BATON ROUGE – A new set of rules goes into effect Friday, April 20, governing disputes between medical providers and insurance carriers over medical treatment recommended for injured workers. Those rules, along with accompanying standardized forms, serve to strengthen medical treatment guidelines adopted last year by the Louisiana Workforce Commission that already have saved Louisiana employers millions in legal costs.
The new rules and forms clarify and bring consistency to workers’ compensation cases when medical treatment is denied, laying out timelines and procedures for appealing those decisions to the LWC Medical Director.
“Our medical treatment guidelines have already improved Louisiana’s business climate by controlling employers’ costs and saving time,” said LWC Executive Director Curt Eysink. “The new rules will make the guidelines even more effective by bringing clarity and consistency all the way through the appeals process so employers can concentrate on doing business rather than fighting in court.”
The guidelines and the new rules govern the appeals process for medical treatment in workers’ comp cases, known as utilization review. It is through the UR process that employers and claims administrators review and determine whether treatment for injured workers is medically necessary. Medical treatment recommended by a physician must be based on these guidelines, which are based on national standards of care.
Since July, the guidelines have saved an estimated $8.5 million in costs typically incurred when workers' comp medical disputes go to court. The use of the guidelines has shortened disputes over medical care to an average of five days, rather than the 15 months it used to take before July, when those cases were resolved in court.
You can view the new rules in their entirety in the April issue of the Louisiana Register here www.doa.louisiana.gov, beginning on Page 1030.
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