How Are Workers' Compensation Medical Benefits Paid?

billing statement with stethoscopeWorkers’ compensation insurance provides compensation for medically-necessary treatment of workplace injuries. However, Louisiana has specific rules on submitting claims for payment, when payments will be made and selecting medical providers.

If you have any questions about the medical benefits to which you may be entitled for your workplace injury, contact one of our Baton Rouge workers’ compensation lawyers. We can represent you throughout the process and pursue the benefits you deserve.

Can I Choose My Own Doctor?

Your employer may provide you with a list of approved physicians you can visit for treatment. The physicians on this list may be doctors who have provided medical services to other employees at your company.

However, under Louisiana Revised Statutes 23:1121(B)(1), you have the right to select one treating physician in any field or specialty. If your employer denies your choice of physician, you have the right to an expedited summary proceeding to appeal.

Unless your employer can show good cause for refusing your chosen doctor, the judge will order your employer to authorize this medical professional. However, in the future, if you want to change physicians for another one in the same specialty, the change must be approved by your employer.

Even though you can choose any doctor you want, you need to be sure to select someone who you trust, are comfortable with and one who has familiarity with workers' compensation claims. Your doctor will make many important decisions that may impact your workers’ compensation claim, including:

  • Whether the injury or condition is considered a disability
  • What treatments are necessary for the injury type
  • Whether surgery will be necessary
  • Whether the injury or condition stemmed from a work-related accident

When Benefits Are Paid

The employer or its workers’ compensation insurance carrier is required to pay all approved and necessary expenses for the treatment of your on-the-job injuries. Your employer or its insurer must also reimburse you for reasonable travel expenses for going to treatment.

Medical benefits must be paid within 30 days of the date the employer or workers’ compensation insurance carrier received written notice of the claim. If your employer is not using electronic billing rules and regulations, the bill must be paid within 60 days from the date the employer or insurance carrier receives the claim.

You should prepare an itemized list of expenses and receipts for out-of-pocket expenses to help ensure you are reimbursed for all costs of your treatment.

When Benefits Require Approval to be Paid

The employer or its workers’ compensation insurance carrier must preapprove any non-emergency medical services or non-emergency hospitalization that costs more than $750.

The medical provider must fill out and submit Form LWC-WC 1010 (Request of Authorization/Carrier or Self-Insured Employer Response) and supporting medical documentation to the employer or its workers' compensation insurance carrier to authorize these services.

At some point in the five days after receiving the form and medical documentation, the employer or its insurance carrier should either approve, deny or approve the request with modification of the requested treatment. If the employer or insurance carrier does not respond, this will be treated as a denial of the request.

The employer or its insurance carrier can initiate the approval process even if it has insufficient information to complete the review for the requested medical treatment. However, the health care provider might be required to provide additional information within 10 business days of a request for this information.

Contact a Lawyer for Help

If you are not receiving the workers' compensation medical benefits to which you are entitled, you should consider hiring an experienced lawyer. He or she can review the specifics of your case and explain the benefits to which you may be entitled.

Our personal injury attorneys do not charge any upfront fees to review your case. You only pay us for our services if we successfully help you recover monetary compensation on your claim.

Complete a Free Case Evaluation form or call (800) 374-8422.

If you are looking for a law firm that has knowledge and experience, you will find it with Simien & Simien, LLC.

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