The process of filing a workers’ compensation claim can be complex — legal terms and insurance companies may be enough to make your head spin.
We’re here to help you understand the Louisiana workers’ compensation process more thoroughly. To start, here’s a glossary of the 10 most important terms you’ll want to know throughout your workers’ compensation claim.
Whether you’ve already filed or are in the process of putting together your claim, take a look – these simple definitions are sure to help you as you submit a claim.
1. Accepted Claim
An accepted claim is fairly self-explanatory. If a claim has been accepted, that means the employer’s insurance company has agreed that the illness or injury is covered by a workers’ compensation claim.
An accepted claim guarantees payment — but it’s important to note that it does not guarantee immediate payment. It is possible for administrative delays or other problems to delay payment in some cases.
2. Alternative Work
If an injury prevents you from performing your previous duties, but a doctor says that you can still perform other work, your employer may choose to offer you alternative work.
Rather than paying for vocational rehabilitation or further schooling, the employer can offer an alternative position that meets the work restrictions, lasts at least a full calendar year (12 months) and pays at least 85 percent of the wages and benefits at the time of the injury.
In addition, this position must be reasonably near the distance of the area in which you lived at the time of the injury, providing a similar commute.
3. Americans With Disabilities Act (ADA)
The ADA is a comprehensive set of federal laws and guidelines that prohibit discrimination against disabled people, providing robust protections for all disabled people in the workplace.
Under the ADA, employers are not allowed to discriminate because of a disability – if you believe that you are being discriminated against, contact the US Equal Employment Opportunity Office to get information on your rights regarding disabilities.
4. Application For Adjudication Of Claim
In Louisiana, this is also known as a “Form 1008” or a disputed claim for compensation. If you have a disagreement with your employer or their insurance company about your benefits, you may file a Form 1008 with the local Workers’ Compensation district office, thereby sending the case to adjudication.
Your employer will be notified of the Form 1008 filing and will be able to respond accordingly. Mediation and out-of-court settlements may occur within 15 days of the filing – if no agreement is made, the case will proceed to courtroom litigation.
5. Future Earning Capacity
Future earning capacity is a standard multiplier that is based on the average amount of wage loss a specific injury can cause – compared to other types of injuries.
In general, the more severe an injury is, the higher the impact on future earning capacity will be. For example, future earning capacity would be impacted more by the loss of a leg than it would of a finger – resulting in a higher disability rating and a higher workers’ compensation payout.
A lien is any claim of payment that is issued against a workers’ compensation case – usually, these claims result from medical services provided during a workers’ compensation case.
These claimants, such as medical providers or physicians, can file forms with the local workers’ compensation board for payment of money owed in a workers’ compensation case.
7. Modified Work
Modified work is a possible solution to a workers’ compensation case. If a doctor says that the injured party could return to their previous position if the work environment was slightly modified, the employer is encouraged to do so. This allows most, or all, of the same duties to be performed even after returning to work.
8. P&S Report
P&S stands for permanent and stationary. This is a report written by a physician, describing the medical condition once it has stabilized, post-injury.
This report is written once the employee has recovered from their injury to the fullest extent possible – or stabilized.
This report is one of the primary means by which the level of disability is assessed and what permanent disabilities have resulted from the work injury, if any.
9. Subjective Factors
Subjective factors can include any symptoms or pain described by an injured worker that contributes to a worker’s permanent disability, as reported by a doctor.
Generally, subjective factors are not given much prominence when a workers’ compensation claim is filed – as “pain and suffering” cannot easily be measured.
10. Utilization Review
Utilization review or UR is the process by which insurance companies decide whether or not treatment is medically necessary for an injury.
Insurance administrators will review the treatment plan, as put forth by a physician, and decide whether or not to approve payment for treatments by using the Louisiana Workers’ Compensation Medical Treatment Guidelines.
Understand These Terms – Make Your Claims Process Easier!
The process of filing a workers’ compensation claim in Louisiana isn’t easy – but if you know some of the basic terms used when filing, it can be much easier! Get informed by reading our glossary, then let us fight for the compensation you deserve – you’ll certainly be glad you did.