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Regular Session, 2012 ENROLLED
SENATE BILL NO. 367
BY SENATOR RISER
AN ACT1
To amend and reenact R.S. 23:1123, 1142(A) and (B)(1), 1203(E), 1307, and 1317.1(A),2
relative to workers' compensation; to provide relative to independent medical3
examinations; to provide that certain information be given to certain injured workers;4
to provide relative to utilization review companies; and to provide for related5
matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 23:1123, 1142(A) and (B)(1), 1203(E), 1307, and 1317.1(A) are8
hereby amended and reenacted to read as follows: 9
§1123. Disputes as to condition or capacity to work, or current medical treatment10
of employee; examination under supervision of the director11
If any dispute arises as to the condition of the employee , or the employee's12
capacity to work, or the current medical treatment for the employee, the director,13
upon application of any party, shall order an examination of the employee to be14
made by a medical practitioner selected and appointed by the director. The medical15
examiner shall report his conclusions from the examination to the director and to the16
parties and such report shall be prima facie evidence of the facts therein stated in any17
subsequent proceedings under this Chapter.18
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§1142. Approval of health care providers; fees20
A. Definitions. For the purposes of this Section, the following terms shall21
have the following meanings unless the context clearly indicates otherwise:22
(1) "Payor" shall mean the entity responsible, whether by law or contract, for23
the payment of the medical expenses incurred by a claimant as a result of a work24
related injury.25
ACT No. 235 SB NO. 367 ENROLLED
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(2) "Utilization review company" shall mean the company or entity1
which contracts with the payor, and which entity reviews the claimant's medical2
records and information and makes the determination of medical necessity in3
accordance with this Chapter, for the purposes of assisting the payor with the4
authorization of the claimant's medical care, services and treatment requested5
pursuant to this Chapter.6
B. Nonemergency care. (1) (a) Except as provided herein, each health care7
provider may not incur more than a total of seven hundred fifty dollars in8
nonemergency diagnostic testing or treatment without the mutual consent of the9
payor and the employee as provided by regulation. Except as provided herein, that10
portion of the fees for nonemergency services of each health care provider in excess11
of seven hundred fifty dollars shall not be an enforceable obligation against the12
employee or the employer or the employer's workers' compensation insurer unless13
the employee and the payor have agreed upon the diagnostic testing or treatment by14
the health care provider.15
(b)(i) The payor may contract with a utilization review company to assist16
the payor in determining if the request for nonemergency diagnostic testing or17
treatment, in an amount which exceeds seven hundred fifty dollars, is a medical18
necessity as provided pursuant to this Chapter.19
(ii) A medical necessity determination by a utilization review company20
and the payor's consent to authorize the requested nonemergency diagnostic21
testing and treatment shall require only a review of the claimant's medical22
records and shall not require an examination of the employee.23
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§1203. Duty to furnish medical and vocational rehabilitation expenses; prosthetic25
devices; other expenses26
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E. Upon the first payment request for authorization pursuant to R.S.28
23:1142(B)(1), for a claimant's medical care, service, or treatment, the payor, as29
defined in R.S. 23:1142(A)(1), shall communicate to the claimant information, in30 SB NO. 367 ENROLLED
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plain language, regarding the procedure for requesting an independent medical1
examination in the event a dispute arises as to the condition of the employee or the2
employee's capacity to work, and the procedure for appealing the denial of3
medical treatment to the medical director as provided in R.S. 23:1203.1. A4
payor shall not deny medical care, service, or treatment to a claimant unless the5
payor can document a reasonable and diligent effort in communicating such6
information. A payor who denies medical care, service, or treatment without making7
such an effort may be fined an amount not to exceed five hundred dollars or the cost8
of the medical care, service, or treatment, whichever is more.9
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§1307. Information to injured employee11
Upon receipt of notice of injury from the employer or other indication of an12
injury reportable under R.S. 23:1306, the office shall mail immediately to the injured13
employee and employer a brochure which sets forth in clear understandable language14
a summary statement of the rights, benefits, and obligations of employers and15
employees under this Chapter, together with an explanation of the operations of the16
office, and shall invite the employer and employee to seek the advice of the office17
with reference to any question or dispute which the employee has concerning the18
injury. Such brochure shall specifically state the procedure for requesting an19
independent medical examination in the event a dispute arises as to the condition of20
the employee or the employee's capacity to work and the procedure for21
appealing the denial of medical treatment to the medical director as provided22
in R.S. 23:1203.1. If such brochure has previously been mailed to an employer23
within the calendar year, the office shall not mail such employer an additional24
brochure unless the employer specifically requests such.25
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§1317.1. Independent medical examinations27
A. Any party wishing to request an independent medical examination of the28
claimant pursuant to R.S. 23:1123, and 1124.1, and 1291(B)(10) and (11) shall be29
required to make its request at or prior to the pretrial conference. Requests for30 SB NO. 367 ENROLLED
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independent medical examinations made after that time shall be denied except for1
good cause or if it is found to be in the best interest of justice to order such2
examination.3
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PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: