Workers’ Compensation – Employee Benefit

Defy

on October 04, 2023

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Workers’ compensation is a system of no-fault insurance that provides medical care and monetary benefits to employees (or their survivors) for work-related injuries, diseases and deaths. Workers’ compensation is governed by state law.

The Louisiana Workers’ Compensation Law (WCL) establishes the benefits available to employees who sustain work-related injuries and illnesses in the state. The Louisiana Office of Workers’ Compensation Administration (OWCA), part of the Louisiana Workforce Commission (Commission), administers the workers' compensation system and calculates the specific benefits payable under the WCL.

This Employment Law Summary provides a general overview of the various types of benefits the OWCA may order an employer to pay if an employee is injured in the course and scope of employment. Employers are free to voluntarily pay additional benefits over and above these requirements.

MEDICAL EXPENSES

Employers must cover the cost of all medical care, services and treatment necessary to address compensable work-related injuries and diseases. This includes all necessary:

Drugs, supplies, hospital care and services;
Medical and surgical treatment;
Any nonmedical treatment that is recognized as legal under Louisiana law; and
Costs of repairing or replacing any prosthetic devices, such as eyeglasses, artificial limbs or hearing aids that are damaged or destroyed as a result of a work-related accident.

TREATMENT COST LIMITS

The WCL limits how much an employer can pay for medical expenses and requires treating health care providers to keep their charges within these limits. The maximum amounts a provider may bill an employer are listed in a reimbursement schedule published by the OWCA each year. These limits apply even if an employee receives treatment outside of Louisiana.

In addition, health care providers must obtain consent from both the injured employee and his or her employer before administering any nonemergency diagnostic testing or treatment that will cost more than $750. Employers that unreasonably withhold their consent for these charges may be required to pay attorney fees and any additional expenses the injured employee may incur as a result of the unreasonable refusal.

Although an employer’s prior consent is never required for emergency treatment expenses, medical providers have the burden of proving that any charge above $750 for which they do not request prior consent is for treatment that was immediately necessary to address the effects of an employee’s work-related injury.

CHOICE OF TREATING PHYSICIAN

Injured employees have the right to select one treating physician, in any field or specialty, to provide medical care related to a work-related injury. An employee’s medical provider for emergency care does not count as a treating physician selection. After making an initial treating physician choice, employees must obtain consent from the employer (or its workers' compensation insurance carrier) before changing to another treating physician within the same field or specialty. Employees are not, however, required to obtain prior approval if they change to a treating physician in another field or specialty.

TRAVEL EXPENSES

Employers must reimburse injured employees for all reasonable and necessary travel expenses they incur to receive medical treatment, services or supplies related to work-related injuries. If an employee uses his or her own vehicle, the reimbursement amount is the mileage rate in effect for state employees at the time the employee incurred the expense.

VOCATIONAL REHABILITATION

If a work-related injury results in an employee’s inability to earn the same or higher wages as he or she earned prior to the injury, the employer may be required to provide rehabilitation services through a licensed professional vocational rehabilitation counselor who is approved by the OWCA.

The goal of vocational rehabilitation is to return a disabled employee to work, with a minimum of retraining, as soon as possible after an injury occurs. Employers (or their insurance carriers) are responsible for selecting a licensed counselor to evaluate and assist a disabled employee with job placement or vocational training. Employers must also help choose, and cover the expenses associated with achieving, the most appropriate vocational goal for a disabled employee. The goal options, in order of priority level under the WCL, are:

Return to the same position;
Return to a modified position;
Return to a related occupation suited to the claimant's education and marketable skills;
On-the-job training;
Short-term retraining program (up to 26 weeks);
Long-term retraining program (up to 52 weeks); and
Self-employment.

MONETARY COMPENSATION

When an employee is unable to work or sustains a permanent physical impairment as a result of a work-related injury, he or she may be entitled to receive monetary payments as compensation for his or her lost wages or physical abilities. An employee’s surviving spouse and other dependents may also be entitled to compensation for the loss of support if a work-related injury results in the employee’s death.

Although most monetary benefits are payable in weekly increments, the WCL includes specific requirements for each of the various types available, all of which are described later in this document. Regardless of the benefit type that may be payable, workers' compensation benefits are not considered income for tax purposes, and they are immune from wage assignments and creditor claims, except in certain cases involving child or spousal support.

WAITING PERIOD

In general, employees may not receive monetary benefits for the first week after the date of injury. However, if an employee is unable to earn wages for two weeks or longer after the date of injury, benefits for the first week may be payable retroactively.

LUMP-SUM PAYMENT FOR CERTAIN LOSSES

In addition to any other benefits payable under the WCL, an employee may be entitled to a lump-sum payment of $50,000, which must be paid within one year after the date of the injury, if his or her work-related injury results in:

Paraplegia;
Quadriplegia;
Third-degree burns to 40 percent or more of the total body surface;
Amputation of both hands, arms, feet, legs or eyes;
Amputation of one hand and one foot; or
Amputation of any two of the body parts listed above.

DEATH BENEFITS

In any case in which a work-related injury causes an employee’s death, the employer must pay between $7,500 and $8,500 to cover the expenses of burial. If the actual expenses of burial are less than $7,500, the difference must be paid to the deceased employee’s estate.

In addition, if a work-related injury causes an employee’s death within two years after the employee last received medical treatment for the injury, the employee’s surviving dependents may be entitled to weekly payments as compensation for the loss of support.

In general, a deceased employee’s surviving spouse is entitled to weekly payments if he or she was living with and actually dependent upon the deceased employee at the time of both the accident and the death. A biological or adopted child of a deceased employee is entitled to weekly payments if he or she was living with and actually dependent upon (or was the beneficiary of a valid child support order against) the deceased parent at the time of the injury and, at the time of the employee’s death, is either:

Under the age of 18 years;
A full-time student who is under the age of 23 years; or
Physically or mentally incapacitated from earning wages.

Other dependent survivors may receive weekly payments only if no surviving spouse or child is entitled to benefits. Similarly, survivors who were only partially dependent on a deceased employee may receive weekly payments only if there are no wholly dependent survivors.