| Annual Report of Workers' Compensation Costs |  | | LDOL-WC 1000 - This Workers' Compensation page provides an annual report of
Workers' Compensation costs. |
| Authorized Group Self-Insurance Company Listing | | 57 KB | |
| Authorized Insurance Companies | | 59 KB | |
| Authorized Third Party Administrators | | 37 KB | |
| Average Weekly Wage Computation | | 74 KB | Instructions for computing an employee’s average weekly wage (Workers' compensation) |
| CERTIFICADO DE CONFORMIDAD DEL TRABAJADOR | | 72KB | LDOL-WC 1025 (en Español) - CERTIFICADO DE CONFORMIDAD DEL TRABAJADOR |
| Cost Containment Application | | 110 KB | LDOL-WC 1021 - Employer’s application for participation in the cost containment program (Workers' compensation) |
| Cost Containment Rules | | 25 KB | Guidelines to establish and implement effective injury control measures (Workers' compensation) |
| Disputed Claim for Compensation - Form 1008 | | 78 KB | LDOL-WC 1008 - Form to be filed with the Workers' Compensation district office when there is any disputed issue in a claim |
| Drug Testing Programs in Job Accident Cases | | 29 KB | Title 40. Chapter 15. Drug Testing Programs in Job Accident Cases. Guidelines for accident-related drug testing (Workers' compensation) |
| Employee's Certificate of Compliance - Form 1025ee | | 57 KB | LDOL-WC 1025.EE - Form filed by injured workers explaining rights and responsibilities while receiving workers’ compensation benefits and penalties for failure to comply |
| Employee's Key Steps | Excel® | | OSHA - 300 Log - Answers to the injured worker's most frequently asked questions and concerns relating to Louisiana's workers' compensation entitlement and pocedures |
| Employee's Monthly Report of Earnings - Form 1020 | | 42 KB | LDOL-WC 1020 - Form filed monthly with the employer’s insurer by the injured worker to report any earnings (Workers' compensation) |
| Employee's Quarterly Report of Earnings - Form 1026 | | 22 KB | LDOL-WC 1026 - Form filed quarterly by the injured worker with their employer or insurer to report any earnings (Workers' compensation) |
| Employer's Certificate of Compliance - Form 1025er | | 14 KB | LDOL-WC 1025.ER - Form filed by the employer explaining the employer’s rights and responsibilities to provide workers’ compensation benefits as well as penalties for failure to comply |
| Exempt Businesses | | 8 KB | Companies exempt from 300 log |
| Exemptions From Coverage | | 24 KB | |
| Fiscal Responsibility | | 38 KB | Guidelines for employers and insurers providing workers’ compensation insurance coverage in Louisiana |
| FORM LDOL-WC 1017 Exemptions by North American Industry Classification System (NAICS) Codes | | 8 KB | |
| General Provisions | | 13 KB | Title 40. Chapter 1. General Provisions. Defines the responsibilities and rights of the employee, employer, and the carrier in the administration of workers' compensation in Louisiana. |
| Glossary of Terms for Form 1017a | | 15 KB | LDOL-WC 1017A - Glossary - Glossary of terms used when completing form LDOL-WC 1017A |
| Hearing Offices Contact Information | | 40 KB | |
| Hearing Rules | | 54KB | Office of Workers Compensation -
Court Hearing Procedures (LAC 40:I.Chapters 55-66). |
| How's Business? | Windows® Media® | 8.4 MB | WAFB Channel 9 Interview with Sonny Mills 4/27/2005 |
| Interpreter/ADA Accommodations New | | 24KB | Form to request for a language interpreter or deaf/hearing impaired assistance in Workers’ Compensation Court |
| Letter of Credit | | 20 KB | Irrevocable Letter of Credit |
| Motion for Recognition of Right to Soc. Sec. Offset - Form 1005a | | 11 KB | LDOL-WC 1005A - Form used by the employer/insurer to request recognition of right to take an offset for social security benefits (Workers' compensation) |
| Order Recognizing Right to Soc. Sec. Offset - Form 1005b | | 14 KB | LDOL-WC 1005B - Order signed by the workers’ compensation judge recognizing entitlement to a social security offset |
| OSHA Forms | Excel® | 152 KB | OSHA Form 300, OSHA Form 300A, OSHA Form 301 |
| Parish Codes for Louisiana | | 6 KB | Listing of codes assigned to each parish |
| Physician Choice Form | | 146 KB | LDOL-WC 1121 - Form to be completed by the injured worker when selecting their physician of choice |
| REPORTE MENSUAL DE GANANCIAS DEL EMPLEADO | | 78KB | LDOL-WC 1020 (en Español) - REPORTE MENSUAL DE GANANCIAS DEL EMPLEADO |
| Request for Compromise or Lump Sum Settlement | | 59 KB | LDOL-WC 1011 - Form filed with OWCA to request the review and approval of a compromise or lump sum settlement agreement |
| Request for Independent Medical Exam - Form 1015 | | 40 KB | LDOL-WC 1015 - Form to be completed by party requesting an Independent Medical Examination (IME) |
| Request for Social Security Benefits Information | | | LDOL-WC 1004 - Form used to gather information from the Social Security Administration and to calculate the amount of any offset (Workers' compensation) |
| Request for Waiver of Payment of Advance Costs | | 113 KB | LDOL-WC 1027 - Form used to determine whether the financial status of an injured worker warrants the waiver of payment of any advanced costs when filing claims (Workers' compensation) |
| Security Agreement for Certificate of Deposit New | | 37 KB | Documentation outlining conditions and containing required forms. |
| Self-Insurer Application | | 57 KB | LDOL-WC 2005 - Application form to be completed by employers wishing to become a self-insured entity (Workers' compensation) |
| Self-Insurer Application Checklist | | 97 KB | LDOL-WC 2005 - Checklist - List of items necessary when submitting application to become self-insured (Workers' compensation) |
| Service Company Application | | 29 KB | LDOL-WC 2007 - Application filed by companies requesting to operate as third party administrators in the state of Louisiana (Workers' compensation) |
| Service Company Application Checklist | | 22 KB | LDOL-WC 2007 - Checklist - Checklist of items necessary when submitting an application in order to process workers’ compensation claims in Louisiana |
| State of Louisiana Indemnity & Guaranty Agreement | | 20 KB | Legal document necessary to guarantee the self-insured’s obligation to pay indemnity benefits (Workers' compensation) |
| Subpoena & Subpoena Duces Tecum - Form 1006 | | 39 KB | LDOL-WC 1006 - Series of forms issued to compel an individual to appear for a deposition or to give testimony, or to produce documentation (Workers' compensation) |
| Surety Bond | | 8 KB | Legal document necessary when making application to become self-insured (Workers' compensation) |
| What is Workers' Compensation Fraud | | 87 KB | Defines Workers' Compensation Fraud |
