Generally, insurance companies do not use delay tactics. Instead, they use rush tactics to get employees back to work as quickly as possible. Once an employee goes back to work, it’s harder to claim that they need benefits based on an inability to work.
These rush tactics are commonly implemented by asking claimants to see a doctor at a walk-in clinic who may advise them to return to work, instead of allowing claimants to see a doctor of their choosing who may perform a more comprehensive evaluation.
This rush tactic can be very effective because many people are not informed of their rights to see a doctor of their choice, and they don’t want to lose a good job. In addition, some people believe the messaging of insurance companies that suggests, If you sue people, you’re a bad person. Because of this, many people never contact an attorney who can advise them of their rights.
As far as delay tactics that may be used, an employer can send their employee making a Workers’ Compensation claim to a doctor of the employer’s choice for a “defense medical examination”. This employer-chosen doctor’s visit could cause a delay if that medical professional makes a statement about the employee’s health that suggests that they are not disabled and are physically ready to return to work.
When it comes to the medical necessity of particular treatment, if an injured employee’s choice of doctor orders imaging or other tests, the employer will get a Utilization Review Process. Through this process, the employer will hire a doctor to look at the medical record (the imaging or tests) and not physically examine the claimant. Instead, the employer’s doctors will look at the records and use the Louisiana Workers’ Compensation medical guidelines to determine whether or not that particular treatment is medically necessary.
If a particular medical treatment is given to a claimant, the doctor providing that treatment will submit a medical report to request payment for those services. If the carrier denies the request, an appeal to the denial can be filed. Ultimately, in the case of an appeal denial, a claimant may file a disputed claim form with the Office of Workers’ Compensation to seek a determination by a judge.
How Are Workers’ Compensation Benefits Going To Be Calculated In Louisiana And What About Future Medical Care And If The Injuries Get Worse And Come Back?
Workers’ Compensation Benefits are available to approved claimants in Louisiana in the amount of 66.66% of the worker’s Average Weekly Wage (AWW). This benefit amount has a maximum limit that will not exceed $710 in weekly payments.
There are formulas to calculate the AWW using the last four full pay periods of a worker’s wages to determine a claimant’s benefit amount. For seasonal employees and employees with different pay schedules, the state offers alternative methods of calculating AWW.
Medical benefits are calculated based on the Louisiana Workers’ Compensation medical guideline statute. The Workers’ Compensation guidelines in Louisiana cover every diagnostic code, every treatment code, etc., with associated dollar amounts. All healthcare professionals who accept Workers’ Compensation claims are well-versed in these reimbursement rates and processes.
When considering the need for future medical care, a person may be eligible for coverage and treatment. It is not uncommon for an individual to return to work and earn their pre-accident or pre-injury wages, but these workers may still be owed medical benefits. If an employee is still receiving medical treatment while returning to work at a reduced capacity, their Workers’ Compensation coverage obligation continues. Questions of future medical need are necessitated by the injury.
Additionally, it may be beneficial to request a life care plan. These plans can determine the costs of future medical expenses and may achieve a lump sum settlement for the indemnity portion to the injured worker.
These Workers’ Compensation settlements are the business decisions of insurance carriers. There is no statutory obligation for insurance carriers or employers to settle a Workers’ Compensation claim.
The only obligation of an insurer or employer is to pay the 66.66% of the AWW, to pay medical benefits that are reasonable and necessary, and to provide vocational training and/or rehabilitation to a person who may need vocational assistance to get back into the workforce.
For more information on Workers’ Compensation Law In Louisiana, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (337) 289-0626 today.
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