HB 780 — WORKERS COMPENSATION: Provides relative to penalties and attorney fees for nonpayment, discontinuance of payment, or failure to consent for a medical treatment for workers' compensation claims, controversion of benefits, and preliminary determination hearings

HLS 26RS-490 ORIGINALENGROSSED Regular Session HOUSE BILL NO.

23:1201(F)(introductoryparagraph)and(2)and1201.1(A),(B), (D), (E), (G) through (I), (J)(2) through (4), and (K)(1)(introductoryparagraph),(K)(1)(introductoryparagraph) and (2) through (5) and to enact R.S.

SectionSection1. 1.

R.S.23:1201(F)(introductoryparagraph)and(2)and1201.1(A), (B),(D), (E), (G) through (I), (J)(2) through (4), (K)(1)(introductoryparagraph) and (2) through (5) are hereby amended and reenacted and R.S.

23:1201(F)(introductory23:1201(F)(6) paragraph)is andhereby (2)enacted andto 1201.1(A)(1),read (2),as and(3),(B),(D),(E),(G)through(I),(J)(2)through(4),(K)(1)(introductoryparagraph),(2)follows: through (5) are herebyamended and reenacted and R.S.

23:1201(F)(6) is herebyenacted to read as follows:

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For purposes of this Subsection, arbitrary, capricious, or without probablecausemeans willful and unreasoningactionwithout consideration and regard for facts and circumstances presented.

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23:1121, 1124, 1208, and 1226, the employeremployerorpayor,ortheirauthorizedagentorattorney,whohasbeennotifiedofthe or payor who has been notified of the claim, shall do all of the following:

(2) Send the notice of the initial indemnity payment required by Paragraph (1) of this Subsection to the injured employee on the same day as no later than ten business days after the first payment of compensation is mademadebythe bythe payor after the payor has received notice of the claim from the employer.

(3) Send acopyofthenoticeoftheinitiala copyof the notice oftheinitial paymentofindemnityrequiredby Paragraph (1) of this Subsection to the office within ten days from the on the same date the original notice was sent to the injured employee or by facsimile to the injured employee's representative.

Upon any modification, suspension, termination, or controvesioncontroversionofcompensation of compensation or medicalmedicalbenefitsforanyreason,includingbut benefits for anyreason, including but not limited to issues ofofmedical medical causation, compensabilityoftheclaim,orissuescompensabilityof the claim,orissues arising outPage 3 of R.S.10 CODING:

23:1121, 1124, 1208, or 1226, the employer or payor shall do all of the following:

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780 (1)out Prepare a "Notice of Payment,R.S. Modification, Suspension, Termination, or Controversion of Compensation or Medical Benefits" on a LWC-WC 1002 form or such other form as may be promulgated by the assistant secretary in accordance with the Administrative Procedures Act.

23:1121, 1124, 1208, or1226,theemployeror payor, or their authorized agent or attorney, shall do all of the following:

(1) Prepare a "Notice of Payment, Modification, Suspension, Termination, or Controversion of Compensation or Medical Benefits" on a LWC-WC 1002 form or such other form as may be promulgated by the assistant secretary in accordance with the Administrative Procedure Act.

* * * D.(1) AnynoticerequiredtobesenttotheinjuredemployeepursuanttoAnynoticerequiredtobesentto theinjuredemployeepursuantto this Section shall be sent bycertified mail or commercial carrier to the address at which the employee is receiving payment of indemnity benefits, electronic mail to the employee's electronic mail address on file with the employer or payor, or hand delivery to the employee.

Proofthatthenoticewas senttosent to theemployee's representativebyfacsimilerepresentativebyfacsimileas as requiredin this ParagraphshallParagraph shall be prima facie evidence of compliance with Subsection A of this Section.

The provisions of this Section shall do not applyapplyto to questions of medical necessity as provided by R.S.

* * * G.(1) If the employer or the payor provides the benefit that the employee claims is due, including any arrearage, on the returned form or letter of amicable Page 4 of 10 CODING:

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780 G.(1) If the employer or the payor provides the benefit that the employee claims is due, including any arrearage, on the returned form or letter of amicable demand within seven ten business days of receipt of the employee's demand, the employerorpayorshallemployer notor bepayor subjectshallnot tobesubjectto anyclaimforanypenaltiesorattorneyfeesanyclaimforanypenaltiesor attorneyfees arising from the disputed payment, modification, suspension, termination, or controversion.

I.(1) An Preliminary determinations as provided for in this Section are favored under the law and an employer or payor who has not complied with the requirements set forth in Subsection A or B of this Section, and who has provided notice as required in Subsection D, through E of this Section or has not initially accepted the claim as compensable, subject to further investigation and subsequent Page 5 of 10 CODING:

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780 notice as required in Subsection D, through E of this Section or has not initially accepted the claim as compensable, subject to further investigation and subsequent controversion shall not be entitled to a preliminarypreliminarydetermination. determination.

Failure to file the motion to strike within the prescribedprescribedtime time period shall be deemed a waiver of anyobjection to the preliminary determination hearing.

(3) The preliminarydetermination hearinghearingshall shall be held no later than ninety days fromfromtheschedulingconference. the schedulingconference.

However,uponashowingofgoodcause,oneHowever,upon a showing of good cause,one extension of an additional thirty days is permitted upon approval by the workers' compensationPage judge.6 of 10 CODING:

The workers' compensation judge shall issue a preliminary determination no later than thirty fifteen days after the hearing.

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780 (4)compensation Anyjudge. employer or payor requesting a preliminary determination hearing shall produce all documentation relied on by the employer or payor in calculating, modifying,suspending,terminating,orcontrovertingtheemployee'sbenefits.

The workers' compensation judge shall issue a preliminary determination no later than thirty fifteen days after the hearing.

(4) Any employer or payor requesting a preliminary determination hearing shall produce all documentation relied on by the employer or payor in calculating, modifying,suspending,terminating,orcontrovertingtheemployee'sbenefits.

(5) Anyinjuredemployeewhodisagreeswiththepreliminarydetermination shall notify the court within ten business days of the receipt of such preliminary determinationofhis desireto proceedtoproceedtoatrialonthemeritsofthemattersthatwere atrialonthemeritsofthemattersthatwerePage the7 subject of the10 preliminaryCODING: hearing.

If the employer or payor has accepted and complied with the preliminary hearing determination, the employer or payor shall Page 7 of 10 CODING:

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