Workers in Louisiana must contend with different risks as part of their employment. Sometimes, during the course of their jobs, it becomes unavoidable that they incur injuries or illnesses. Fortunately, benefits are accessible to help them recover. In case of death, these benefits are paid to their loved ones. These payments are known as workers’ compensation.
The remuneration provided to injured workers is crucial, especially in Louisiana. A significant portion of employees in the Pelican State work in the healthcare and retail trade sectors. These industries are known for injuries caused by slips and falls, as well as cuts. Burns are also common, especially for young workers.
Unfortunately, for some injured employees, their claim for workers’ compensation benefits can be hindered by disputes with employers or insurers. Indeed, over 3,100 disputed claims were processed by the Office of Workers’ Compensation Administration, or OWCA, in 2022. This department operates under the Louisiana Workforce Commission, or LWC.
This article explains how disputes occur in a workers’ compensation claim. It also delivers an overview of the step-by-step process of filing a claim. Additionally, the article lists legal resources that workers can use to help in their recovery.
Louisiana Workers’ Compensation Insurance Requirement
Employers throughout Louisiana are required to have workers’ compensation insurance. This rule applies even if they have one employee. The worker may be full-time, part-time, seasonal, or temporary.
Not all employees, though, qualify for workers’ comp insurance benefits. For instance, domestic workers are not entitled to injury-related payments from an insurer. Similarly, professional musicians, real estate agents, and executive officers of not-for-profit organizations are not covered by insurance policies.
Workers who qualify for benefits under other laws, like the Longshore and Harbor Workers’ Compensation Act, are not part of the same system as covered employees in Louisiana.
In addition, independent contractors are not eligible for benefits. State law defines these as workers who:
Maintain freedom from control and direction in how they perform their job;
Perform tasks that do not fall under the usual work of their employer or engage in activities outside the business premises;
Are part of an independently established business.
All these factors must apply to an individual for them to be considered an independent contractor. Given that an employee qualifies for workers’ compensation benefits, a sticking point is if they are misclassified as independent contractors. One may contact LWC to obtain assistance regarding their job classification. The agency is accessible through its hotline at (833) 708-2866.
Another point to consider is Louisiana employees working outside the state. If they were injured or died because of workplace-related accidents, they or their representative can obtain workers’ comp benefits. State law allows these awards if the worker’s employment during their injury is primarily localized in Louisiana. They may qualify for injury-related benefits if their employment contract is likewise made in the Pelican State.
Businesses seeking to purchase workers’ compensation insurance may do so through two avenues. One is private insurers. More than 500 active insurance companies offer workers’ comp policies. The other provider — and the largest one — is the Louisiana Workers’ Compensation Corporation. Employers can also elect to become self-insured.
There are other ways to comply that businesses must keep in mind. For example, they need to print and display a notice at a convenient and visible location in the workplace. This poster tells workers that an eligible claimant has 30 days from the employee’s injury or death to report such an incident to their employer.
Penalties are in place for companies that do not comply with workers’ compensation laws. These sanctions are different depending on the violation. For instance, those who deliberately fail to purchase coverage for workplace-related injuries or deaths face imprisonment for up to one year. They can also deal with fines worth as much as $10,000.
Louisiana Workers’ Compensation Benefits
The benefits an injured worker can obtain help them deal with various costs. These include:
Medical care treatments;
Vocational rehabilitation services;
There is also the matter of disability payments, which are part of workers' compensation benefits. Such benefits are further categorized into four. These are:
Supplemental earnings benefits. Provided to workers who can return to work but cannot earn 90% or more of their wages before the injury occurred.
Temporary total disability benefits. Given to those who, for the short-term, cannot go back to work at any job, even at something they are qualified for, given their experience or education.
Permanent partial disability benefits. Awarded to those who experience amputation or loss of function of various body parts.
Permanent total disability benefits. Granted to those who cannot resume employment despite other work opportunities requiring less physical demand.
Remember that insurance companies do not cover injuries caused by horseplay. Similarly, the insurer does not pay for accidents arising from disputes between the injured employee and another worker. Additionally, injuries caused by the use of intoxicating substances or the failure of the employee to utilize adequate protection can be grounds for denial.
Furthermore, injured workers must note the exclusive remedy laws present in Louisiana. In other words, there is a limited opportunity for individuals to sue their employers outside of the workers’ compensation system. Lawsuits against businesses, however, can still occur if their behavior is found to be deliberately or recklessly negligent. One example of such behavior is if they did not warn their workers of the presence of toxic chemicals.
How to File a Workers’ Comp Claim in Louisiana
Workers, employers, and insurers are responsible for keeping in mind the filing deadlines throughout the workers’ compensation process. For injured employees, remembering these time limits is crucial to avoiding the invalidation of their claims. Meanwhile, not keeping track of deadlines for employers and insurers can lead to penalties.
When Is the Deadline for Workers’ Compensation Claims in Louisiana?
Injured employees have 30 days to notify their employer of the accident. In situations involving a worker’s death, their representative must also submit a notice within the 30-day period. The document should contain various information. These include the employee’s name and address. It also consists of details about the injury, its nature, time, place, and cause.
In some cases, the employee may not experience a dramatic deterioration of their physical health. Instead, as part of their particular work, they incur illnesses or injuries that worsen over time. These are known as occupational diseases. One such example is carpal tunnel syndrome. Submission of claims involving these is allowed within one year from knowledge of the condition. The period also applies in circumstances that involve work-related fatalities. Note that state law excludes heart-related conditions and mental health illnesses in its definition of occupational diseases.
If the injured employee or their representative plans to seek benefits beyond what the workers’ comp policy offers, they can do so through a lawsuit. Given the exclusive remedy laws present in Louisiana, such legal actions are valid if the employer acted recklessly or was intentionally negligent.
Step-By-Step Guide on Filing a Workers’ Compensation Claim in Louisiana
1. Report the Illness or Injury to the Employer.
The first step in the workers’ compensation process is the notice and formal petition. The latter document is where basic information about the claim is stated. These details range from the cause and nature of the injury to the addresses and names of the parties involved. Sometimes, disputes arise over areas like whether the illness is an occupational disease. In that case, the worker may file Form LWC-WC-1008. This document pertains to the Disputed Claim for Compensation.
Both the petition and Form 1008 are submitted to the relevant parties. These must also be sent to OWCA, which operates under LWC. Note that OWCA releases Form LWC-WC-1025.EE. This document refers to the Employee Certificate of Compliance. The worker in question must fill out the form within 14 days after receiving the document from LWC. It also needs to be sent to the employer or their insurer during the same period.
Similar to nearby Mississippi, Louisiana is a federal OSHA state. As such, employers in the Pelican State follow multiple OSHA-mandated guidelines. One of these is that workplace fatalities are to be reported to OSHA within eight hours after the incident or knowledge of it. On the other hand, employers need to report hospitalizations or amputations within 24 hours.
2. Employer Submits Claim to Insurer; Insurer Notifies LWC.
After receiving the notice from the employee, the employer must fill out Form LWC-WC IA-1. This is their First Report of Injury or Illness. They must submit the document to their insurer within 10 days after the notice was given. The insurance company then notifies OWCA through the Electronic Data Interchange website.
The first report should contain multiple pieces of information about the employee. These include their Social Security number and wages at the time of the injury. Additionally, it must detail the nature and cause of the work-related accident.
Unfortunately, for some injured workers, their employers fail to send the necessary forms to their insurers. In such cases, employees can verify the insurance carrier in question through a coverage verification page managed by LWC. Workers may also contact the agency to report labor violations through a call at (800) 201-3362.
3. Employer Files an Answer.
Within 21 days from receipt of the petition or Form 1008, the employer needs to file an Answer. This document allows them to avoid default judgments. Such decisions are valid if the worker notifies the employer. This action must be performed seven days before the judgment.
In addition, the Answer allows the employer to show why their employee does not deserve injury-related compensation.
Some matters that are decided by default include:
The average weekly wage of the employee;
Whether an occupational disease exists;
The presence of an employer-employee relationship;
Whether the accident happened during the course of employment.
4. Attend Mediation, if Necessary.
Mediations are informal meetings presided over by a neutral person. This individual is known as a mediator, whose job is to help both parties come to an agreement. These meetings can occur before or after Form 1008 is filed. Mediation is voluntary unless required by the workers’ comp judge. A party who did not attend the required meeting faces up to $500 in fines. They may also have to pay for the legal fees associated with the mediation incurred by the other party.
5. Receive Indemnity and Medical Benefits, if Applicable.
The first installment of lost wages is given to the worker 14 days after their notice of injury to the insurer or employer. This compensation, also known as indemnity benefits, helps employees with temporary or permanent total disability. It applies in cases where the individual in question cannot return to work for seven consecutive days. The employee will receive Form LWC-WC 1002 the same day the first indemnity payment is made. This document will be given to them by their employer or insurer.
In addition, lost wages are provided to representatives or family members of deceased workers. Under state law, in situations involving an employee’s death two years after their last treatment, their surviving spouses, dependent children, or both can receive indemnity benefits. The eligible next of kin are the parents if there are no spouses or children. They each receive a one-time benefit worth $75,000.
If a worker incurs catastrophic injuries, they are entitled to a $50,000 one-time payment.
Medical benefits are a different story. These are payable within 30 days after the employer or insurer possesses knowledge of the accident. However, non-emergency medical services and hospitalization worth more than $750 need pre-approval from insurance companies or employers.
The healthcare provider treating the worker needs to submit Form LWC-WC 1010. This document pertains to the Request for Authorization/Carrier or Self Insured Employer Response. In other words, the physician or hospital uses this form to obtain payment for medical services above the $750 limit. The insurer or employer has five business days to respond. They can elect not to grant this request, which counts as a denial. This decision, though, may come under OWCA review.
6. File for Settlement Benefits, if Appropriate.
Six months after the last payment for temporary total disability benefits, a worker may file for settlement with the insurance company to get a lump sum payment. One of the required documents to obtain such a benefit is Form LWC-WC 1011. Once the workers’ compensation judge approves the settlement, it becomes final. It cannot be reopened, even if the worker's medical condition worsens. However, they may cancel the settlement in situations involving misrepresentation or fraud on the insurer's part. Actions against these are rare, though.
What Should One Do If a Workers’ Compensation Claim Has Been Denied?
Insurers deny claims for multiple reasons. One is if the employee did not report the injury within the 30-day period. If they had pre-existing medical conditions or tested positive for illegal drugs, that could also be grounds for denial.
One may file Form 1008 in cases involving disputes over compensation. If the situation entails the denial of medical benefits, this requires Form 1009. This document refers to the Disputed Claim for Medical Treatment. It needs to be submitted to OWCA within 15 calendar days from the date of denial. For disagreements over health-related compensation, the worker can request an independent medical examination. This is done through Form LWC-WC 1015. The document must then be forwarded to OWCA.
The insurer or employer can request a preliminary determination hearing to achieve a decision. Such proceedings differ from a full hearing and may involve negotiations between both parties. Discovery also occurs during the preliminary hearing, wherein the parties exchange case-related information.
The workers’ comp judge may order a full hearing if no resolution is reached in the preliminary hearing. During this, they listen to the testimony of various individuals, like physicians. The judge then makes a decision. Employees unsatisfied with this may further submit a motion for a new trial. This action needs to be performed within seven days from the day the judgment is signed. The seven-day period also starts from the date OWCA mails the notice of judgment.
Workers seeking to appeal this decision may do so through the applicable Circuit Court of Appeals. They can file a motion within 30 days if they want to suspend the effect of the judgment. If they wish not to suspend the decision’s effect, they may submit an appeal within 60 days. The judgment of the Circuit Court of Appeal is final. A workers’ compensation case may end up in the Louisiana Supreme Court, but it mainly considers appeals involving constitutional issues.
Legal Resources for Injured Workers in Louisiana
The listed resources provide opportunities for injured workers seeking assistance on a variety of matters, from job search to bill assistance. These resources link to state agencies and non-profit organizations.
Louisiana Workforce Commission
The commission helps Louisianians obtain jobs or grow their businesses. It maintains multiple programs that help injured workers. One of these is a job search platform on the commission’s website. Individuals may find work based on factors like offered salary, educational requirements, and occupational outlook. The commission also oversees the Helping Individuals Reach Employment, or HIRE program. This allows eligible people to qualify and receive unemployment insurance benefits. One can view its dedicated HIRE webpage to start the process or send an email to HiRE@lwc.la.gov for inquiries. Individuals may also contact the Commission at (225) 342-3111.
Louisiana Housing Corporation
The corporation seeks to provide opportunities for Louisianans seeking energy-efficient, safe, and affordable housing. It handles different programs that aid individuals, including workers who have a disability. An example is the Low-Income Home Energy Assistance Program, or LIHEAP. This project allows recipients to manage their heating or cooling costs. Another example is the Weatherization Assistance Program, or WAP. It helps families with minor children, seniors, and persons with disabilities decrease their energy bills through duct-sealing and weather stripping. One can request more information by filling out its constituent services request form. Additionally, the corporation is reachable at (888) 454-2001.
The organization has been working to deliver community-based services for people with disabilities throughout Louisiana since 1973. It manages a range of initiatives that aim to empower individuals. One of these is the Supported Employment Program. It assists people with disabilities to find work opportunities at various businesses, including grocery stores, offices, retail stores, and banks. It also helps individuals gain employment at government agencies. Another initiative OPTIONS oversees is its transportation program. This allows individuals access to rides for activities like work, shopping, and church. One may reach the organization through their email address at firstname.lastname@example.org. OPTIONS can also be contacted at (985) 345-6269.
Disability Rights Louisiana
DRLA aims to empower and protect Louisianians with disabilities. It helps individuals obtain opportunities to gain employment and assists them with issues involving discrimination. The organization also assists workers in obtaining access to assistive technology devices. These include wheelchairs, Braille displays, tablet computers, and video relay systems. One can ask the organization about its programs by calling their toll-free number, (800) 960-7705. Individuals can also fill out an intake form regarding their specific service or program requests.
Louisiana State Bar Association
LSBA serves the interests of the public and the legal profession in Louisiana. It handles different programs, one of which is the Client Assistance Fund. Individuals who lost money because of the dishonest actions of their attorney are eligible for reimbursement from the association. Clients can receive up to $50,000. Another area that the association manages is the Disabilities Assistance Network, or DAN. Louisianans facing a disability-related issue may find applicable attorneys through its DAN search. For other concerns, the association is accessible through their phone number, (800) 421-5722.
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