LOUISIANA WORKFORCE COMMISSION OFFICE OF WORKERS’ COMPENSATION ADMINSITRATION PRESENTED BY:DARRICK M. LEE, J.D.,LL.M. OWCA FRAUD DIRECTOR

LOUISIANA WORKERS’ COMPENSATION The Office of Workers’ Compensation Administration (OWCA) was created in 1983 within the Louisiana Department of Labor (now the Louisiana Workforce Commission) to administer the provisions of the Louisiana Workers’ Compensation Act.

LOUISIANA WORKERS’ COMPENSATION OWCA investigates allegations of fraud; monitors compliance with the requirement that employers insure their workers’ compensation obligation; compiles information regarding workers’ compensation claims; resolves disputes over the necessity, advisability, and cost of hospital care or services, as well as conflicts concerning medical, surgical and non-medical treatment;

LOUISIANA WORKERS’ COMPENSATION provides Occupational Safety & Health Administration (OSHA) consultation services; and assists Louisiana employers in the development and implementation of a safety management plan in their workplace. The OWCA, however, does not pay any benefits to employees as a result of a covered on the job injury.

LOUISIANA WORKERS’ COMPENSATION The OWCA has exclusive original jurisdiction to resolve disputes in workers’ compensation matters. There are ten district offices located throughout the state (see attached list) where disputed claims for compensation are filed and which provide the framework for the resolution of disputes regarding claims for benefits, the entitlement to benefits, or other relief under the Louisiana Workers’ Compensation Act.

LOUISIANA WORKERS’ COMPENSATION

LOUISIANA WORKERS’ COMPENSATION Workers’ compensation is a legal remedy whereby an employee who is injured on the job may be entitled to certain benefits. The benefits can include medical care for the injury, indemnity wage benefits, vocational rehabilitation services, and/or death benefits.

LOUISIANA WORKERS’ COMPENSATION These benefits are the obligation of the employer and are paid directly to the employee by the employer or its workers’ compensation insurer. Every employer, unless statutorily exempted, is responsible for the medical care and the payment of indemnity wage benefits to any employee who is injured while in the course and scope of his or her employment.

LOUISIANA WORKERS’ COMPENSATION The law covers both mental and physical injuries from either accidents or occupational diseases. However, a mental injury must be the result of a physical injury or of a sudden, unexpected and extraordinary stress related to the employment and in either case must be proved by clear and convincing evidence.

LOUISIANA WORKERS’ COMPENSATION An accident is defined by the Louisiana Workers’ Compensation Act as an unexpected or unforeseen actual, identifiable, precipitous event happening suddenly or violently, with or without human fault, and directly producing at the time objective findings of an injury which is more than simply a gradual deterioration or progressive degeneration.

LOUISIANA WORKERS’ COMPENSATION An occupational disease is defined by the Louisiana Workers’ Compensation Act as only that disease or illness which is due to causes and conditions characteristic of and peculiar to the particular trade, occupation, process, or employment in which the employee is exposed to such disease.

LOUISIANA WORKERS’ COMPENSATION The event causing the injury must arise out of and be within the course and scope of the employee’s employment.

Generally, the fault of the employer or employees does not affect the compensability of an injury. However, no compensation may be allowed if the injury was caused by the employee’s willful intention to injure himself/herself or others; or by the injured employee’s intoxication at the time of the injury, unless resulting from activities in pursuit of the employer’s interests or from activities in which the employer procured and encouraged the use of the beverage or substance.

LOUISIANA WORKERS’ COMPENSATION An employee may not be entitled to benefits if he is the aggressor in an unprovoked physical altercation. The employee may not be entitled to benefits if it is determined that he/she was a participant in “horseplay” at the time that the injury occurred.

LOUISIANA WORKERS’ COMPENSATION An employee who suffers a covered injury may be entitled to weekly/monthly indemnity benefits if the injury prevents the employee from returning to work for more than seven calendar days.

LOUISIANA WORKERS’ COMPENSATION The first installment of benefits payable for Temporary Total Disability (TTD), Permanent Total Disability (PTD) or death shall become due on the fourteenth day after the employer or insurer has knowledge of the injury or death.

LOUISIANA WORKERS’ COMPENSATION No compensation shall be paid for the first week after the injury occurs unless the disability from the injury continues for two weeks or longer after the date of the accident. This “waiting period” indemnity payment shall be paid after the first two weeks have elapsed.

LOUISIANA WORKERS’ COMPENSATION An employee has the right to select one doctor of his or her choice in each specialty field for treatment of the job-related injury. The employer or its workers’ compensation insurer is required to pay all approved necessary expenses for medical treatment and all reasonably and necessarily incurred travel to obtain treatment.

LOUISIANA WORKERS’ COMPENSATION What happens if I am denied workers' compensation benefits? An option you have is to file a Disputed Claim for Compensation, Form LWC-WC 1008 (PDF), which is an administrative law proceeding through one of ten offices in the State of Louisiana. This process could take six to nine months, or longer if the case is appealed.

LOUISIANA WORKERS’ COMPENSATION Employers in Louisiana are required to maintain workers’ compensation insurance even if they only have one employee. This includes part-time, full-time, temporary, or seasonal employees.

LOUISIANA WORKERS’ COMPENSATION There are certain employees exempt from coverage under the law. Some include: Certain employees of a private residence Certain employees of a private unincorporated farm Certain musicians and performers Employees covered by certain federal laws Employees of railroads or other vessels in interstate or foreign commerce Crews of airplanes engaged in crop dusting or spraying operations Uncompensated officers and members of boards of directors of certain non-profit organizations Landmen

LOUISIANA WORKERS’ COMPENSATION Business owners and certain officers of a corporation may choose to exempt themselves from a workers’ compensation insurance policy only if they own at least 10% of the company. This exemption must be done in writing to the insurance company.

LOUISIANA WORKERS’ COMPENSATION Louisiana law makes is very clear that employers cannot withhold premium payments from their employees to pay for workers’ compensation insurance. This includes employees misclassified as independent contractors. Employers found in violation may face serious civil and criminal fines as well as possible incarceration.

LOUISIANA WORKERS’ COMPENSATION Employers who fail to carry workers’ compensation insurance can be fined up to $250 per employee for a first violation and $500 per employee for subsequent violations up to $10,000.

LOUISIANA WORKERS’ COMPENSATION Additionally, an employer can be charged with criminal violations for his/her willful failure to provide workers’ compensation insurance, for providing false information regard to having a workers’ compensation insurance policy, or for provide false information in order reduce the amount of a workers’ compensation insurance premium.

LOUISIANA WORKERS’ COMPENSATION Employers in violation of the laws regarding workers’ compensation insurance may be served an injunction against doing further business until a policy is obtained and proof is provided to the Office of Workers’ Compensation.

LOUISIANA WORKERS’ COMPENSATION Workers’ Compensation Fraud is the willful intent of an individual to withhold information or provide false information in an effort to obtain or defeat workers' compensation benefits.

LOUISIANA WORKERS’ COMPENSATION Workers' compensation fraud comes in many forms. It ranges from an injured worker receiving benefits and not reporting wages being received from another job, to a physician or health care provider billing for services not performed.

LOUISIANA WORKERS’ COMPENSATION The Second Injury Fund is a state agency which reimburses employers or, if insured, their insurance carriers for part of the workers’ compensation costs in certain instances when an employee with a pre-existing permanent partial disability is injured on the job.

LOUISIANA WORKERS’ COMPENSATION The Basic Pre-Requisites For Second Injury Fund Reimbursement are: 1. The employee must have a pre-existing permanent partial disability as listed and defined by R.S. 23:1378(F) that is an obstacle or hindrance in obtaining employment. 2. The employer must establish that they had actual knowledge of the employee’s preexisting permanent partial disability prior to the subsequent injury.

LOUISIANA WORKERS’ COMPENSATION 3. The employee must sustain a subsequent (occupational) injury that results in liability for workers’ compensation and: The subsequent injury would not have occurred but for the pre-existing permanent partial disability; or The disability is greater than would have resulted had the pre-existing permanent partial disability not been present and the employer has been required to pay compensation for the greater disability

LOUISIANA WORKERS’ COMPENSATION 4. The employer or, if insured his insurer, must file a Notice of Claim within fifty-two (52) weeks after the first payment of any benefits (indemnity or medical) by mailing the Notice to the Second Injury Fund

LOUISIANA WORKERS’ COMPENSATION If you would like to report someone for committing workers' compensation fraud, contact the Fraud Section at 1-800-201-3362, email wcfraud@lwc.la.gov or fill out the online form.