Louisiana Workers' Compensation Resources and Forms

• Always report your injury to your supervisor as soon as you are physically able to do so.
• Your employer then sends a form reporting the accident to the Louisiana Office of Workers’ Comp.
• It’s your employer’s responsibility to send all needed paperwork to the state office. This is what starts your claim.

• Your employer and their workers’ compensation insurance should pay for all of your medical care related to your injury.
• You have the right to select your own doctor.
• Your employer can send you to another doctor for a second opinion.
• If the doctors disagree, the Louisiana Office of Workers’ Comp serves as a tie breaker.
• If you disagree with the result, you can still file a claim with an administrative law judge.
• You should be assigned an insurance adjuster for your case.
• You should receive checks to replace some of your lost wages in a timely fashion.

The Louisiana Workers’ Comp Act can be complicated. Working with the Louisiana Office of Workers’ Comp can be confusing:

• If your employer denies your claim, you should get help from a lawyer.
• If your supervisor doesn’t report your accident, you should get help from a lawyer.
• If your employer refuses to pay for you to see a doctor you pick, you should get help from a lawyer.
• If your doctor takes you out of work but you aren’t getting workers’ comp benefits, you should get help from a lawyer.
• If your checks from the insurance company are late or not the right amount, you should get a lawyer.
• If the insurance adjuster won’t authorize medical treatment, you should get a lawyer.
• If you don’t have a lawyer, you’re leaving all the decisions up to the insurance claims adjuster.

This is one of the first forms you’ll see once you start receiving checks for lost wages. It shows how your weekly amount was calculated.

You’ll also receive another one of these notices when the amount of your check changes or your benefits are being stopped.

If we disagree about the amount or a termination of benefits, we’ll send back a Notice of Disagreement. Your claims adjuster will have five days to correct any mistakes or request a hearing with a workers’ compensation judge.

If the adjuster doesn’t follow through and the check amount or termination was wrong, the insurance company may have to pay penalties and attorney fees.

Download form →

Within 30 days of your case being closed, the workers’ comp insurer must send a copy of this form to you and to the Louisiana Office of Workers’ Compensation.

The Louisiana Workforce Commission uses this form to keep track of costs related to workers’ compensation.

Download form →

Employers use this form to request information about whether you are receiving Social Security Disability benefits in addition to workers’ compensation benefits.

If your workplace injury creates a permanent disability so you receive Social Security Disability benefits, your workers’ compensation checks can be decreased.

Download form →

These forms are used to document a reduction in your workers’ compensation benefits because you are receiving Social Security benefits.

Download form 1005A →

Download form 1005B →

The Louisiana Office of Workers’ Compensation sends this form to notify a person that they are required to visit one of its district offices and give testimony on a workers’ comp case.

Similar to a lawsuit in a state court, a workers’ compensation case includes testimony taken and evidence produced.

But in workers’ comp, the goal is always to prove whether or not someone was injured badly enough on the job that they can no longer work.

Just like in civil or criminal court, if you’re subpoenaed to appear and you don’t, you can be held in contempt of court.

Download form →

This is the first report your employer has to send in to its workers’ compensation insurer after your incident.

The insurer then reports the information to the Louisiana Office of Workers’ Comp.

This form should have all of the basic information about your accident and injury. It’s always a good idea to ask for a copy.

Download form →

When a dispute comes up with your workers’ compensation claim, this form puts your claim in front of your district office of the Louisiana Office of Workers’ Compensation.

An administrative hearing officer, who essentially has all of the power and authority of a state court judge, will decide on the dispute.

Here are some common reasons we file a Form 1008:

• You’re not receiving lost wages payments.
• Your medical treatment isn’t getting covered.
• Your checks are for the wrong amount.
• Your checks were improperly reduced or stopped.
• You’re denied medical treatment you need.
• You’re denied the opportunity to see the doctor you chose.
• You have a disability and are unable to work.
• You’re getting denied vocational rehabilitation services.

Download form →

When you disagree with your employer about medical treatment, this is the form we use.

This form is the next step after your doctor sends a Form 1010, requesting authorization for medical treatment, to the claims adjuster.

The Form 1009 goes to the medical director at the Louisiana Office of Workers’ Compensation, who gives an opinion about the treatment being disputed.

After the medical director makes a decision, if we or the workers’ comp insurer disagrees with the decision, either of us can file a Form 1008 to register the disagreement.

We can only file a Form 1009 if the insurer has denied a request for medical treatment, has modified the request somehow or has not acted on a request.

We also can file a Form 1009 if the treatment you’re requesting isn’t addressed in the Louisiana Workers’ Compensation Medical Guidelines.

Download form 1005A →

Your health care provider must file a Form 1010 anytime he or she wants to provide treatment that will cost more than $750.

For instance, if your doctor wants to send you to physical therapy, the doctor needs to fill out the form, explain why the physical therapy is needed and send his or her medical notes to the workers’ compensation claims adjuster.

If your doctor doesn’t fill out Form 1010 the right way or doesn’t provide the supporting records, the request for treatment will be delayed or denied. Our staff works closely with the doctors who treat our clients to make sure this process moves ahead on schedule – if not, you can be denied medical treatment.

Download form →

If you are going to receive a final settlement of an entire claim for benefits, the Louisiana Office of Workers’ Compensation has to approve it.

This means you can’t just settle your case forever and give up your right to future medical treatment and indemnity benefits for lost wages.

If you settle your whole claim, the insurer will have its attorney draft the settlement documents that go with this form.

You will have to sign a release that outlines the terms. You may also have to set up a Medicare Set-Aside Arrangement.

These are legally binding documents. Before you settle your case, call Mitchell & Associates for help.

Download form →

When there’s a dispute between your doctor and the doctor your employer selected for a second opinion, this is the form you use to ask for another medical evaluation to break the tie.

The vast majority of the time, it’s the employer who makes this request.

The director of the Louisiana Office of Workers’ Compensation selects a doctor to serve as the tie breaker.

Regardless of the result, you’re still entitled to your day in court if your benefits are going to be stopped.

Download form →

If you can return to work with restrictions after you’re hurt on the job, you still may be entitled to weekly checks.

As long as you’re unable to make more than 90% of what you made before your accident, you should get supplemental earnings benefits (SEB). Those benefits cover some of the difference between what you used to make and what you can make now.

You may be required send another Form 1020 every month to the claims adjuster to show how much you made each month. If you’re making money and don’t report it, all of your benefits can be stopped.

If you reach 90% of what you made before your incident, your workers’ comp checks may be stopped.

Download form →

We use this form so you can select your doctor. Under the Louisiana Workers’ Compensation Act, you’re entitled to choose your own doctor.

Keep in mind that once you pick a doctor, it’s very difficult to change to another doctor in the same field or specialty. But you can be referred to a specialist.

Your employer will be responsible for paying both doctors.

For example, if you chose to be treated by Dr. Smith, an orthopedist, and want to start seeing another orthopedist, you may not be able to. But if Dr. Smith refers you to Dr. Jones, a neurologist, workers’ comp should cover both doctors.

Avoid picking the company doctor as your doctor. They may not work in your best interests, and it can be very difficult to switch.

Download form →

Most people who work in Mississippi are protected by the Mississippi Workers’ Compensation Act. If you work for a business with five or more regular employees and experience an injury or illness because of hazardous conditions at your job, you probably will be covered by workers’ comp insurance.

If you have a different work arrangement, it’s possible that you’re not covered. These are some of the exceptions to the insurance mandate:

• Employers with fewer than five employees can choose to provide workers’ comp, but they are not required to do so.
• Employers in domestic and farm labor are not required to cover their employees, but they can voluntarily opt into insurance programs.
• Nonprofit fraternal, charitable, religious or cultural organizations are not required to carry workers’ comp insurance.
• Federal government employees are already covered by federal compensation laws, so they don’t qualify for Mississippi workers’ comp.
• Certain transportation and maritime employees also have their own compensation systems, so they are not included in Mississippi’s system.
• Independent contractors are usually excluded from coverage. But employees of subcontractors remain eligible for special protection.

If you suffer from any injury – whether it is relatively minor or extremely serious – during the “course and scope of employment,” your injury is covered under Mississippi workers’ comp.

Accidental death during work also prompts benefits for families.

And workers’ comp is not just for traumatic injuries. Illnesses and diseases that develop over time from occupational hazards are also covered.

The injury does not need to occur on your employer’s property. It can be a work-related injury that occurs while you are carrying out a task that benefits your employer or acting within the scope of your employment.

Mississippi has two types of workers’ comp benefits for injured workers: medical benefits and wage loss benefits.

What Medical Benefits Provide:

• Medical treatment for your injury, including doctor and hospital visits, nursing services, medication, physical therapy, certain rehabilitation services and equipment that helps you recover
• Reimbursement for costs of traveling to doctor’s appointments

You should never have to pay a deductible for health care under workers’ comp.

What Wage Loss Benefits Provide:

• Payment for lost wages for two-thirds of your average weekly wage, up to a cap
• In 2017, the cap in Mississippi was $477.82 each week. So if your earnings are high enough, you’ll get less than two-thirds of your pay.

You should never have to pay taxes on wage loss benefits.

How Long You’ll Get Benefits:

Your wage loss benefits will continue for different lengths of time, depending on the nature of your injury:

• Permanent Total Disability (PTD) If you are unable to return to any job because of your injury, you are eligible to receive workers’ compensation benefits up to 450 weeks.
• Temporary Total Disability (TTD) You can receive TTD benefits as long as you are unable to return to work and receive full pay.
• Permanent Partial Disability (PPD) If your injury allows you to return to work, but prevents you from earning as much as you earned before, you could receive wage loss benefits that make up two-thirds of the difference in your pay before and after your injury.

You should receive checks for lost wages at least every 14 days, for as long as the covered injury persists, subject to a maximum time limit of 450 weeks.

Because of this time limit, the maximum overall amount that a worker can be compensated for lost wages was about $215,000 as of 2017. The maximum amount is adjusted from time to time.

• Step 1: Immediately notify your employer about your accident. In Mississippi, you must report your injury within 30 days, or you risk your right to workers’ comp.
  Once you report it, your employer has an obligation to notify its insurance company and file a report with the Mississippi Workers’ Compensation Commission.
• Step 2: Seek prompt medical attention for your injury. Tell the health care provider you see that you were hurt on the job.
• Step 3: If your employer doesn’t cooperate with you or you get denied benefits, get help from an experienced workers’ comp attorney.

For a denial, you have 30 days to file an appeal in county circuit court. An attorney can help you through this complex process.

At Mitchell & Associates, we’ll provide an initial assessment of your case for free. Call us now!

You are covered starting from day one on the job.

There is no minimum earning requirement or waiting period. As soon as you begin work, you’re eligible for Mississippi workers’ comp.

If your injury causes you to miss fewer than 14 days of work, wage loss payments are not made for the first five days. Payment will be made only for the number of disability days beyond the fifth day.

If you suffer 14 or more days of disability, then you will be entitled to wage loss payments for the total period of your disability, including the first five days.

Yes. You have the right to select any medical provider you choose. Your chosen provider can also refer you to specialists. If you want to see any other health care providers, you have to get them approved.