Basic Benefits & Players in Lousiana's Workers' Comp System
This is only a general explanation of Louisiana's workers' compensation system and how it affects employers and employees. Details on specific regulations, coverage, benefits and other technical aspects are not included.
What is workers' compensation? Workers' comp is a type of insurance which provides healthcare and disability benefits when you experience a job-related injury. Premiums for this coverage are paid totally by your employer. Because these benefits are outlined under state law, you should receive them timely without needing to hire an attorney, even if the accident was your fault. (As with any law, there are a few exceptions such as if the injury was due to your intoxication, horseplay or fist fighting.)
Who receives benefits?
Just about all employees who are injured as a result of their jobs may be eligible for workers' compensation benefits. The key question is whether the condition happens while you were at work and because of your employment. This broad definition covers many common workplace injuries. Some employers are not required to provide workers' comp insurance.
What benefits are payable?
Three basic types of benefits may be provided when employees are injured on the job:
Who is LWCC?
- All reasonable and necessary medical care. This includes reasonable and necessary doctor bills, medicine, hospital charges, lab tests, x-rays, crutches, mileage expense incurred for treatment--in short, everything medically necessary to treat the effects of the injury. There is no deductible or dollar limit for the employee for covered treatment*
- Disability Benefits. These are tax-free weekly payments that partially replace lost wages when an injured employee cannot return to work because of his injury. They are calculated at two-thirds of the employee's average weekly wage. Benefits are also paid if the injured employee is unable to earn 90% of his pre-injury wages because of the injury.
- Death Benefits. If the injury results in death, payments are made to surviving dependents, including a set funeral benefit. If there are no dependents, benefits are paid to biological parents.
- Rehabilitation services. If the injury is serious enough to prevent the employee from ever returning to his previous occupation, he may qualify for vocational rehabilitation to identify other work he could perform or to prepare him for re-entering the workforce in a different position.
LWCC is a private, non-profit workers' compensation insurance company. Through licensed insurance agents, we sell workers' compensation insurance policies to more than 23,000 Louisiana businesses. LWCC is not a state agency, and does not set the laws regarding workers' compensation. LWCC does pay workers' compensation benefits according to the law to the injured employees of those businesses who have purchased a workers' comp policy with us.
What is the Louisiana Office of Workers' Compensation (OWC)?
The Office of Workers' Compensation (OWC) is part of the Louisiana Workforce Commission (LWC) and is not affiliated with LWCC, which is a private insurance company. The OWC is responsible for regulating workers' compensation, self-insurance and overseeing compliance. In addition, OWC hearing officers settle disputed claims statewide. The Medical Services Section resolves conflicts over the necessity, advisability and cost of certain healthcare services and treatment. The agency also encourages employers to adopt safety and health policies and procedures.
What is the Louisiana Department of Insurance?
The Louisiana Department of Insurance is responsible for watching the financial stability of insurance companies operating in the state. These companies are required to meet strict statutory financial requirements and are audited regularly. The department also investigates consumer complaints concerning specific companies. If the problem concerns casualty insurance, the Consumer Affairs Division can be reached at 800-259-5300. If the problem is about life and health insurance, call 800-259-5301. The department does not sell or place insurance.
*There is one exception is when the injured employee chooses a brand-name drug in filling a prescription when a generic is both available and allowed by the prescribing physician. In these cases, the employee is required to pay the difference in cost between the generic and the brand-name drug.