re: Louisiana Workers Comp Questions

If you have ever worked for a company that is no longer in business, you may not receive worker’s comp.

Don’t waste your one choice of a dr on a primary care doctor. Save it in case you need to see an ortho or other specialist, unless you go to one of those directly. Once you use your choice, como can force you to go to any dr of their choice for any further referrals.

You need to just talk to your boss. We have plenty of small companies that pay out of pocket initially and only file comp if the treatment end up looking like more than a couple weeks. He may gladly work something out to avoid filing a claim. Even if a small company, they or their comp may direct you to an occupational medicine dr to start and then you can go from there.

Good grief!!!!! No wonder why businesses stay away from La!!!!

quote:

---

Don’t waste your one choice of a dr on a primary care doctor. Save it in case you need to see an ortho or other specialist, unless you go to one of those directly. Once you use your choice, como can force you to go to any dr of their choice for any further referrals.

---

Wrong answer. The injured worker gets one choice of physician in each specialty which is relevant to the injury.

quote:

---

You need to just talk to your boss. We have plenty of small companies that pay out of pocket initially and only file comp if the treatment end up looking like more than a couple weeks. He may gladly work something out to avoid filing a claim. Even if a small company, they or their comp may direct you to an occupational medicine dr to start and then you can go from there

---

Would you allow an untrained claim adjuster to just jump into your company without training and knowledge of your profession and perform the services that your company provides. Doubtful. What makes you think you can handle a workers compensation claim properly?

You would be in violation of your obligations to promptly report the claim to your WC carrier. If the claim takes a downward turn and your WC insurer has been unduly prejudiced in handling the claim they might decline to cover you.

If penalties are assessed due to your inept assumption of claims handling you may be forced to pay those penalties along with attorney fees to the injured workers attorney.

You have no right to force your employee to seek treatment at an occupational medical clinic. If you deny the employee right to a physician that might result in penalties and attorney fees.

Do you not know that medical payments are governed by a fee schedule? That there is a process to having medical procedures approved?

Of course once your realize how expensive a WC claim can actually be you will make a belated report to the carrier and expect them to clean up the mess you created. That often results in the claim being more expensive and actually more detrimental to your experience mod.

quote:

---

Would you allow an untrained claim adjuster to just jump into your crew and perform the craft that your company provides. Doubtful. What makes you think you can handle a claim properly.

You, sir are in violation of your obligations to promptly report the claim to your WC carrier. If the claim takes a downward turn and your WC insurer has been unduly prejudiced in handling the claim they might decline to cover you. If penalties are assessed due to your inept assumption of claims handling you may be forced to pay it.

You have no right to force your employee to incur his own medical expenses and hope to be reimbursed eventually for " reasonable medical expenses." Who determines reasonableness?

Do you not know that medical payments are governed by a fee schedule? That there is a process to having medical procedures approved?

Of course once your realize how expensive a WC claim can actually be you will make a belated report to the carrier and expect them to clean up the mess you created.

Don't be a dick, report your claims properly. Would you allow an untrained claim adjuster to just jump into your crew and perform the craft that your company provides. Doubtful. What makes you think you can handle a claim properly.

---

quote:

---

tigersbb

---

Just reiterating this. Tigersbb obviously lawyers or insures. I would turn it into work comp and let it run its course. The injured employee could be sitting at home on pain pills and see a get gordon commercial and call them. Its all down here from there.

Also- to the EMOD claim. Yes it will be effect your emod- but when computing it only the first 8,000 is weighted heavily into the emod. Anything over the 8,000 is not weight as heavily. The calculation also takes into account the frequency vs severity of claims. Lots of $5,000 weigh more heavily than one $25,000 claim.

If you do have a claim, ask the agent upon renewal to make sure the claim was submitted correctly. For example a claim may be closed and done but adjuster may not close it out. An open claim affects renewals. Also ask agent to make sure paid out amounts are correct. If claim only paid out 8,000 and is closed, then you dont want the 10,000 reserve on there.


Good article from NCCI about EMOD

quote:

---

If you do have a claim, ask the agent upon renewal to make sure the claim was submitted correctly. For example a claim may be closed and done but adjuster may not close it out. An open claim affects renewals. Also ask agent to make sure paid out amounts are correct. If claim only paid out 8,000 and is closed, then you dont want the 10,000 reserve on there.

---

Good point. Also, failure to report timely might affect opportunities for pursuit of subrogation against negligent third parties or Second Injury Fund recovery both of which might have a positive impact in lessening the effects on the EMod and loss ratio.

quote:

---

Are you a lawyer, producer, or underwriter?

---

Claims , how about yourself?

My question is, if I went to my personal doctor, would WC reimburse me for the bill?

No. I am an EHS Manager with a fortune 500. Your company has to send over paperwork for it to be covered by WC. They issue a WC # and that is how it is covered.

Additionally, because this happened at work, your employer will want to see you to an in-network occupational doctor to hopefully prevent this injury from becoming a loss time or recordable.

quote:

---

That's how it is with my company. If you fail, you're not only denied WC

---

Not always as cut and dried as it should be but it does present the claimant a hurdle to overcome.

quote:

---

I at least know the fire part is right. We drive between accounts for work. If you get in a wreck on company time, you immediately get drug tested after the cops get a report and leave. Any drug or alcohol in your system and you're fired.

---

All companies have their drug policies related to the employment relationship.

With WC there are processes to follow , chain of custody requirements, verification and other factors.

What may also come into play is whether the drug usage affected causation. The questions raised might involve whether the accident would have happened anyway, did the drug usage impede the employee's ability to avoid being injured, was the employee proximately located in the range of danger due to the drug usage or was it unexpected.

For instance a drug impaired worker might be properly located at a construction site and another worker might do something to cause the accident. He might be a paasenger in a vehicle accident for which he had no control over causation. The intoxication defense can be asserted in those instances where the worker is under the influence and the burden shifts to the worker to prove its lack of effect on causation.