Representation for Workers Compensation Cases

As opposed to The Long shore and Harbor Workers Compensation Act (LHWCA), a federal workers’ compensation statute that covers injured workers engaged in “maritime employment.” Louisiana Worker’s Compensation handles most everyone else. Like Long shore claims these are also handled by administrative process but through the Louisiana State Department of Labor not the U.S. Department of Labor. Injured workers who qualify will likewise receive benefits regardless of employer fault.

Report your accident or injury to your employer as soon as possible and get a copy of the accident report for your records.

If your injury or illness is found to be job-related, you may be entitled to receive:

Lifetime medical care for the injury or illness, Disability compensation for all (TTD: Temporary Total Disability) or a portion (SEBs: Supplemental Earnings Benefits) of 2/3 of your wages (up to a cap), these benefits, unlike those “unscheduled” benefits under the LSHWA, are usually limited to ten years.

Rehabilitation services, and, Death, benefits payable to your survivors.

As with the LSHWA, you are not entitled to pain & suffering because of the injury or illness from your employer.

You or your attorney must file a timely Disputed Claim for Compensation Form LWC-WC 1008, which is an administrative law proceeding through one of ten offices in the State of Louisiana.

Note: your employer or his insurance company may hire private investigators to secretly observe and record your daily activities. These videotapes will likely be used in court against you. PLEASE BE CAREFUL OUT THERE!

Louisiana law requires that an employer have workers' compensation insurance, he must either be self-insured or have workers' compensation insurance policy. It is against the law not to be either self-insured or covered by a valid policy. Severe penalties exist for failure to be either self-insured or covered by a valid policy.

1. Any employee of a private residential householder or any employee of a private unincorporated farm,
2. Musicians and performers who are rendering services pursuant to a performance contract,
3. Some members of crews of any airplane engaged in dusting or spraying operations,
4. Uncompensated officers and uncompensated members of boards of directors of certain nonprofit organizations,
5. Any real estate broker or agent licensed to do business in the state of Louisiana,
6. Many land-man rendering services relating to the exploration, development, production, or transportation of minerals,
7. Many deputy sheriffs are also exempt.
8. Independent contractors involved in manual labor are NOT exempt.

IMPORTANT: Where applicable, an employee who falls under these exemptions may seek tort recovery for injuries arising out of such labor, work, or services from any insurance policy that a homeowner or employer may have which extends coverage to persons injured on their premises or because of their negligence.

An experience lawyer will know when to file in comp., tort or both.

The Bar Association flatly prohibits most loans to clients. Assistance, such as food stamps, may be available through social services. You may also want to contact local charities or churches in your area. You may not receive unemployment benefits because you are admitting that you are fully able to work without restriction during the time you received such benefits. Obviously, this is bad for your comp. case.

A lump sum settlement is an agreement where the insurer/employer agrees to pay the present value of the disputed claim at once, and his/her future obligations to the injured workers are fully and finally released. To determine the value, the sum of payments owed the claimant may not be discounted at a rate greater than eight percent per year.

Much less than in a tort case. There is no pain & suffering and you are entitled to only 2/3 (subject to a cap) of lost wages (and this usually for a maximum of ten years) not 100% of all your predicted lost wages as in tort. The value of a workers' compensation claim depends on various factors: your compensation at the time of your injury vs. your likely future earning capacity (usually times 2/3 (capped) over a ten year period) plus your future lifetime medical needs related to the injury plus any penalties due.

You are not required to have an attorney in workers' compensation proceedings; however, you may contact one at any time during the process; however, obtaining one is strongly recommended if any dispute arises. An experienced attorney is more likely to get you all of the benefits you deserve. An attorney will make sure that your interests are aggressively represented thru out the administrative process and will negotiate a fair settlement of your claim should you decide to settle for a lump sum payment. (I've seen many unrepresented workers get taken to the cleaners at settlement time.) A lawyer will also be able to tell you if you have any claims arising from any subsequent employer misconduct such as wrongful termination, fraud, libel or slander. An attorney will also be able to tell you if you have any additional claim in tort against a third-party and how to avoid wrecking your comp. claim while you recover against a third-party.

If you have an attorney, contact him first. If you don’t you should contact your employer or your employer's insurance carrier. With a paper & pen in hand try to pin your adjuster down on exactly why benefits have been halted, get the adjusters words down as correctly as possible, mark down who you spoke to, the time and date. If you cannot resolve the problem with them, you should get an attorney ASAP. Provide that attorney with your notes. We can help or contact your nearest Workers' Compensation District Office. They can provide you with a list of attorneys who practice in this area.

An injured worker has the freedom to choose his or her treating physician and may switch from one specialty of care to another without having to seek approval of the employer/insurer. The worker must, however, have employer’s/insurer’s permission to switch from one provider to another within the same field of specialty. This will usually not be forthcoming without good cause. Basically, you are stuck with the doctor you choose in that specialty, therefore chose well or before you do, contact an experienced attorney who will know which doctor’s to avoid. While the injured worker has the freedom to select the treating physician, actually receiving timely treatment from that doctor is another matter entirely.

The treating doctor must ask approval from the employer/insurer for any proposed non-emergency treatment > $750.00.  This is accomplished via a difficult and complex process: first the doctor files a Form 1010 with extensive supporting medical documentation; within 5 days the insurer may deny the proposed treatment by Form 1010A claiming the treatment is not necessary or by citing concerns with the doctor’s Form 1010 and/or the supporting documentation; the treating doctor then has 10 days to respond in writing.  If the insurer still denies the proposed treatment, the treating doctor can appeal to the Medical Director with the Office of Workers’ Compensation via a Form 1009 attaching the Form 1010 & 1010A along with all attached documents with service on all parties.  The Medical Director will the determine within 30 days if the proposed (but denied) treatment is “necessary.”  Finally, the losing party may appeal this decision by Form 1008 with the Office of Workers’ Compensation.  As a result, many doctors choose not take comp.

There may come a time when your employer/insurer will require you to be examined by a physician of his choice. You must go, just as you got your choice, they now get one too. Your failure to attend may cause your compensation payments to be temporarily suspended until you do so. If your physician and your employer's physician do not agree about your medical condition, you may be sent to an Independent Medical Examination.  If you’re this far along, it is high time you got experienced counsel on your side. 

Contact the medical provider/collection agent and find out if these bills have been previously sent to your employer or the insurance carrier, if they have, get this information in writing from the medical provider/collection agent and then contact an experienced attorney at once. If the medical bills have not been previously sent to your employer or the insurance carrier you should send them to your employer or the insurance carrier; however, you should keep copies.

Under Louisiana Law, your employer cannot terminate your employment because you filed a workers' compensation claim. This is called a wrongful termination claim and you may want to contact an attorney. However, your employer does not have to keep a job open for you or make one available when you are able to return to work. So how do you prove the employer fired you because you file a comp. claim rather than that he needed a new warm body (This is legally O.K.)…? Did he fill the position…? Does he fire everyone who files a claim…? Did he fire you when you returned to work & were able to do that job…? An experienced attorney can guide you here.

This is one of the weakest areas of the Louisiana Worker’s Compensation Statute. The employer/insurer may simply do a job survey to find which jobs are available in your area, within the limits approved by your doctor but you must also have the educational & vocational abilities also. Always request that you be given a contemporaneous (at the same time) copy of the survey so that you can immediately apply for the alleged positions. Cooperate with Voc Hab, you want to get a job, have them help write your resume but be sure they are sending you, on a real time basis, the job leads they claim exist so that you can immediately apply for these positions. Get a notebook fill it out with their jobs, when you applied, who you spoke to, what happened, and your follow up. Do this also for similar jobs & those other jobs you think you are able of doing that you find in the newspaper or elsewhere.

Your first payment should be paid on the fourteenth day after your employer has knowledge of your injury resulting in loss of income. There is a 7-day waiting period for which you will not be paid benefits. However, if you miss more than 42 consecutive days, you will be paid for the 7-day waiting period.

Often an Employer\Insurer Scam.

Why does this even matter? A finding of fraud results in a loss of all worker’s compensation benefits forever (at least as interpreted by a recent, terrible 5th Cir. decision). While we can all agree that when an injured employee is working and getting Temporary Total Disability benefits that this is fraud. Yes this is fraud but many, many other things that you would not think are fraud have been determined to be fraud by unthinking judges who were “bamboozled” by private detectives and overly creative defense counsel. In one such egregious decision, a man, whose injury finally resulted in his leg being amputated above the knee due to insufficient blood flow caused by the injury, was prior to the amputation, found to be “exaggerating his pain and his abilities” and therefore had committed fraud. Specifically, the employer/insurer never claimed that he could do any kind of work at all! Given such not infrequent gross miscarriages of justice, an experienced attorney is more likely to avoid these pitfalls and get you the benefits you deserve. There are many other such potential miscarriage of justice areas: be extremely careful when you fill out 1020 forms, better that your attorney do this or if you are self-employed, that a CPA do it, be extremely careful when you fill out mileage reimbursement, better not to do it at all or have your attorney do it with the aid of map-quest. “Extreme care to be accurate should be exercised when submitting for mileage reimbursements.”, this according to the State of Louisiana Department of Labor’s Official site. You have been warned!

All related expenses reasonably and necessarily incurred for obtaining services, medicines, and prosthetic devices should be paid. However, actually getting these things will likely require the services of an experienced attorney. If you are denied these devices please contact us or other experienced counsel