, the employee may file a new Form LWC-WC 1008
(Disputed Claim for Compensation) or amend a pending disputed claim. Once the Form LWC-WC 1008
is filed, the employer/payor may in its answer request a preliminary determination hearing with the
Workers’ Compensation Judge. Failure to request a preliminary determination will result in the disputed
claim being set for a trial on the merits.
The Form LWC-WC 1002 (Notice of Payment, Modification, Suspension, Termination, or Controversion
of Compensation or Medical Benefits/Notice of Disagreement) does not apply to issues concerning the
necessity of recommended medical treatment under La. R.S. 23:1203.1 and the Medical Treatment
Schedule. A copy of the Form LWC-WC 1002 (Notice of Payment, Modification, Suspension,
Termination, or Controversion of Compensation or Medical Benefits/Notice of Disagreement) is
attached and also is available at http://www.laworks.net/Downloads/OWC/1002form.pdf.
HOW ARE MEDICAL BENEFITS PAID?
An employee has the right to select one doctor of his or her choice in each specialty field for treatment
of the job-related injury. The employer or its workers’ compensation insurer is required to pay all
approved necessary expenses for medical treatment and all reasonably and necessarily incurred travel
to obtain treatment. Medical benefits payable under the Louisiana Workers’ Compensation Act shall be
paid within 30 days after the employer or its workers’ compensation insurer receives written notice
thereof, or within 60 days if the provider of medical services is not utilizing the electronic billing rules
and regulations provided for in R.S. 23:1203.2. An itemized list of out of pocket medical expenses and
receipts paid by the employee should be sent to the employer or its workers’ compensation insurer for
reimbursement.
Any non-emergency medical services over $750 and any non-emergency hospitalization must be preapproved by the employer or its workers’ compensation insurer. The healthcare provider seeking
authorization to exceed the $750 statutory limit for medical services must submit a request for such
authorization to the employer or its workers’ compensation insurer on a Form LWC-WC 1010 (Request
of Authorization/Carrier or Self Insured Employer Response).
The Form LWC-WC 1010 and all supporting medical documentation are to be faxed to the employer or its workers’ compensation insurer and/or the designated utilization review representative. Within five business days of receipt of the Form LWC-WC 1010 and the supporting documentation from the healthcare provider, the employer or its workers’ compensation insurer will issue a response of either approval, denial, or approval with modification of the requested treatment on the Form LWC-WC-1010 and return the form to the requesting healthcare provider. Failure to act on behalf of the employer or its workers’ compensation insurer within five business days of receipt will be deemed a tacit denial of the request for treatment and this denial may be reviewed by the OWCA Medical Director.
The employer or its workers’ compensation insurer and/or utilization review representative may
respond to the request for authorization by completing the Form LWC-WC-1010A (First Request) when the medical documentation submitted with the Form LWC-WC-1010 does not sufficiently provide the necessary information to complete the review of the requested medical services. The healthcare provider must then respond to the request for additional information within 10 business days from receipt of the Form LWC-WC-1010A. Failure to act on behalf of the provider within 10 business days of receipt of the Form LWC-WC-1010A will be deemed a tacit withdrawal of the request for authorization of treatment.
Any request for review by the OWCA Medical Director shall be filed on a Form LWC-WC 1009 (Disputed
Claim for Medical Treatment). The Form LWC-WC 1009 must be filed within 15 calendar days of the
date of denial by the employer or its workers’ compensation insurer or the date the denial is received. A
copy of the completed Form LWC-WC 1009 must be mailed to all involved parties.
The Form LWC-WC 1009 must be accompanied by a copy of the Form LWC-WC 1010 (and Form LWC-WC
1010A, if applicable), a copy of the peer review denial from the employer and/or its workers’
compensation insurer, and a copy of the medical records substantiating the medical necessity of the
requested treatment. Any incomplete Form LWC-WC 1009 or a completed Form LWC-WC 1009 that is
not submitted with the supporting documentation will be rejected and returned to the requesting party.
Within 30 days after receipt of the Form LWC-WC 1009 and supporting documentation, the OWCA
Medical Director will determine whether the treatment prescribed by the healthcare provider is in
accordance with the Louisiana Workers’ Compensation Medical Treatment Guidelines. Any party feeling
aggrieved by the determination of the OWCA Medical Director shall seek a judicial review by filing a
Form LWC-WC 1008 (Disputed Claim for Compensation) with the appropriate OWCA district office
within 15 days of the date said determination is mailed to the parties. The filed Form LWC-WC 1008
shall include a copy of the Form LWC-WC 1009, and a copy of the determination of the OWCA Medical
Director. A party filing such appeal must simultaneously notify the other party that an appeal of the
medical director’s decision has been filed. The determination of the OWCA Medical Director may be
overturned if it is shown by clear and convincing evidence that the determination was not in accordance
with the provisions of the Louisiana Workers’ Compensation Medical Treatment Guidelines.
WHAT IS AN INDEPENDENT MEDICAL EXAMINATION (IME)?
In the event that there are opposing medical opinions regarding claimant’s condition or capacity to
work, the Office of Workers’ Compensation Administration will appoint an independent medical
examiner of the appropriate licensure class to examine the claimant, or review the medical records at
issue. The expense of this examination will be set by the director and will be borne by the carrier/self-insured employer.
WHAT IF A PROBLEM DEVELOPS WITH A CLAIM?
An employee, who has a problem with his or her claim, should first contact the employer or its workers’
compensation insurer. If the employee and the employer (or the employer’s workers’ compensation
insurer) are unable to resolve the problem, either party has the right to request a mediation conference
with an Office of Workers’ Compensation mediator who is a licensed attorney specially trained in the
mediation process with knowledge of resolution techniques and experienced in Louisiana workers’
compensation law. For more information on the right to a mediation conference, please refer to the
Mediation Rights which is available at http://www.laworks.net/downloads/owc/MediationRightsForm.pdf.
If the problem does not resolve at the mediation conference, an employee should contact the nearest
OWCA district office to file a Form LWC-WC 1008 (Disputed Claim for Compensation). The district office
can provide the employee with a Form LWC-WC 1008 or that form is also available for download at
http://www.laworks.net/Downloads/OWC/1008form.pdf. A filing fee of $50 plus any applicable service
fees are charged at the time of filing. If the employee is unable to afford these fees, a request may be
made for approval by the Workers’ Compensation Judge to proceed without paying costs in advance.
An employee may consult an attorney if he or she wishes, but it is not required. If an employee hires an
attorney, the employee can be charged up to twenty percent of the amount recovered plus the
attorney’s expenses. These fees and expenses may be deducted from the employee’s indemnity
payments. The local bar association may be able to recommend an attorney who is experienced in
workers’ compensation.
WHEN SHOULD THE FORM LWC-WC 1008 (DISPUTED CLAIM FOR COMPENSATION) BE FILED?
There are separate time limits for filing claims for medical and indemnity benefits. Filing a claim for one
type of benefit usually does not stop the clock from running on any other type of benefit.
Claims for medical benefits generally must be filed within one year of the date of the accident causing
the injury. If the employer or its workers’ compensation insurer has paid medical expenses, the period
for asserting a claim is extended for three years from the last payment of a medical benefit.
Claims for indemnity benefits, often called weekly benefits, generally must be filed within one year of
the date of the accident causing the injury. If the employer or insurer has paid indemnity benefits, the
employee may still assert a claim for Temporary Total Disability (TTD), Permanent Total Disability (PTD),
or Permanent Partial Disability (PPD) benefits if done within one year after the last payment of
indemnity benefits.
Claims for Supplemental Earnings Benefits (SEB) may be made for up to three years after the last
payment of any claim of indemnity benefits.
Claims for occupational diseases, including carpal tunnel, may be filed up to one year from the date of
knowledge of the disease, related disability, or a reasonable belief that the disease is work related,
whichever occurs last.
MAY I SETTLE MY CLAIM?
You may enter into a lump sum or compromise settlement upon agreement of all of the parties and with
the approval of the Workers’ Compensation Judge, provided that, (a) the settlement is clearly in the best
interest of all of the parties, and (b) six months have passed since the end of Total Temporary
Disability (TTD). However, the six months waiting period may be waived by the consent of the
parties.
AM I ENTITLED TO MY OLD JOB?
An employer may not be required to hold a job open for you while you are unable to perform the duties
of your job or to create a new job for you when you are able to return to work. However, your employer
cannot terminate your employment solely because you filed a workers’ compensation claim.
WHAT IF I CANNOT RETURN TO MY OLD JOB?
Under certain circumstances, you may qualify for vocational rehabilitation. An employee who is unable
to earn wages equal to the wages he was earning before his workers’ compensation accident is entitled
to prompt vocational rehabilitation services. The goal of vocational rehabilitation is to return the
employee back to work as soon as possible after the injury occurs with a minimum amount of retraining,
if deemed necessary. The employer is responsible for selecting a licensed professional vocational
rehabilitation counselor to evaluate and assist the employee in job placement or vocational retraining.
Appropriate options to consider when returning an employee back to work at the earliest possible
moment are: (1) return the employee to the same position; (2) return the employee to a modified
position; or (3) return the employee to a related occupation suited to the employee’s education and
marketable skills. Whenever possible, employment in the employee’s local job pool must be considered
and selected prior to consideration of employment in a worker’s statewide job pool. If all of the
previous options fail, a vocational rehabilitation counselor may seek on–the-job training for the
employee, as well as a minimum amount of retraining or self-employment.
When it does appear that retraining is necessary and desirable to restore the employee to suitable
gainful employment, the employee shall be entitled to reasonable and proper retraining not to exceed
26 weeks. The request for retraining must be made and begun by the employee within two years from
the date of termination of temporary total disability as determined by the treating physician. The
employee’s retraining may be extended for an additional period not to exceed 26 weeks if the retraining
is determined to be necessary and proper by the workers’ compensation judge. The employer or insurer
shall pay the reasonable cost of board, lodging, or travel if the retraining program requires residence at
or near the facility or institution and away from the employee’s customary residence. However, a
retraining program shall be performed at facilities within the state when such facilities are available.
If the employer refuses to provide vocational rehabilitation services or a dispute arises concerning the
quality of services being provided, the employee may file a disputed claim with the workers’
compensation court to have it review the necessity and/or quality of the services being provided. The
employee shall have the right to an expedited hearing on the matter. Similarly, the employee must
cooperate with the vocational rehabilitation counselor. An employee’s refusal may reduce his weekly
workers’ compensation benefits, including supplemental earnings benefits, by fifty (50%) percent for
each week during the period of refusal.