Downloads (Publications, Forms, Posters, etc.)

Workers' Compensation

Please visit the Downloads Main Menu to view information about the file formats used and where to download the applications needed to view these formats.


Fraud

Name Format Size Description
Adjuster's Guide to Fighting Workers' Compensation Fraud This document is a PDF. 108 KB A training guide for adjusters in the fight against workers' compensation fraud
Employer's Guide to Fighting Workers' Compensation Fraud This document is a PDF. 107 KB A training guide for employers in the fight against workers' compensation fraud
Fraud Rules This document is a PDF. 10 KB Title 40, Chapter 19 Rules. Outlines the guidelines required for compliance with the Workers' Compensation Act.
Warning Signs of Workers' Compensation Fraud This document is a PDF. 30 KB Outlines signs of Workers' Compensation Fraud
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Medical Services

Name Format Size Description
CPT Codes - 2000 Update This document is a PDF. 426 KB Updated CPT for 2000
Rehabilitation Services This document is a PDF. 19 KB Louisiana Maximum Fee Schedule, Chapter 7. Rehabilitation Services. Establishes guidelines for the rehabilitation of occupationally disabled employees
Special Reimbursement Reconsideration Appeal Form This document is a PDF. 27 KB LDOL-WC 3000 - Form to be completed by medical provider when requesting reimbursement reconsideration appeal
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Record Management

Name Format Size Description
1999 OWCA Annual Report Supplement This document is a PDF. 44 KB
2000 OWCA Annual Report Supplement This document is a PDF. 46 KB
2001 OWCA Annual Report This document is a PDF. 239 KB
2001 OWCA Annual Report Supplement This document is a PDF. 42 KB
2002 OWCA Annual Report This document is a PDF. 237 MB
2002 OWCA Annual Report Supplement This document is a PDF. 424 KB
2003 OWCA Annual Report This document is a PDF. 206 MB
2003 OWCA Annual Report Supplement This document is a PDF. 223 KB
2004 OWCA Annual Report This document is a PDF. 239 KB
2005 OWCA Annual Report This document is a PDF. 428 KB
2006 OWCA Annual Report This document is a PDF. 452KB
An Overview of OWCA Section's Activity HTML
Body Parts Diagram This document is a PDF. 63 KB
Employer's Key Steps HTML Key Steps.EE - Answers to the employer's most frequently asked questions and concerns relating to Louisiana's workers' compensation entitlement and procedures
Employer's Report of Injury/Illness LDOL-WC- 1007 This document is a PDF. 127KB LDOL-WC 1007 - This form requires employers to complete the OWCA Form 1007 for Injury & Illness and forward this form to their workers' compensation insurance carrier or self- insured fund. In turn, the insurance carrier, self-insured fund or self-insured employer is now obligated to forward the form to the OWCA.
OWCA Annual Reports Menu This document is a PDF. This Workers' Compensation page provides annual statistics including reports and supplements.
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Second Injury Board

Name Format Size Description
Electronic Funds Transfer Enrollment Form This document is a PDF.
Notice of Claim with Second Injury Fund This document is a PDF. 21 KB SIB Form A - Form to be completed and submitted by the insurer, self-insured employer, or third party administrator, along with documentation listed on the form with each new claim filed
P & I Form This document is a PDF. 121 KB SIB Form B - Form submitted with each request for reimbursement from the Second Injury Board
Partial Payments for October 2005 Board This document is a PDF. 245 KB
Second Injury Board Mtg. Agenda New This document is a PDF. 70 KB Agenda for the Second Injury Board that meets the first Thursday of every month
Second Injury Fund This document is a PDF. 17 KB SIF Brochure - Rules of Practice and Procedures
Second Injury Fund This document is a PDF. 21 KB SIF Brochure - Brochure explaining the basic operation of the Second Injury Board
Settlement Evaluation This document is a PDF. 29 KB Form submitted to the Second Injury Board for approval of a settlement on a claimant who is receiving supplemental earnings benefits
Settlement Evaluation - Permanent and Total This document is a PDF. 31 KB Form submitted to the Second Injury Board for approval of a settlement on a claimant who has been declared permanently and totally disabled
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Workplace Safety

Name Format Size Description
Directory of Safety Services This document is a PDF. 131 KB Directory of Safety Services - Revised March 2008
Directory of Safety Services - Consultants - Applications This document is a PDF. 35 KB Application for Directory of Safety Services
Quarterly Report of Injury/Illness Web Application LDOL-WC 1017A - Quarterly Report of Injury/Illness
Safety Requirements This document is a PDF. 24 KB Guidelines for implementing a working and occupational safety plan
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Miscellaneous

Name Format Size Description
Annual Report of Workers' Compensation Costs This document is a PDF. LDOL-WC 1000 - This Workers' Compensation page provides an annual report of Workers' Compensation costs.
Authorized Group Self-Insurance Company Listing This document is a PDF. 57 KB
Authorized Insurance Companies This document is a PDF. 59 KB
Authorized Third Party Administrators This document is a PDF. 37 KB
Average Weekly Wage Computation This document is a PDF. 74 KB Instructions for computing an employee’s average weekly wage (Workers' compensation)
CERTIFICADO DE CONFORMIDAD DEL TRABAJADOR This document is a PDF. 72KB LDOL-WC 1025 (en Español) - CERTIFICADO DE CONFORMIDAD DEL TRABAJADOR
Cost Containment Application This document is a PDF. 110 KB LDOL-WC 1021 - Employer’s application for participation in the cost containment program (Workers' compensation)
Cost Containment Rules This document is a PDF. 25 KB Guidelines to establish and implement effective injury control measures (Workers' compensation)
Disputed Claim for Compensation - Form 1008 This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 8 KB Companies exempt from 300 log
Exemptions From Coverage This document is a PDF. 24 KB
Fiscal Responsibility This document is a PDF. 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 This document is a PDF. 8 KB
General Provisions This document is a PDF. 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 This document is a PDF. 15 KB LDOL-WC 1017A - Glossary - Glossary of terms used when completing form LDOL-WC 1017A
Hearing Offices Contact Information This document is a PDF. 40 KB
Hearing Rules This document is a PDF. 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 This document is a PDF. 24KB Form to request for a language interpreter or deaf/hearing impaired assistance in Workers’ Compensation Court
Letter of Credit This document is a PDF. 20 KB Irrevocable Letter of Credit
Motion for Recognition of Right to Soc. Sec. Offset - Form 1005a This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 6 KB Listing of codes assigned to each parish
Physician Choice Form This document is a PDF. 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 This document is a PDF. 78KB LDOL-WC 1020 (en Español) - REPORTE MENSUAL DE GANANCIAS DEL EMPLEADO
Request for Compromise or Lump Sum Settlement This document is a PDF. 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 This document is a PDF. 40 KB LDOL-WC 1015 - Form to be completed by party requesting an Independent Medical Examination (IME)
Request for Social Security Benefits Information This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 37 KB Documentation outlining conditions and containing required forms.
Self-Insurer Application This document is a PDF. 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 This document is a PDF. 97 KB LDOL-WC 2005 - Checklist - List of items necessary when submitting application to become self-insured (Workers' compensation)
Service Company Application This document is a PDF. 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 This document is a PDF. 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 This document is a PDF. 20 KB Legal document necessary to guarantee the self-insured’s obligation to pay indemnity benefits (Workers' compensation)
Subpoena & Subpoena Duces Tecum - Form 1006 This document is a PDF. 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 This document is a PDF. 8 KB Legal document necessary when making application to become self-insured (Workers' compensation)
What is Workers' Compensation Fraud This document is a PDF. 87 KB Defines Workers' Compensation Fraud
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This page was last updated on July 19, 2007.
Note: This revision date does not reflect the individual revision dates of the materials listed above, nor does it reflect the last time the listing was updated. Materials are updated on a regular basis and added to the list above as soon as they are made available.