In workplace injuries occurring on land in Louisiana, or even on platforms in both navigable and non-navigable Louisiana waters, workplace injuries are typically governed by the provisions of the Louisiana Workers’ Compensation Act. Approximately 100 years ago, numerous states throughout this country realized that some type of automatic and effective system needed to be implemented in order to deal with workplace injuries. After much national discussion and debate, a great compromise was reached. The compromise called for employers to be responsible for all workplace injuries suffered by their employees and, in order to ensure this responsibility, such employers would be required to purchase insurance to pay weekly compensation benefits and medical expenses of the employees. In return, the employers would not be liable for any suits or other claims of the employees. The employees would be limited to the statutory remedies provided under workers’ compensation. In Louisiana, the law provides that when an employee is injured and medically unable to work for any period of time, he will receive a weekly compensation benefit equal to two-thirds of his average weekly wage, up to a maximum amount. The current maximum weekly compensation benefit in Louisiana as of April 2013 is $605.
The employer must pay these benefits as long as the employee is disabled. This period of temporary disability is known as “temporary total disability.” In many cases involving serious injury, an employee will reach a point of maximum recovery and will be able to return and engage in some type of work.
However, the injury might result in a partial disability, which will prevent an employee in engaging in certain types of work and occupations. In these types of cases, the workers’ compensation insurer and the employee (usually represented by a workers’ compensation attorney) will try to determine what type of occupations an employee can safely engage in. If a shortfall exists between what an employee earned before his accident and what an employee’s earning capacity is after he recovers, then an employee may have a claim for further compensation benefits. These benefits are known as “supplementary earnings benefits” and are typically two-thirds of the difference between what the employee earned before the accident and what he is capable of earning after the accident. Supplemental earnings benefits are limited in duration and will only be paid for a maximum of 520 weeks, or 10 years.
If an employee is so seriously injured that he cannot engage in gainful employment of any type, he will be considered totally and permanently disabled. In such a case, an employee would be entitled to workers’ compensation benefits for the remainder of his life.
In addition to all the different types of compensation benefits due under the Louisiana Workers’ Compensation Act, employers are also obligated to secure coverage to pay for the medical expenses of an employee injured on the job. An employee has a legal right to choose his own treating physician. Likewise, an employer has a statutory right to have the employee examined by a physician of its choosing. If at any point the two physicians cannot agree on a medical course of action, either party may ask for the appointment of a third independent doctor. The opinion of the third doctor will typically be conclusive as to what medical treatment is ordered in the matter. An employer’s responsibility for medical payments under the Louisiana Workers’ Compensation Act is unlimited and will extend over the lifetime of the injured employee.
1. Claim Procedure for Workers’ Compensation Act - The employee typically begins dealing with a workers’ compensation adjuster for the insurance carrier of the employer. The adjuster is the individual who makes the decisions about the rate of compensation and what medical treatment will be authorized. If an employee does not agree with a decision or feels that the employer is not acting reasonably, a claim can be filed with the
Louisiana Office of Worker’s Compensation (“OWC”). A claims examiner will be assigned to the case by the OWC and will first attempt to help the two parties agree through a mediation process. If the disagreement persists, a formal claim should be filed by the employee or his legal representative, and the matter will be resolved by a trial.
All disputes under the Louisiana Workers’ Compensation Act are required to be tried by an administrative law judge who is appointed by the Louisiana Office of Workers’ Compensation. These judges conduct trials which are not subject to all of the evidentiary and procedural requirements of cases tried in courts. However, the trials greatly resemble normal trials. Either party disagreeing with the ruling of the administrative law judge then has the option of appealing to the appellate court in which the workers’ compensation office is located. Appeals from workers’ compensation decisions in Southwest Louisiana are made to the Louisiana Third Circuit Court of Appeal in Lake Charles.
2. General Observations – As a general matter, workers’ compensation is a very limited and usually insufficient remedy for a serious workplace injury. At most, an employee will receive two-thirds of his average weekly wage for a fairly limited time. An employee is not compensated for pain and suffering, loss of enjoyment of life, or disfigurement.
However, the positive thing about workers’ compensation is realized when an employee is solely at fault for his own accident. In such a case, workers’ compensation must be paid automatically. In this case, an employee receives at least some compensation to help pay for daily living expenses, and all of his medical expenses should be paid.
If you have questions about workers’ compensation, then call us today or contact us using the form on our contact page.