This course provides an analysis of the Louisiana Workers' Compensation Act, plus coverage of the administrative rules, court decisions, and practical pointers.
It covers the structure of and how to navigate the administrative system for both undisputed and disputed claims. You will learn the various benefit forms and when they are due, including detailed analysis of Louisiana's counterpart to non-scheduled partial disability benefits, the Supplemental Earnings Benefits claim. Also included is the administration of medical and rehabilitation benefits under the Louisiana Act, such as the medical fee schedule, Utilization Review, and the ranking of rehabilitation options.
The course is designed for the insurance and claims professional and includes periodic updates on legislation, regulatory changes, and court decisions. Learning Objectives
By taking this course, you will learn the ins and outs of how insurance companies operate in Louisiana. The course is delivered via self-paced, online modules and an end-of-course exam, as described below.
- Louisiana Workers’ Compensation Insurance System Overview
This module covers the technical aspects of insurance in Louisiana including how insurance underwriters determine the premium employers pay and what factors drive up the cost of a workers’ compensation insurance policy.
- How Louisiana Workers' Compensation Works
This module provides historical background and examines where the Louisiana Workers' Compensation Act fits in the panoply of remedies that employees have against employers for occupational injuries and illnesses. The basic statutory and regulatory scheme for the Louisiana Workers' Compensation Act is covered as well as who are "employers" and "employees" under the Louisiana Act.
You will gain an overview of the administrative and court systems for claims under the Louisiana Act, as well as learn jurisdictional criteria for federal compensation remedies common in Louisiana and how to evaluate which remedy applies.
- Claim Fundamentals in Louisiana Workers' Compensation Law
This module includes key definitions and concepts such as "occupational injury," "occupational illness," and Louisiana's special rules for occupational illnesses. You will learn the literal "ins" and "outs" of coverage under Louisiana's Act. You will also learn Louisiana's rules on independent contractors, liabilities to borrowed employees and statutory employees, as well as the steps through the administrative process for voluntary payment of benefits.
This module also examines posting and notice requirements under Louisiana law as to both employers and employees and the effects defaults in postings or notices can have on claims. It concludes with Louisiana's time bar or "prescription" rules for benefit claims, and a brief introduction to the three forms of benefits provided by the Louisiana Act.
- Disability and Death Benefits Under Louisiana Workers' Compensation Law
This module covers the various disability or "indemnity" benefits payable as a result of a covered injury or illness, and the legal rules for determining which benefit applies in a specific instance as well as coordination of benefits that overlap in applicability. You will also learn calculations of average wages and compensation rates and offsets and credits for disability benefits.
Also covered are the statutory rules and the extra-statutory judicial "gloss" placed on those rules by Louisiana courts for the determination of Louisiana's most common disability benefit and Louisiana's counterpart to a non-scheduled partial disability benefit: the Supplemental Earnings Benefit or SEB.
- Medical and Rehabilitation Benefits Under Louisiana Workers' Compensation Law
In this module, you will learn the forms of medical benefits under the Louisiana Act and when they are due, as well as important cost-saving rules for the management of benefits.
Louisiana's Utilization Review ("UR") regulations are examined as well as the role of the Medical Case Manager. You will learn Louisiana's rules requiring pre-certification and the exception for "emergency care." Also covered are the law on the employee's choice of physician, employer's second medical opinions, State Independent Medical Examinations, and access to medical information by all participants in the system. Medical expense offsets and credits are examined.
This module includes review of the rehabilitation benefit that is a significant feature of Louisiana law, including the rules applicable to Vocational Rehabilitation Counselors, the roles of the various participants in the system concerning rehabilitation, and the legal effects of an employer's refusal to provide this benefit and an employee's refusal to cooperate when this benefit is provided.
- Penalties, Fees, Forfeitures and Defenses
Louisiana does not automatically award attorney fees to a prevailing claimant, but only assesses fees or penalties for statutorily-defined misconduct. You will learn the legislative intent behind these statutes and the occasionally conflicting intent of the courts in applying penalty and fee statutes. The various instances in which penalties and fees can be assessed against an employer or an insurer are examined with emphasis on the applicable level of misconduct that must be found to award penalties or fees.
Also covered are the rights of healthcare providers to seek penalties and fees on top of payment of medical benefits in specific instances, and acceleration of payments and execution in a court of general jurisdiction. Louisiana's strong anti-fraud statute is examined as to its applicability and effects on both employees and insurers or employers. You will learn about Louisiana's forfeiture rules for employee misrepresentations of medical history.
This module also covers the employer's usual "defense on the merits" as well as specific statutory and some non-statutory affirmative defenses to benefits claims.
- Important Issues for the Louisiana Claims Professional - Settlements, Third Party Claims and the Like
This module covers important issues that overlap the core subject of the administration of claims, including the rules for second injury fund relief, claims for contribution and indemnity, and the rights of the participants in a workers' compensation claim when a third party may be liable in tort for the occupational injury or illness. You will learn how to settle compensation claims, both in connection with a third party tort action and when no tort claim exists.
You will also learn Louisiana's rules on the modification of benefit awards. Workers' compensation mediations are covered, as are Medicare set asides and Louisiana's law on retaliation against an employee who files a benefits claim. '
- Trends and Updates in Louisiana Workers' Compensation
Workers' Compensation is one of the Louisiana legislature's most frequently visited topics and is an often-revised area of law. Hardly a regular legislative session goes by without at least some notable alteration or tweaking of the compensation statutes. This module tracks changes in the statutes and also changes in the administrative regulations. This module further monitors noteworthy court decision