Ivey (HB 450) Act No. 317
Existing law provides procedure for submitting claims for workers' compensation
reimbursement.
Prior law (R.S. 23:1203.1(J)) provided that if a dispute arises regarding medical care, the
aggrieved party shall file an appeal with the office of workers' compensation administration
(OWCA) medical director.
New law authorizes the director to hire an associate medical director and provides for his
qualifications.
New law defines associate medical director and medical director.
New law provides that if a conflict of interest exists among any party to the suit, the director
or the associate medical director, that the conflict shall be communicated, in writing, to the
director, who shall make a determination within two business days on whether a conflict
exists.
New law requires that in the event of a conflict of interest, the director shall notify the
patient, the physician, and if represented, the attorney, within two business days.
Prior law (R.S. 23:1203.1(M)) provided that all medical treatment not covered by the
medical treatment schedule shall be in accordance with prior law (R.S. 23:1203.1(D)).
Prior law (R.S. 23:1203.1(D)) provided that medical treatment guidelines shall be based on
the following criteria:
(1)Rely on specified, comprehensive, and ongoing systematic medical literature review.
(2)Contain published criteria for rating studies and for determining the overall strength
of the medical evidence, including the size of the sample, whether the authors and
researchers had any financial interest in the product or service being studied, the
design of the study and identification of any bias, and the statistical significance of
the study.
(3)Are current and the most recent version produced, which shall mean that documented
evidence can be produced or verified that the guideline was developed, reviewed, or
revised within the previous five years.
(4)Are interdisciplinary and address the frequency, duration, intensity, and
appropriateness of treatment procedures and modalities for all disciplines commonly
performing treatment of employment-related injuries and diseases.
(5)Are, by statute or rule, adopted by any other state regarding medical treatment for
workers' compensation injuries, diseases, or conditions.
New law retains prior law and further provides that in instances in which a treatment is not
covered by the medical treatment schedule, the employer is liable to pay when it has been
demonstrated by a preponderance of the scientific evidence to the medical director, in
accordance with prior law (R.S. 23:1203.1(C)), that the treatment is appropriate.
Effective August 1, 2013.
(Amends R.S. 23:1203.1(A), (J), (K), and (M); Adds R.S. 23:1203.1.1)