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FILING A CLAIM FOR LOUISIANA WORKERS COMPENSATION BENEFITS
If you have an accident at work, you must report your
accident or injury to your employer within 30 days of the
day that it occurs or your right to recover Workers
Compensation disability and medical benefits may expire.
Because the law does recognize a very few exceptions to the
limitation of the time period for reporting your accident,
you should contact an attorney for assistance with your
claim even if more than 30 days have passed to determine if
one of the exceptions may apply.
Don't forget to ask your employer for a copy of your
accident report because the report can provide proof to
establish the date your accident happened and the date it
was was reported. Employers are supposed to use a Louisiana
Department of Labor Form 1007 (Employer Report of Injury or
Illness) to provide the Office of Workers Compensation with
information about your accident and claim.
FILING A "DISPUTED CLAIM FOR COMPENSATION" WITH THE LOUISIANA OFFICE OF
WORKERS
COMPENSATION
If your employer is underpaying, or not paying, your
Louisiana Workers Compensation wage or medical benefits, you or your
attorney may file a
Louisiana Department of Labor Form 1008
with the Office of Workers Compensation. Filing this form
starts the process that can ultimately result in a trial
before a Louisiana Workers Compensation Judge. There is a
small fee to to file the form, but it may be
deferred if you also file a
Louisiana
Department of Labor Form 1027 showing that it would be a
hardship for you to pay the fee.
If you have a disagreement with your employer about your
Louisiana Workers Compensation benefits and would like for the
dispute to be submitted to the Louisiana Workers Compensation Court,
you must file your claim with the Court within the following
time periods:
- A claim for medical benefits must be filed within one year
of the date of the accident or within three years of the date
that Workers Compensation medical benefits were last paid,
whichever is later.
- If you have not received any Louisiana Workers Compensation
income (indemnity) benefits as a result of your current
injury, a claim for Louisiana Workers Compensation
income benefits must be filed within one year of the date
of your accident. In some unusual circumstances involving
"developmental injuries," the time limit for filing a claim
may be extended up to a total of three years, as long as that
is still not more than one year from the date that your
injury developed.
- If you have been paid Louisiana Workers Compensation
indemnity benefits due to your current injury, your right to
file a claim for Temporary Total Disability, Permanent
Partial Disability or Permanent Total Disability benefits
will expire if your claim is not filed with the Louisiana
Office of Workers Compensation within one year of the date
through which you were last paid indemnity benefits.
- For Supplemental Earnings Benefits, three different
rules and time frames apply.
- If you have not received any type of Louisiana
Workers Compensation income (indemnity) benefits due
to your current injury, you must file a Disputed
Claim for Compensation with the Louisiana
Office of Workers Compensation within one year of
your accident date.
- If you have previously received Supplemental
Earnings Benefits due to your current claim, your
time limit for filing a Disputed Claim for
Compensation with the Louisiana Office of Workers
Compensation expires at the end of two years from
the date through which you were last paid
Supplemental Earnings Benefits if "SEB has not
been payable to [you] for any given thirteen
consecutive weeks" during those two years.
- If you have previously received only Temporary
Total Disability, Permanent Partial Disability or
Permanent Total Disability benefits, your right to
file a Disputed Claim for Compensation with the
Louisiana Office of Workers Compensation expires at
the end of three years from the date through which
you were last paid one of those types of benefits.
The Louisiana Supreme Court explained the
rule in the following way:
To summarize the SEB scheme put in
place by the legislature, § 1209(A) sets forth the
applicable three-year prescriptive period from the date of
the last indemnity benefit payment for filing a claim for
SEB. Once a worker begins to receive SEB, § 1221(3) governs the calculation and
termination of these benefits. In any week where the worker
is unable to earn at least 90 percent of his pre-injury
wages, SEB will be payable to him, for a maximum of
520-weeks. If the worker is able to earn his full pre-injury
salary in any given week, the employer will not owe SEB, but
these weeks will not be counted toward the 520-week maximum
time period. § 1221(3)(d)(ii) Under certain circumstances,
the worker's SEB payments will end before the expiration of
520-weeks. One of these circumstances arises under §
1221(3)(d)(i), where a worker has begun to draw SEB, but
where SEB has not been payable to him for any given thirteen
consecutive weeks in any two-year period after termination
of TTD, presumably because the worker is able to work at
full earning capacity during this period of time. This
situation is distinguishable from the situation of the
current plaintiff, who has never filed a claim for SEB and
has never received SEB payments, and where, consequently, §
1221(3)(d)(i) has not been triggered.
In this action, plaintiff is asserting that she is entitled
to begin receiving SEB payments for the first time. Her
claim is timely under § 1209(A) because it was filed within
three years after termination of her last TTD payment, and the court of appeal incorrectly found
that § 1221(3)(d)(i) bars this action.
Dufrene v. Video Co-op, 2002-CA-1147
- The time limit for filing a claim for Workers Compensation
benefits is not extended because you received another type
of disability benefits, such as Social Security Disability
or benefits from a private short term disability policy.
- A claim for Workers Compensation benefits that is not based
upon a specific accident but is instead based upon a
work-related illness or disease must be filed with the
Louisiana Office of Workers Compensation within one year of
the date that:
- The disease manifested itself.
- The employee is disabled from working as a result of the
disease.
- The employee knows or has reasonable grounds to believe
that the disease is occupationally related.
Louisiana Courts have decided that your right to file claims
for Workers Compensation medical benefits and Workers
Compensation indemnity benefits are separate legal rights.
Thus, the Courts have held that your time limit for filing a
claim for indemnity benefits can expire even though the
Workers Compensation insurance company is still paying for
all of your medical treatment. This is an area of the law
that can appear confusing and unfair and its impact can
depend heavily upon the specific circumstances of your case.
You should consult with an attorney even if you think your
time limit for filing a claim has expired. The calculation
of legal time limits can be subject to many surprising
exceptions. Additionally, in a Workers Compensation claim,
you may need to request information from the insurance
company before you can determine when your time limitations
began or expired.
Next: Termination of
Income Benefits
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