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FILING A CLAIM FOR LOUISIANA WORKERS COMPENSATION BENEFITS

If you have an accident at work, you must report your accident or injury to your employer within 30 days of the day that it occurs or your right to recover Workers Compensation disability and medical benefits may expire. Because the law does recognize a very few exceptions to the limitation of the time period for reporting your accident, you should contact an attorney for assistance with your claim even if more than 30 days have passed to determine if one of the exceptions may apply.

Don't forget to ask your employer for a copy of your accident report because the report can provide proof to establish the date your accident happened and the date it was was reported. Employers are supposed to use a Louisiana Department of Labor Form 1007 (Employer Report of Injury or Illness) to provide the Office of Workers Compensation with information about your accident and claim.

FILING A "DISPUTED CLAIM FOR COMPENSATION" WITH THE LOUISIANA OFFICE OF WORKERS COMPENSATION

If your employer is underpaying, or not paying, your Louisiana Workers Compensation wage or medical benefits, you or your attorney may file a Louisiana Department of Labor Form 1008 with the Office of Workers Compensation. Filing this form starts the process that can ultimately result in a trial before a Louisiana Workers Compensation Judge. There is a small fee to to file the form, but it may be deferred if you also file a Louisiana Department of Labor Form 1027 showing that it would be a hardship for you to pay the fee.
 
If you have a disagreement with your employer about your Louisiana Workers Compensation benefits and would like for the dispute to be submitted to the Louisiana Workers Compensation Court, you must file your claim with the Court within the following time periods:

  • A claim for medical benefits must be filed within one year of the date of the accident or within three years of the date that Workers Compensation medical benefits were last paid, whichever is later.
      
  • If you have not received any Louisiana Workers Compensation income (indemnity) benefits as a result of your current injury, a claim for Louisiana Workers Compensation income benefits must be filed within one year of the date of your accident. In some unusual circumstances involving "developmental injuries," the time limit for filing a claim may be extended up to a total of three years, as long as that is still not more than one year from the date that your injury developed.
      
  • If you have been paid Louisiana Workers Compensation indemnity benefits due to your current injury, your right to file a claim for Temporary Total Disability, Permanent Partial Disability or Permanent Total Disability benefits will expire if your claim is not filed with the Louisiana Office of Workers Compensation within one year of the date through which you were last paid indemnity benefits.
      
  • For Supplemental Earnings Benefits, three different rules and time frames apply.
      
    1. If you have not received any type of Louisiana Workers Compensation income (indemnity) benefits due to your current injury, you must file a Disputed Claim for Compensation with the Louisiana Office of Workers Compensation within one year of your accident date.
       
    2. If you have previously received Supplemental Earnings Benefits due to your current claim, your time limit for filing a Disputed Claim for Compensation with the Louisiana Office of Workers Compensation expires at the end of two years from the date through which you were last paid Supplemental Earnings Benefits if "SEB has not been payable to [you] for any given thirteen consecutive weeks" during those two years.
         
    3. If you have previously received only Temporary Total Disability, Permanent Partial Disability or Permanent Total Disability benefits, your right to file a Disputed Claim for Compensation with the Louisiana Office of Workers Compensation expires at the end of three years from the date through which you were last paid one of those types of benefits.

The Louisiana Supreme Court explained the rule in the following way:

To summarize the SEB scheme put in place by the legislature, § 1209(A) sets forth the applicable three-year prescriptive period from the date of the last indemnity benefit payment for filing a claim for SEB. Once a worker begins to receive SEB, § 1221(3) governs the calculation and termination of these benefits. In any week where the worker is unable to earn at least 90 percent of his pre-injury wages, SEB will be payable to him, for a maximum of 520-weeks. If the worker is able to earn his full pre-injury salary in any given week, the employer will not owe SEB, but these weeks will not be counted toward the 520-week maximum time period. § 1221(3)(d)(ii) Under certain circumstances, the worker's SEB payments will end before the expiration of 520-weeks. One of these circumstances arises under § 1221(3)(d)(i), where a worker has begun to draw SEB, but where SEB has not been payable to him for any given thirteen consecutive weeks in any two-year period after termination of TTD, presumably because the worker is able to work at full earning capacity during this period of time. This situation is distinguishable from the situation of the current plaintiff, who has never filed a claim for SEB and has never received SEB payments, and where, consequently, § 1221(3)(d)(i) has not been triggered.

In this action, plaintiff is asserting that she is entitled to begin receiving SEB payments for the first time. Her claim is timely under § 1209(A) because it was filed within three years after termination of her last TTD payment, and the court of appeal incorrectly found that § 1221(3)(d)(i) bars this action. Dufrene v. Video Co-op, 2002-CA-1147

  • The time limit for filing a claim for Workers Compensation benefits is not extended because you received another type of disability benefits, such as Social Security Disability or benefits from a private short term disability policy.
       
  • A claim for Workers Compensation benefits that is not based upon a specific accident but is instead based upon a work-related illness or disease must be filed with the Louisiana Office of Workers Compensation within one year of the date that:
      
    • The disease manifested itself.
    • The employee is disabled from working as a result of the disease.
    • The employee knows or has reasonable grounds to believe that the disease is occupationally related.

Louisiana Courts have decided that your right to file claims for Workers Compensation medical benefits and Workers Compensation indemnity benefits are separate legal rights. Thus, the Courts have held that your time limit for filing a claim for indemnity benefits can expire even though the Workers Compensation insurance company is still paying for all of your medical treatment. This is an area of the law that can appear confusing and unfair and its impact can depend heavily upon the specific circumstances of your case.

You should consult with an attorney even if you think your time limit for filing a claim has expired. The calculation of legal time limits can be subject to many surprising exceptions. Additionally, in a Workers Compensation claim, you may need to request information from the insurance company before you can determine when your time limitations began or expired.

Next: Termination of Income Benefits

 

 

David Buie, Louisiana Workers Compensation Attorney and Social Security Disability Attorney, 650 Poydras Street, Suite 1400, New Orleans, LA 70131, (800) 851-9405 / Fax: (866) 702-5297 Representing claimants in:
Alexandria Baton Rouge Bossier City Covington Gretna
Hammond Harahan Harvey Houma Kenner Lafayette Lake Charles
Laplace Marrero Metairie Monroe New Iberia New Orleans
Opelousas Ruston Shreveport Slidell Terrytown

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