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LOUISIANA WORKERS' COMPENSATION MEDICAL BENEFITS
Employers
are required to provide medical care to any employee who is
injured in the course and scope of their employment. If your
employer refuses to authorize or arrange medical care for
you, you should get treatment on your own as soon as
possible and have your attorney provide your employer with a
copy of the billing information. Delaying medical care may
cause your condition to worsen unexpectedly, resulting in
substantially more time missed from work.
It's also important that you get a
written statement from the doctor about your work-status,
i.e., you may need to ask the doctor for a note that says whether you
can go back to work or not. If the doctor releases you to
return to light-duty, the note should outline your
restrictions and an estimate of how long those restrictions
are expected to last. You may need to
provide your employer (or their insurance company) with a
copy of the note from the doctor before they will begin your Workers'
Compensation wage benefits. Additionally, many employers
will not allow you to return to come back to work following a
job-related injury without a doctor's note releasing you to
unrestricted duty.
As a general rule, you're allowed to select
the doctor that will be your treating physician and the doctor
you select does not have to be included on a list of "approved
doctors" maintained by your employer or their Workers'
Compensation insurance company. But the law
is very strict and you can easily forfeit your right to pick your own
doctor by acting hastily. The
Louisiana Workers' Compensation Act states:
If the employee is treated by any physician
to whom he is not specifically directed by the employer or
insurer, that physician shall be regarded as his choice of
treating physician.
When the employee is specifically directed
to a physician by the employer or insurer, that physician may
also be deemed as the employee's choice of physician, if the
employee has received written notice of his right to select
one treating physician in any field or specialty, and then
chooses to select the employer's referral as his treating
specialist after the initial medical examination as signified
by his signature on a choice of physician form.
* * *
If the employee fails of refuses to sign the form as provided
[by the statute], the employer or his insurer shall be
entitled to seek an expedited hearing to be held within ten
days, and upon order of the court, may suspend medical benefits
until such time as the employee complies with [the
requirements of the statute].
More:
La.R.S. 23:1121
Considering the current state of the law, you
should not sign any forms, or even schedule any
medical appointments, until after you have a consultation
with an attorney who is experienced in Louisiana Workers'
Compensation matters.
You're also allowed to select additional doctors in other medical
specialties if the treatment that they provide is medically
necessary and applies to your work-related condition. You're
usually not allowed to see two doctors of the same medical specialty
without first getting the Workers' Compensation insurance
company's consent. If they refuse to
allow you to switch to another doctor, you should contact an
attorney. Your attorney may be able to help you obtain
approval from the Workers' Compensation Court despite the
insurance company's initial denial of your request to see a new
doctor.
Your
employer (or their insurance company) may also set up appointments with doctors that they
have selected. In most cases, these appointments will be only
examinations and the doctor will not provide you with
any actual medical treatment. It's important that you attend
these appointments because your employer may obtain approval
from the Workers' Compensation Court to suspend your benefits
if you don't go. This is one of the few areas in which Court
approval is required prior to the suspension of a claimant's
benefits. Your
employer is not allowed to require you to be examined by more
than one doctor in each medical specialty without your
consent. You should consult with an attorney before agreeing to an examination with a second doctor of the same
medical specialty.
Always remember that it's important to select
your doctors wisely. Their methods of treatment and opinions
will have a tremendous impact upon the extent of your recovery
and the outcome of your case.
EMERGENCY MEDICAL
TREATMENT
You are
usually required to obtain approval from your employer or
their Workers' Compensation insurance company before your
first appointment with any new doctors or hospitals. If you do
not contact your employer (or their insurer) before beginning
treatment with each health care provider, your employer's
responsibility for the charges incurred with each health care
provider may be limited to only $750.00. You or the health
care provider may be responsible for the additional charges. As a practical
matter, most doctors and hospitals require
verification of billing arrangements before providing
treatment, but it's the injured employee's responsibility to
verify that payment arrangements have been made.
Some
people are accustomed to receiving most of their medical
treatment through a hospital's Emergency Room. In a Workers'
Compensation claim, it's usually difficult to get ongoing
medical treatment through the Emergency Room because your
employer will be responsible for the cost of treatment
provided on an emergency basis only if the treating physician
certifies that you had a genuine medical emergency.
It's best to
attend regular appointments with your treating physician at
the doctor's office rather than relying upon the Emergency
Room for treatment. Nonetheless, if your have a genuine
medical emergency, you should not hesitate to get treatment
immediately.
INDEPENDENT MEDICAL EXAMINATIONS
If your
doctor and your employer's doctor disagree about your medical
condition or your ability to return to work, the Court or the
Louisiana Office of Workers' Compensation may select a third
doctor to perform an Independent Medical Examination.
Though
both you and your employer have the right to
request an
Independent Medical Examination,
the cost of the exam will always be paid by the insurance
company. The
doctor that performs the Independent Medical Examination will
send the report of the examination directly to the Judge that
will hear your case.
Unfortunately, Workers' Compensation insurance company
representatives often tell injured employees that they have
arranged an "Independent Medical Examination," when in
reality, what they mean is that they have scheduled an
appointment for you with a doctor that they selected. Written
notice of a true "Independent Medical Examination" will come
to you directly from the Louisiana Office of Workers'
Compensation Medical Services Division or from the Workers'
Compensation Court.
DRUG
& ALCOHOL TESTING
Your
employer may require you to take a drug & alcohol test
immediately following a work-related accident as a condition
of receiving Workers' Compensation medical and disability
benefits. If you refuse to take the test, the Court will
presume that you were intoxicated.
You may
not be allowed to recover benefits if your injury resulted
from your own intoxication or drug use. If the test determines
that you had alcohol or unauthorized/illegal drugs in your
system at the time of your injury, the Court will presume that
it was your intoxication that caused your injury and you may
not be allowed to receive Workers' Compensation benefits. It
will be up to you to convince the Judge that your alcohol or
drug use was not a cause of the accident.
Additionally, your wage benefits may be terminated and your
claim for Supplemental Earning Benefits may be denied if you
fail a return-to-work drug screen. This rule does not
apply to just illegal drugs. You can lose your
benefits if you test positive for prescription pain medication
that was never prescribed to you.
Your employer
and their medical representatives are required to ensure that
you are given a valid test and that "chain of custody" rules
are followed for handling the blood or urine sample.
If a test
detects the presence of alcohol or drugs in your system and
you believe that the results of the test are incorrect, you
have the right to be re-tested immediately at your own
expense.
PRESCRIPTION MEDICATION & TRAVEL EXPENSE
Your
employer is responsible for the cost of any medication or
medical devices that your doctors prescribe for you during
your claim.
Some
Workers' Compensation insurance companies provide injured
employees with prescription cards to present to their
pharmacist at the time of purchase. You do not owe a
co-payment or deductible when using one of these cards.
Other
Workers' Compensation insurance companies require the
pharmacist to contact an insurance company representative each
time a prescription needs to be filled. This often results
in unnecessary delay and significant frustration. It's important to remember that insurance
companies are closed on Saturdays and Sundays. If you're
required to obtain approval for each prescription, don't wait
until Friday afternoon or the weekend to go to the pharmacy. But
if you forget, or if it's important that you get your
prescription filled immediately, you
can personally pay for your medication and submit your receipts
to the insurance company for reimbursement.
The insurance company
should also reimburse you for any travel
expense that you incur to receive medical care. Travel
expenses are currently reimbursed at the rate of forty
cents per mile for use of your vehicle, but may also include
other transportation expenses in some claims. You should
periodically submit a statement of your expenses, and any
supporting documents, to your employer's Workers' Compensation
insurance company for reimbursement. Be certain to keep a copy
of any information that you provide to the insurance company.
Download a copy of the form we use for
submitting mileage reimbursement requests.
If you're
unable to drive or do not have access to a vehicle, we will
help you arrange for medical transportation.
Remember, if your ability to drive is impaired by prescription
medication, you are not only putting yourself and other
drivers in danger, you are often breaking the law. Plus, if
you get into an automobile accident while you are under the
influence of pain medication, you may not only have problems
with the police, the Traffic Court, the other driver, the passengers and
the automobile insurance companies, if you are injured in an
automobile accident, your employer may use this as a pretext
for terminating your Workers' Compensation benefits. Don't
drive when you're taking strong pain medication. Call us and
we will help arrange transportation for you to get to your
doctor appointments.
Next: Filing a Claim for Benefits
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