In 2009, the Louisiana Legislature passed RS 23:1203.1 which provided the process of adopting a medical treatment schedule with the purpose of assisting with the decision-making process regarding proposed medical treatment for the injured worker. The Medical Treatment Guidelines became effective July 13, 2011.
A copy of the MTG can be found on the Louisiana Workforce Commission’s website, www.laworks.net. The Medical Treatment Guidelines can be located on the homepage under the “Businesses” tab then “Workers’ Compensation.”
All medical providers and insurance carriers are expected to comply with the MTG.
Effective April 20, 2012, the healthcare provider (HCP), when seeking authorization to exceed the $750 statutory limit for medical services, completes the LWC-WC Form 1010–Request of Authorization/Carrier or Self-Insured Employer Response form.
The health-care provider (HCP), when seeking authorization to exceed the $750 statutory limit for medical services, completes the LWC-WC Form 1010. Section #1 and #2 of the LWC-WC Form 1010 must be completed by the requesting health-care provider. The 1010 Form and all supporting medical documentation are faxed to the C/SIF and/or the designated utilization review (UR) representative. The C/SIF must respond in five business days by returning the Form 1010 to the requesting HCP with their decision determination designated in Section 3.
The C/SIF or UR representative will initiate the LWC-WC Form 1010A when the medical documentation submitted with the Form 1010 does not sufficiently provide the necessary information to complete the review of the requested medical services. The HCP must respond to the request within ten business days from the date of receipt. Failure to submit the requested information shall result in a withdrawal of the request for authorization.
The forms are posted on the Louisiana Workforce Commission’s website, www.laworks.net. You can access the form from the numerical listing by clicking on “Downloads,” then on “Workers’ Compensation,” then “Forms–Numerical.”
For any dispute as to whether the recommended care, services or treatment is in accordance with the medical treatment schedule, or whether a variance from the medical treatment schedule is reasonably required, any aggrieved party shall file an LWC-WC Form 1009 Disputed Claim for Medical Treatment appeal with the Office of Workers’ Compensation Administration medical director.
The LWC-WC Form 1009 must be completed and submitted, via mail, to the OWCA medical director along with the LWC-WC Form 1010, Form 1010A (if applicable), and supporting medical documentation.
The LWC-WC form must be filed within 15 calendar days of the date denial by the C/SIF or the date the denial was received. The medical director shall render a decision as soon as is practicable, but in no event, not more than 30 calendar days from the date of filing.
A COPY OF THE COMPLETED 1009 MUST BE MAILED TO ALL INVOLVED PARTIES.
The form is posted on the Louisiana Workforce Commission’s website, www.laworks.net. You can access the form from the numerical listing by clicking on “Downloads,” then on “Workers’ Compensation,” then “Forms–Numerical.”
The statute states “any aggrieved party” shall file, within 15 calendar days, an appeal with the OWCA medical director. Aggrieved party is defined as “a person whose personal or property rights are adversely affected by a judgment or decree of a court.”
The LWC-WC Form 1009 must be received in the OWCA Medical Services Section no later than 15 calendar days from the date on the written denial letter issued by the C/SIF.
In addition to the completed LWC-WC Form 1009, the following information is necessary:
- Copy of the LWC-WC Form(s) 1010 and 1010A
- Copy of the peer review denial from the C/SIF
- Copy of the medical record(s) substantiating the medical necessity of the requested services
Requests submitted without the supporting documentation as stated above will be returned to the requesting party.
Any LWC-WC Form 1009 with incomplete information will also be returned to the requesting party.
Any party feeling aggrieved by the determination of the medical director shall seek a judicial review by filing Form LWC-WC-1008–Disputed Claim for Compensation with the appropriate hearing office within 15 days of the date said determination is mailed to the parties. The filed LWC-WC-1008 shall include the following:
- Copy of the Form LWC-WC-1009–Disputed Claim for Medical Treatment
- Copy of the decision of the medical director
A party filing such appeal must simultaneously notify the other party that an appeal of the medical director’s decision has been filed. The decision of the medical director may be overturned when it is shown by clear and convincing evidence that the decision of the medical director was not in accordance with the provisions of the Louisiana Workers’ Compensation Medical Treatment Guidelines.
Yes. Even if the recommended medical treatment is in compliance with the MTG, all medical services exceeding the statutory limit of $750 will require the prior approval from the C/SIF as stated in the Workers’ Compensation Statute (R.S. 23:1142).
In 2009, the Louisiana Legislature passed RS 23:1203.1 which provided the process of adopting a medical treatment schedule with the purpose of assisting with the decision-making process regarding proposed medical treatment for the injured worker. The medical treatment guidelines became effective July 13, 2011.