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Regular Session, 2012
SENATE BILL NO. 367
BY SENATOR RISER
WORKERS' COMPENSATI ON. Provides for medical examinations in workers'
compensation cases. (8/1/12)
AN ACT1
To amend and reenact R.S. 23:1123, 1142(A)(1), 1203(E), 1307, and 1317.1(A), relative to2
workers' compensation; to provide relative to independent medical examinations; to3
provide that certain information be given to certain injured workers; to provide4
relative to utilization review companies; and to provide for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 23:1123, 1142(A)(1), 1203(E), 1307, and 1317.1(A) are hereby7
amended and reenacted to read as follows: 8
§1123. Disputes as to condition or capacity to work, or current medical treatment9
of employee; examination under supervision of the director10
If any dispute arises as to the condition of the employee , or the employee's11
capacity to work, or the current medical treatment for the employee, the director,12
upon application of any party, shall order an examination of the employee to be13
made by a medical practitioner selected and appointed by the director. The medical14
examiner shall report his conclusions from the examination to the director and to the15
parties and such report shall be prima facie evidence of the facts therein stated in any16
subsequent proceedings under this Chapter.17 SB NO. 367
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* * *1
§1142. Approval of health care providers; fees2
A. Definitions. For the purposes of this Section, the following terms shall3
have the following meanings unless the context clearly indicates otherwise:4
(1) "Payor" shall mean the entity responsible, whether by law or contract, for5
the payment of the medical expenses incurred by a claimant as a result of a work6
related injury or the utilization review company retained by that entity.7
* * *8
§1203. Duty to furnish medical and vocational rehabilitation expenses; prosthetic9
devices; other expenses10
* * *11
E. Upon the first payment for a claimant's medical care, service, or12
treatment, the payor, as defined in R.S. 23:1142(A)(1), shall communicate to the13
claimant information, in plain language, regarding the procedure for requesting an14
independent medical examination in the event a dispute arises as to the condition of15
the employee or the employee's capacity to work, and the procedure for16
appealing the denial of medical treatment to the medical director as provided17
in R.S. 23:1203.1. A payor shall not deny medical care, service, or treatment to a18
claimant unless the payor can document a reasonable and diligent effort in19
communicating such information. A payor who denies medical care, service, or20
treatment without making such an effort may be fined an amount not to exceed five21
hundred dollars or the cost of the medical care, service, or treatment, whichever is22
more.23
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§1307. Information to injured employee25
Upon receipt of notice of injury from the employer or other indication of an26
injury reportable under R.S. 23:1306, the office shall mail immediately to the injured27
employee and employer a brochure which sets forth in clear understandable language28
a summary statement of the rights, benefits, and obligations of employers and29 SB NO. 367
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employees under this Chapter, together with an explanation of the operations of the1
office, and shall invite the employer and employee to seek the advice of the office2
with reference to any question or dispute which the employee has concerning the3
injury. Such brochure shall specifically state the procedure for requesting an4
independent medical examination in the event a dispute arises as to the condition of5
the employee or the employee's capacity to work. If such brochure has previously6
been mailed to an employer within the calendar year, the office shall not mail such7
employer an additional brochure unless the employer specifically requests such.8
* * *9
§1317.1. Independent medical examinations10
A. Any party wishing to request an independent medical examination of the11
claimant pursuant to R.S. 23:1123, and 1124.1, and 1291(B)(10) and (11) shall be12
required to make its request at or prior to the pretrial conference. Requests for13
independent medical examinations made after that time shall be denied except for14
good cause or if it is found to be in the best interest of justice to order such15
examination.16
* * *17
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Carla S. Roberts.
DIGEST
Present law provides that, relative to workers' compensation, if any dispute arises as to the
condition of the employee, capacity to work, or the current medical treatment, the director
of the office of workers' compensation, upon application of any party, shall order an
examination of the employee by a medical practitioner appointed by the director. Requires
the medical examiner to report his conclusions from the examination to the director and to
the parties and provides such report shall be prima facie evidence of the facts in any
subsequent proceedings regarding the claimant's workers' compensation case.
Proposed law retains present law but provides technical changes to language regarding the
employee's capacity to work.
Present law defines "payor" for purposes of workers' compensation as the entity responsible,
whether by law or contract, for the payment of the medical expenses incurred by a claimant
as a result of a work related injury.
Proposed law retains present law and adds utilization review companies as a "payor."
Present law requires, in workers' compensation cases, the employer to furnish all necessary SB NO. 367
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drugs, supplies, hospital care and services, medical and surgical treatment, and any
nonmedical treatment recognized by the laws of this state as legal.
Present law requires that, upon the first payment for a claimant's medical care, service, or
treatment, the payor, to communicate to the claimant information regarding the procedure
for requesting an independent medical examination in the event a dispute arises as to the
condition of the employee. Prohibits a payor from denying medical care, service, or
treatment unless the payor can document a reasonable and diligent effort in communicating
such information. Provides that a payor who denies medical care, service, or treatment
without making such an effort may be fined up to $500 or the cost of the medical care,
service, or treatment, whichever is more.
Proposed law retains present law but provides that present law also applies to disputes about
the employee's capacity to work and the procedure for appealing the denial of medical
treatment to the medical director at the office of workers' compensation.
Present law requires that, upon receipt of notice of injury from the employer or other
indication of an injury, the office of workers' compensation administration shall mail
immediately to the injured employee and employer a brochure which sets forth in clear
understandable language a summary statement of the rights, benefits, and obligations of
employers and employees. Requires the brochure to specifically state the procedure for
requesting an independent medical examination in the event a dispute arises as to the
condition of the employee.
Proposed law retains present law but provides that present law also applies to disputes about
the employee's capacity to work.
Present law provides that the director of the office of workers' compensation shall have
certain powers, including the use of a utilization review process and to engage qualified
experts in the appropriate health-care fields to assist him in the discharge of his
responsibilities in utilization review.
Present law requires any party wishing to request an independent medical examination of
the claimant, including the examinations at the direction of the director of the office of
workers' compensation, to make its request at or prior to the pretrial conference.
Proposed law retains present law but removes the requirement that the request for an
independent medical examination made at the behest of the director shall be made prior to
the pretrial conference.
Effective August 1, 2012.
(Amends R.S. 23:1123, 1142(A)(1), 1203(E), 1307, and 1317.1(A))