A Notice of Claim form is completed and submitted to the Second Injury Board at the address provided at the top of the form. Enclose as much of the information requested on the form as possible when filing the claim. At the least, the first report of injury and proof of insurance coverage/self-insurance must be submitted with the Notice of Claim form. Completed forms can be mailed or faxed to (225) 219-5968.
The employer, or if insured, his insurer, must file a Notice of Claim form within 52 weeks after the first payment of any benefit (indemnity or medical) by mailing or faxing the form to the Second Injury Board.
The Notice of Claim (PDF) form can be obtained by downloading it from this site, or by calling the Second Injury Board at (800) 201-2493.
A self-insured employer, the employer's insurance company, a third party administrator responsible for administering the employer's workers' compensation claims, or an attorney representing either the employer or the employer's insurance company can file a claim.
No. The employee must sustain a subsequent (occupational) injury that results in liability for workers' compensation benefits occurring after the employer is made aware of an employee's pre-existing permanent partial disability and all the pre-requisites are met.
Every property and casualty insurer, individual self-insurer and group of self-insurance funds that have paid workers' compensation benefits make an annual payment (assessment) to the fund. The assessment rate is based on a percentage of the total benefits paid in the prior calendar year. Any entity required by law to pay an assessment to the Fund and has not done so shall not be eligible to receive reimbursement.
For dates of accident before July 1, 2004 & on/after July 1, 2009, but before July 1, 2010:
TTD/SEB/PTD After the first 104 weeks of payment of benefits
Death benefits after the first 175 weeks of payment of benefits
50% of all reasonable and necessary medical expenses actually paid which exceed $5,000.00, but no less than $10,000.00
100% of all reasonable and necessary medical expenses actually paid which exceed $10,000.00
On/after July 1, 2004 & before July 1, 2009:
After the first 130 weeks of payment of benefits
100% of all reasonable and necessary medical expenses actually paid which exceed $25,000.00
On/after July 1, 2010
After the first 104 weeks of indemnity
100% of all reasonable and necessary medical expenses actually paid which exceed $25,000.00, including reasonable and necessary Vocational Rehabilitation expenses, if such expenses are directly related to services provided in the actual retention or reemployment of the employee.
Requests for reimbursement are made using Form B, which can be found on the Downloads section of this site. Instructions for a proper submittal are included on this form. Reimbursement requests are processed in the order that they are received in the office. Prior to any payments being made, Board approval must be obtained. The Second Injury Board meets on the first Thursday of each month. You may use the following link to view the current month's agenda.
First, the insurer must be a registered vendor with the State of Louisiana. Registration can be obtained at https://www.doa.la.gov/pages/osp/vendorcenter/vendorregn.aspx. In the past, all reimbursements were made by check. Now, Electronic Fund Transfer is available. Enrollment forms can be obtained by visiting the EFT site at http://www.doa.la.gov/OSRAP/EFTforWebsite.pdf.
Yes. An appeal must be filed within 30 days from the receipt of the Board's decision. Appeals are taken to the 19th Judicial District Court, Parish of East Baton Rouge.
To obtain the status of an existing claim, please contact the Second
Fax: (225) 219-5968