Louisiana Workers’ Compensation Claims: Eligibility, Filing, and Appeals
Virtually all employers in Louisiana are required to carry workers’ compensation insurance. As in the rest of the country, the workers’ compensation system in Louisiana is a no-fault system designed to compensate injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must take certain steps required by Louisiana law.
Who Is Eligible for Workers’ Comp Benefits?
Workers’ compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp. On the other hand, injuries that occur while you’re off-duty are generally not compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, your injuries will typically not be covered by workers’ comp. For more information, see our article on what types of injuries are covered by workers’ comp.
Workers’ comp covers both traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
If you’re injured at work, you must report your injuries to your employer within 30 days. However, it’s usually best to report your injuries right away. Insurance companies are less skeptical of claims that are reported immediately. And, the sooner your report your injury, the sooner your workers’ comp benefits can begin.
Once you give notice, your employer should complete a form called a “First Report of Injury” and provide it to its insurer. The insurer will then submit the form to the Louisiana Workforce Commission. You should also receive a copy of the form.
How Do I Get Medical Treatment?
In an emergency, you can choose which doctor or hospital to seek treatment from. For non-emergency care, you can also choose doctors in any medical specialties required to treat your injuries. However, if you want to switch from one doctor to another in the same specialty, you will likely need to get the employer’s approval first. And, if any treatment costs more than $750, the doctor must get approval from the insurer before moving forward with the treatment.
What Benefits Can I Receive?
All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive temporary disability payments and a permanent disability award.
You will be eligible to receive compensation for wage loss during the time you are temporarily disabled and unable to work. Temporary total disability payments are two-thirds of your average weekly wages, subject to a minimum of $168 and a maximum of $630 per week (as of September 1, 2014).
You can continue to receive temporary total disability until your doctor finds that you’ve reached maximum medical improvement (MMI), meaning that your condition has plateaued and is not expected to improve.
If you’re able to return to part-time or light-duty work while you’re recovering, but earn less than 90% of your normal wages, you may eligible for supplemental earning benefits. These benefits are two-thirds of the difference in your average weekly wages, subject to the same minimum and maximum amounts noted above. These benefits are available for a maximum of 520 weeks.
If you are found to be totally and permanently disabled, you will receive the same weekly amount that you received in temporary total disability payments: two-thirds of your average weekly wages, subject to a minimum of $168 and a maximum of $630 per week. Permanent total disability benefits are available for as long as the disability continues. These benefits are available only to workers with severely debilitating injuries, such as the loss of both hands, feet, arms, legs, or eyes. Workers are considered totally disabled only if they cannot earn any wages in the same job or another job.
For most other workers, permanent partial disability benefits are available. You will receive two-thirds of your average weekly wage, subject to a minimum of $168 and a maximum of $630 per week. How long you’ll receive these benefits depends on a state schedule and the disability rating assigned by your doctor. Louisiana’s state schedule lists various body parts, such as arms, legs, feet, and hands. For each body part, the schedule identifies the maximum number of weeks for a total loss of use of that body part. For example, a worker with a 100% loss of use of an arm will receive benefits for 200 weeks. However, if the worker had a 50% loss of use, he or she would receive benefits for 100 weeks.
There are certain injuries that are not included on the schedule, such as injuries to the head, spine, and organs. For non-scheduled injuries, payments are available for a maximum of 520 weeks, depending on the severity of the injury.
You may also receive benefits for significant scarring or disfigurement to the face, head, or neck, or to another body part if it will impede your ability to find new work. These benefits are equal to the total temporary disability rate, subject to the same minimum and maximum amounts. Benefits are available for up to 100 weeks.
Workers who have suffered catastrophic injuries may also be entitled to a lump sum payment of up to $50,000. The following injuries are considered catastrophic:
- paraplegia and quadriplegia
- the amputation of both hands, arms, feet, or legs
- the physical loss of both eyes, or
- the amputation of one hand and one foot.
What if My Claim Is Denied?
If your workers’ comp claim has been denied, or the insurance company is disputing any portion of your claim, you have the right to a hearing before a workers’ comp judge. If you disagree with the judge’s decision, you may file an appeal with the Circuit Court of Appeals.
For more information on the appeals process, see our article on appealing a denial of your Louisiana workers’ comp claim.