If your workers' comp claim has been denied, or you have a dispute with the insurance company about your benefits, you can request a formal hearing with the Office of Workers' Compensation. (For an overview of eligibility and benefits, see our article on filing a Louisiana workers' comp claim.)
If your workers' comp benefits have been denied, you may request a hearing before a worker's comp judge by filing a Disputed Claim for Compensation (Form 1008). You should mail this form to your employer (or its insurer) and to the Office of Worker's Compensation at the following address:
Office of Workers' Compensation
Post Office Box 94040
Baton Rouge, LA 70804-9040
The Disputed Claim for Compensation should be filed when your disagreement with the insurance company is over temporary or permanent disability benefits. You should be aware of the strict time limits for filing your claim. You must file your claim within one year of your accident, or if you've received any disability benefits, within one year of the last payment you received.
If your dispute with the insurance company is over medical benefits, you must submit a Disputed Claim for Medical Treatment (Form 1009). For medical disputes, you must file your claim within one year of your injury, or if you've received any medical benefits, within three years of the last payment.
Once the insurance company receives your claim, it will have 14 days to respond by filing a legal document called an Answer. The Office of Workers' Compensation will assign your case to the nearest district office and schedule a hearing. The entire process, from filing the claim until the hearing, can take anywhere between 6-9 months.
The Office of Workers' Compensation runs a voluntary mediation program to help workers and their employers reach a resolution of their dispute. The mediation can take place before or after Form 1008 is filed. However, both parties must agree to participate.
The mediation is an informal conference, during which the parties will discuss the claims. A licensed attorney will typically act as the mediator, going back and forth between the parties to try and reach an agreement. However, the mediator does not actually make a decision in your case. If you and your employer can't agree, you will move onto the hearing.
The workers' comp hearing is a more formal legal process, during which the parties will present arguments and evidence. Formal hearings can take up to several hours or may require the parties to continue in a second session.
During the hearing, each party will have the opportunity to question witnesses, submit documents, and make legal arguments. A workers' comp judge will preside over the hearing and mail a written decision to the parties. Unless one of the parties appeals this decision, it will be final and binding.
Although workers' compensation hearings are less formal than court proceedings, there are still procedural rules that must be followed. And, in most cases, your employer will have a lawyer representing its interests. To avoid being at a disadvantage, you should consult with a workers' compensation attorney to represent you. In most cases, you won't have to pay for attorneys' fees out of pocket. Workers' comp attorneys typically work on a contingency fee basis, which means that they take a percentage of anything recovered on your behalf.
Unlike many other states, Louisiana does not have a second level of administrative review. This means that if you disagree with the judge's decision, you must appeal to the Circuit Court of Appeal. To do so, you must file the appropriate paperwork with the court, typically within 30 days.
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