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Getting injured on the job is one level of pain. Getting the compensation that is deserved from an employer for that injury can also be a challenge for someone’s financial pain threshold. 

According to the 2020 Annual Report from the Louisiana Workforce Commission, in 2020, the Hearings Section of the Office of Workers’ Compensation Administration received 3,119 disputed claims for compensation, which is a decrease from the year before. Add onto that, as of April 17, 2022, the Department of Labor reports that 708 workers’ compensation claim applications were filed in Louisiana, with only 255 claims paid.

Why the decrease in claims, and why are workers’ compensation claims frequently denied in Louisiana? We will dig further under the surface to discover the common reasons why people with legitimate claims receive denial letters – and how these injured employees should instead be protected and paid for their accident-related medical bills and expenses.

What Does Louisiana Workers’ Compensation Cover?

There is Louisiana workers’ compensation legislation and guidelines in place that dictate reasonable and necessary medical treatment for employees injured on the job, as well as a medical fee schedule that outlines the costs. In general, with the exception of emergency care, the insurance company is required to approve in advance any medical treatment totaling over $750.

Work-related medical bills can include:

• Doctors’ visits for medical treatments
• Hospital stays and care
• X-rays and MRIs
• Surgeries and special surgical treatments
• Medical supplies
• Prescription drugs
• Bloodwork, medical, and lab tests
• Physical therapy or medical rehabilitation
• Prosthetic devices
• Travel costs to get medical supplies and services
• Any legally bound, non-medical treatment related to the work injury

Typical Reasons Workers’ Compensation Insurance Companies Deny Claims in Louisiana

There are many reasons that are usually tied to an employer’s workers’ compensation insurance denying employee claims, with the main overarching theme relating to the insurance companies delaying and complicating cases and claims as much as possible. 

Here is a handful of those:

1. The employee or employer did not report the injury within the proper time limit. First of all, if the employee fails to file an injury report within 30 days after the injury, denial of benefits is more commonplace because it may seem like the injury must not have been severe enough. The same can be said if the employee does not seek medical attention immediately after the accident. Second, if the employer does not let the insurer know or file a First Report of Injury or Illness within 10 days, this could also increase the chances of claim denial or delayed payment. 
2. The employee had a pre-existing injury or condition. Sometimes the workers’ compensation insurance company can claim that the employee’s reported injury is actually pre-existing, like ongoing back problems, and not caused by the workplace injury, resulting in complete denial of the claim. In Louisiana, medical care and workers’ compensation must be provided for on-the-job injuries that are proven not to be connected to any pre-existing condition. 
3. The employee tested positive for illegal drugs shortly after the work-related accident. Right after an employee comes into a hospital or doctor’s office with a work-related injury, a drug screen is performed by medical staff. If the test is positive, workers’ compensation will most likely be denied. There are ways, however, that an experienced workers’ compensation attorney can fight the presumption of this failed drug test.
4. The employee’s injury did not happen on the job. Employers and their insurance companies will often contend that the employee’s injury did not technically happen while working their shift or within the workplace environment. But evidence, such as video footage, time logs, eyewitnesses, a doctor’s testimony, medical records, or more, can prove otherwise. 
5. The employee can safely return to work. Insurance companies will frequently dispute that the injured employee can safely return to work and medical care is no longer needed. It is a situation that is more common when the employee uses the insurance company’s doctor instead of their own physician. False claims made by the insurance company may include that the employee’s medical condition does not fall under Louisiana’s Medical Treatment Guidelines, that the employee refused to sign personally invasive medical authorization, or that medical treatment overall is not necessary. 

All of these reasons for why workers’ compensation is denied will need to be fought through the Utilization Review process, which is best guided by an attorney who is an expert in this facet of law practice.

What is the Utilization Review Process of Louisiana?

In essence, the complicated Utilization Review process was designed by workers’ compensation insurance companies to discourage injured employees from receiving full, more expensive medical treatments (or completely denying certain claims) with the goals that:

• Injured employees will give up on the claim and treatment they need and deserve.
• If the claim is denied, the attorney on the case, the medical providers, and the injured employee will not challenge it. 
• If the claim is approved, it is for less expensive, less extensive medical treatment that the employee deserves. 

How Can an Injured Employee Dispute the Denial of Workers’ Compensation?

If an injured employee’s workers’ compensation benefits are denied or delayed, the employee may file Form WC 1008, Disputed Claim for Compensation, with the state’s Office of Workers’ Compensation.

This opens the door to payment of penalties (no more than $8,000, per Louisiana law) and attorney’s fees made to the employee in addition to the regular workers’ compensation benefits. 

When to Hire a Workers’ Compensation Attorney in Louisiana

In short, many injured employees wait too long to hire a workers’ compensation attorney to fight for their case and much-deserved benefits. By that time, the employee’s rights have been depleted, and the value of their claim, sadly reduced. 

Do not wait to get the support and protection you deserve right away by contacting the law firm of Stephenson, Chavarri & Dawson, LLC, a team that is renowned throughout Louisiana for going the extra mile to fight for the benefits their clients deserve for their injuries on the job.