reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 63 - Judgments › Subchapter C - Modification › Section I-6317 - Exception

Current through Register Vol. 50, No. 6, June 20, 2024
A. A motion for new
					 trial shall be governed by Code of Civil Procedure
					 Articles
					 1971 et seq.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 64 - Appellate Procedure › Subchapter A - General › Section I-6401 - General

Current through Register Vol. 50, No. 6, June 20, 2024
A. All appeals
					 shall be taken in accordance with the procedures set forth in
					 R.S.
					 23:1310.5 and, where not in conflict, the
					 Louisiana Code of Civil Procedure and the relevant rules of the appropriate
					 circuit court of appeal.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 64 - Appellate Procedure › Subchapter A - General › Section I-6405 - Payment of Appellate Costs

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Payment of appellate costs shall be governed by Code of Civil Procedure
					 Articles
					 2126, et seq.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 65 - Special Disputes › Subchapter A - Attorney Fees › Section I-6501 - Disputed Attorney Fees

Current through Register Vol. 50, No. 6, June 20, 2024
A. When a
					 dispute arises among several attorneys as to the identity of claimant's counsel
					 of record, or when several successive attorneys lay claim to a fee in the same
					 case, the judge shall decide the issues raised and allocate the fee allowed in
					 accordance with Rule 1.5 of the Rules of Professional Conduct of the Louisiana
					 Supreme Court.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 65 - Special Disputes › Subchapter A - Attorney Fees › Section I-6503 - Attorney Fees; Application, Review and Approval

Current through Register Vol. 50, No. 6, June 20, 2024
A. Whenever the judge renders an award of
					 penalties or attorney fees due to the conduct of the other party under any
					 provision authorized by the Workers' Compensation Act, the judgment shall state
					 the specific acts or omissions of the party which gave rise to the award of a
					 penalty or attorney fee. When attorney fees are awarded due to the conduct of a
					 party the judgment shall state the basis for the amount of the award.
B. Attorney fee claims under
					 R.S.
					 23:1141 for allowable portions of periodic
					 payments of indemnity benefits recovered by claimants shall only be authorized
					 after approval by the presiding judge upon filing of a motion for such fees
					 filed by the claimant's attorney.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 65 - Special Disputes › Subchapter B - Social Security Offset › Section I-6507 - Offset

Current through Register Vol. 50, No. 6, June 20, 2024
A. A request for
					 offsets pursuant to
					 R.S.
					 23:1225(C) made in
					 connection with a disputed claim shall be made by filing Form LDOL-WC-1008 or
					 by responsive pleading. An order shall be issued recognizing the entitlement to
					 the offset for social security benefits from the date of judicial demand, and
					 setting the amount of the offset after a determination of the character of the
					 disability, the right to the offset, and calculation of the offset. A
					 contradictory hearing properly noticed by the court may be set by the judge for
					 this determination. Notice shall be provided to the claimant or his
					 representative prior to issuance of the order. The order shall be served by
					 certified mail upon all parties and the Social Security Administration. Such
					 offsets may be taken upon receipt of proof of service of the order upon the
					 Social Security Administration by the Office of Workers' Compensation
					 Administration. Such offsets shall not be taken unless the social security
					 offset has been removed.
B. A
					 request for offsets pursuant to
					 R.S.
					 23:1225(A) made in
					 connection with a claim not in dispute may be made by motion on Form
					 LWC-WC-1005(A) or by letter, filed in the appropriate district office. When
					 properly filed, the motion or letter requesting an offset may be granted ex
					 parte from date of filing. Such offsets shall not be taken unless the social
					 security offset has been removed. No fee shall be charged in connection with a
					 request made under this Subsection.
C. A unilateral reverse offset shall not be
					 recognized by this office after March 20, 1993. A unilateral offset under any
					 other Subsection of
					 R.S.
					 23:1225 shall not be recognized by this
					 office after January 1, 2000.
D.
					 Information concerning receipt of Social Security benefits and the amounts
					 thereof shall be obtained on Form LDOL-WC-1004, which shall be properly
					 executed by an official designated by the Social Security
					 Administration.
E. An official of
					 the Social Security Administration shall not be subject to subpoena under this
					 rule unless for good cause shown.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 65 - Special Disputes › Subchapter C - Financial and Compliance Hearings › Section I-6509 - Financial and Compliance Hearings

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Any party may request a mediation conference which shall be held within 15 days
					 of the filing of an appeal for financial and compliance matters.
B. If a resolution is not reached, a hearing
					 on the appeal held pursuant to
					 R.S.
					 23:1171 shall be held within 15 days of the
					 conclusion of the initial mediation conference, and shall be conducted in
					 accordance with the provisions of the Administrative Procedure Act.
C. Suspensive appeals of a determination of
					 the financial and compliance officer will not be entertained.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter A - General › Section I-6601 - Other Applicable Rules

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Unless otherwise provided for in these rules, any practice or procedure not in
					 conflict with either the Workers' Compensation Act or these rules will be
					 guided by practice and procedure provided for in the Louisiana Code of Civil
					 Procedure.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter A - General › Section I-6603 - Local Rules Prohibited

Current through Register Vol. 50, No. 6, June 20, 2024
A. Local
					 rules by any district office of the Office of Workers' Compensation
					 Administration are prohibited.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter A - General › Section I-6605 - Fees

Current through Register Vol. 50, No. 6, June 20, 2024
A. The clerks for
					 the Office of Workers Compensation Administration shall be entitled to demand
					 and receive the following fees as court costs in a workers compensation
					 dispute. Fees not pre-paid shall be due upon dismissal of or final judgment in
					 the docket number, or on demand by the clerk:
1. filing of LWC-WC-1008-$50;
2. filing of LWC-WC-1011 when no LWC-WC-1008
					 for the same parties, same accident, and same issue(s) is
					 pending-$50;
3. service of process
					 on secretary of state-$50 or as otherwise set by the secretary of
					 state;
4. copies of any paper in
					 any suit record-$0.25 per page;
5.
					 for each certification-$ 1 per page;
6. filing by facsimile or electronic
					 transmission-$5 transmission fee per hearing rule,
					 §5701.
					 C.1 c, in addition to $5 for the first 5
					 pages and $2.50 for each page thereafter;
7. cost of preparation of record for
					 appeal-available upon request from the district offices;
8. cost of service by certified mail-$8 per
					 service;
9. subpoenas/subpoenas
duces tecum-$5;
10. privilege of litigating without prior
					 payment of costs.
a. If a requestor is unable
					 to pay the costs of court in advance because of his or her poverty and lack of
					 means, the requestor shall fully execute an
in forma pauperis
request on the LWC request for waiver of advance costs form, and file the form
					 with the Office of Workers Compensation Administration. If the form is deemed
					 proper and the relief sought appropriate, a workers compensation judge shall
					 execute the pauper order, and the filing fee will not be due in advance or as
					 they accrue. If the request is denied by a workers compensation judge, all
					 costs shall be pre-paid in full before any documents may be filed.
b. In the event any person seeks to prosecute
					 a suit in a workers compensation court while incarcerated or imprisoned for the
					 commission of a felony without paying the costs in advance as they accrue or
					 furnishing security thereof, the court shall require such person to advance
					 costs in accordance with
Louisiana Code of Civil Procedure
,
					 article 5181(B) and (C).
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter A - General › Section I-6607 - Posting of Docket

Current through Register Vol. 50, No. 6, June 20, 2024
A. The clerk of
					 the district office shall keep a docket upon which shall be entered the docket
					 reference number of all matters set for mediation, hearing, or trial. The
					 docket shall be posted on the Department of Labor website and in a conspicuous
					 location of the district office on the first work day of each week for that
					 week.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter B - Costs › Section I-6609 - General

Current through Register Vol. 50, No. 6, June 20, 2024
A. The awarding of
					 costs shall be governed by
					 R.S.
					 23:1317(B) and Code of Civil
					 Procedure Article 1920.
B. The
					 costs of preparing an appeal shall be initially sustained by the appellant. In
					 the case of pauper, the costs incurred by the Office of Workers' Compensation
					 Administration in preparing the transcript shall be sustained by the Office of
					 Workers' Compensation Administration only where the pauper is the losing
					 party.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter B - Costs › Section I-6611 - Medical Costs

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except as
					 provided in
					 R.S.
					 23:1034.2(E), the
					 determination of all medical reimbursement shall be based upon the
					 reimbursement schedule in effect at the time the services are rendered. Every
					 attempt to resolve disputes over medical reimbursement shall be made by
					 applying said schedule(s).
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter C - Waiver of Costs for Indigent Party › Section I-6613 - General

Current through Register Vol. 50, No. 6, June 20, 2024
A. Waiver of costs
					 for indigent party shall be governed by
Code of Civil
					 Procedure
, articles 5181 et seq. The request for waiver of costs shall
					 be made on LWC request for waiver of payment of advance costs form.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter D - Severability of Sections › Section I-6627 - General

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any provision
					 or item of a Section, or the application thereof, is held to be invalid, such
					 invalidity shall not affect other provisions, items, or applications of the
					 section which can be given effect without the invalid provision, item or
					 application.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6629 - Annual Report of Workers' Compensation Costs ; Form LDOL-WC-1000

Current through Register Vol. 50, No. 6, June 20, 2024
ANNUAL REPORT OF WORKERS' COMPENSATION COSTS
FOR CALENDAR YEAR _____________
1. EMPLOYER INFORMATION
2. INSURANCE COMPANY INFORMATION
Fed EIN: Phone Number:
()
3. Coverage Provided: [] Self-insured / Excess
								  Insurance[]Conventional Workers' Compensation Policy
[] Combination of Insurance Policies
								  [R.S.
								  23:1168(A)(2)]
4. COSTS INCURRED DURING THE CALENDAR YEAR (See
								  Instructions)
Paid by Employer
Paid by Insurance
A. Indemnity Benefits:
1. Temporary Total
2. Supplemental Earnings
3. Permanent Partial
4. Permanent Total
5. Death Benefits
6. Other Compensation
TOTAL INDEMNITY BENEFITS
B. TOTAL COMPROMISE/LUMP SUM SETTLEMENTS:
C. Medical Expenses:
1. Hospital
2. Physicians
3. Diagnostic Tests/Procedures
4. Prescription Drugs
5. Transportation
6. Independent Medical Exams
7. Physical/Occupational Therapy
8. Other
TOTAL MEDICAL EXPENSES
D. Rehabilitation Expenses
1. Vocational Rehabilitation
2. Labor Market Surveys
3. Evaluations
4. Other
TOTAL REHABILITATION EXPENSES
Paid by Employer
Paid by Insurance
E. TOTAL FUNERAL EXPENSES
F. Legal Expenses
1. Attorney Fees
2. Court Costs
3. Deposition Costs
4. Investigation Costs
5. Penalties and Interest
6. Administrative/Other Costs
TOTAL LEGAL EXPENSES
G. Cost Summary
1. Total Indemnity Benefits (ITEM A)
2. Total Compromise/Lump Sum Settlements (ITEM
								  B)
3. Total Medical Expenses (ITEM C)
4. Total Rehabilitation Costs (ITEM D)
5. Total Funeral Expenses (ITEM E)
6. 3rd Party Recoveries for Costs (Not Included
								  Above)
7. Total Assessable Costs (1+2+3+4+5+6)
8. Total Legal Expenses (ITEM F)
9. TOTAL WORKERS' COMPENSATION COSTS
H. Number of Claims Summary
1. Carried over from prior year
2. Opened during current year
3. Closed during current year
4. Open at year end ( 1 + 2 - 3)
5. Total Medical only claims
I. OPEN RESERVE CLAIMS (at year end) Number
								  Amount
NOTE: The amount of compensation benefits paid
								  will be used by the director to make assessments for the administration of the
								  Workers' Compensation Office under the provisions of Act 29, 1983,
								  R.S.
								  23:1291.1 All other information submitted
								  will be used for statistical records only with the names of employers and
								  carriers being confidential and privileged. (R.S.
								  23:1293)
FOR OFFICIAL USE ONLY
I certify that the information contained herein
								  is true and correct to the best of my knowledge and belief.
____________________________
Signature Date
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6631 - Notice of Payment, Modification, Suspension, Termination or Controversion of Compensation or Medical Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
EMPLOYER/PAYOR MAIL TO:
1. Employee Social Security No.
					 ______-_____-_______
OFFICE OF WORKERS' COMPENSATION
2. Payor Claim No.:
					 _____________________________
POST OFFICE BOX 94040
3. Date of Injury/Illness
					 _________________________
BATON ROUGE, LA 70804-9040
4. Date of Notice: ______________________________
NOTICE OF PAYMENT, MODIFICATION,
						SUSPENSION, TERMINATION OR CONTROVERSION
OF COMPENSATION OR MEDICAL BENEFITS
5. Purpose of
					 Form (check one):
Initial Payment ____ Modification ____ Suspension ____
						Termination____ Controversion ____
6.
(a)
					 Employee Name:
Address:
						______________________________________________
Telephone:
						______________________________________________
(b) Employee Representative Name (if known)
Address:
						______________________________________________
Telephone:
						______________________________________________
Facsimile:
						______________________________________________
(c) Employer Name:
					 ______________________________________________
Address:
						______________________________________________
______________________________________________
Telephone:
						______________________________________________
Facsimile:
						______________________________________________
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6637 - Motion for Recognition of Right to Social Security Offset ; Form LDOL-WC-1005A

Current through Register Vol. 50, No. 6, June 20, 2024
Attached hereto and designated as "Attachment Number
						5."
STATE OF LOUISIANA
DEPARTMENT OF LABOR
OFFICE OF WORKERS' COMPENSATION
__________________________________________________________ * SS#:
VERSUS * DOCKET NO:________________________
___________________ * DISTRICT:
MOTION FOR RECOGNITION OF RIGHT TO SOCIAL SECURITY
						OFFSET
NOW INTO COURT as undersigned comes
						______________________________________________, employer/insurer in the
						referenced case, and requests the Workers' Compensation Judge to enter an order
						recognizing its right to take the reverse offset, since the claimant in this
						matter is receiving permanent total disability benefits under the Louisiana
						Workers' Compensation Act in addition to benefits under 42 U.S.C. Chapter 7,
						Subchapter II, entitled Federal Old Age, Survivors, and Disability Insurance
						Benefits.
SIGNED this the day of
,
20__.
__________________________
(PRINT NAME)
Agent for _________________
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6639 - Order Recognizing Right to Social Security Offset ; Form LDOL-WC-1005B

Current through Register Vol. 50, No. 6, June 20, 2024
Attached hereto and designated as "Attachment Number
						6".
STATE OF LOUISIANA
DEPARTMENT OF LABOROFFICE OF WORKERS'
						COMPENSATION
_________________ * SS#:
VERSUS * DOCKET
						NO:
____________________________
____________ * DISTRICT:
ORDER RECOGNIZING RIGHT TO SOCIAL SECURITY OFFSET
This matter is before the Workers' Compensation Judge on
						the motion of the employer/insurer for recognition of its right to claim the
						Social Security reverse offset in this case. The Workers' Compensation Judge
						finds that the claimant is receiving permanent total disability benefits under
						the provisions of the Louisiana Workers' Compensation Act in addition to
						benefits under 42 U.S.C. Chapter 7, Subchapter II, entitled Federal Old
						Age,
Survivors, and Disability Insurance Benefits. The
						Workers' Compensation Judge further finds the under that provisions of
						L.R.S.
						23:1225(A) the
						employer/insurer has claimed and is entitled to a reduction in the Workers'
						Compensation benefits paid to claimant in the amount of.
IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the
						employer/insurer is hereby allowed to offset the Workers' Compensation benefits
						paid to claimant in the amount of __________, beginning on _______, 20____, the
						date of employer/insurer's judicial demand.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the
						Social Security Administration reverse its Social Security offset effective
						_______, 20_____, the date of employer/insurer's judicial demand.
READ, RENDERED AND SIGNED this the ________ day of
						__________, 20 ___ at __________________ Parish, Louisiana.
___________________________________
WORKERS' COMPENSATION JUDGE
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6641 - Subpoena for Deposition and Subpoena Deuces Tecum ; Form LDOL-WC-1006A

Current through Register Vol. 50, No. 6, June 20, 2024
SUBPOENA FOR DEPOSITION
AND SUBPOENA DUCES TECUM
__________________________________
* DOCKET NO.
__________________
DISTRICT
VERSUS
* OFFICE OF WORKERS'
						COMPENSATION
* STATE OF
LOUISIANA
TO
___________________________________________
______________________________________________
YOU ARE HEREBY COMMANDED
to appear at the
						office of ________________________________________________
____________________________________________________________
____________________________________________________________,
address__________________________________________________________________________Telephone
						# ________ at ______________ o'clock ___________
________ .m. on the day of, 20, to have your oral
						testimony taken in the above entitled and numbered cause.
YOU ARE/ARE NOT (circle one) FURTHER COMMANDED
to produce at the above time and place the following:
This
SUBPOENA
was issued by the Office of
						Workers' Compensation on the ______________ day of
						____________________________, 20________.
_______________________________________
J. KAREN BEVAN, RECORDS MANAGER
Office of Workers' Compensation
This
SUBPOENA
was ordered by
								  Attorney:
_________________________
I hereby certify I have served a copy of this
								  subpoena on all attorneys of record.
_________________________
						____________________________
_________________________
Telephone:
(
						)
________________________
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6643 - Subpoena Deuces Tecum for Inspection ; Form LDOL-WC-1006B

Current through Register Vol. 50, No. 6, June 20, 2024
SUBPOENA AND SUBPOENA DUCES TECUM
_____________
* DOCKET NO.
__________________
DISTRICT
VERSUS
* OFFICE OF WORKERS'
						COMPENSATION
_____________
* STATE OF
LOUISIANA
TO
_______________________________________________________
_____________________________________________________________
YOU ARE HEREBY COMMANDED
to appear before
						the Workers' Compensation Court at
__________________________ Telephone #
						_________
_
_______ at o'clock
________ .m. on the________ day of _________, 20, or on
						any other day that this matter may be continued to give testimony in the above
						entitled and numbered cause.
You must remain in Court until discharged by
						the Judge. You must testify to the truth, to the best of your knowledge in this
						case
.
YOU ARE/ARE NOT (circle one) FURTHER COMMANDED
to produce at the above time and place the following:
FAILURE TO APPEAR OR PRODUCE AS DIRECTED ABOVE SHALL
						SUBJECT YOU TO ANY PENALTY AS PRESCRIBED BY LAW.
This
SUBPOENA
was issued by the Office of
						Workers' Compensation on the ______________ day of
						__________________________________, 20________ .
___________________________________
J. KAREN BEVAN, RECORDS MANAGER
Office of Workers' Compensation
This
SUBPOENA
was ordered by
								  Attorney:
_________________________
I hereby certify I have served a copy of this
								  subpoena on all attorneys of record.
______________________
						______________________
__
______________________
Telephone
:
(_____)________________________
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6645 - Subpoena and Subpoena Deuces Tecum ; Form LDOL-WC-1006C

Current through Register Vol. 50, No. 6, June 20, 2024
SUBPOENA AND SUBPOENA DUCES TECUM
*
DOCKET NO.
DISTRICT
VERSUS *
OFFICE OF WORKERS'
						COMPENSATION
*
STATE OF
LOUISIANA
TO
___________________________________________
______________________________________________
YOU ARE HEREBY COMMANDED
to appear before
						the Workers' Compensation Court at
_______________________________________________________________________________________________________________________
						,
_______Telephone # ___________at____________
						o'clock
________ .m. on the____________ day of, 20|___________,
						or on any other day that this matter may be continued to give testimony in the
						above entitled and numbered cause.
You must remain in Court until
						discharged by the Judge. You must testify to the truth, to the best of your
						knowledge in this case
.
YOU ARE/ARE NOT (circle one) FURTHER COMMANDED
to produce at the above time and place the following:
FAILURE TO APPEAR OR PRODUCE AS DIRECTED ABOVE SHALL
						SUBJECT YOU TO ANY PENALTY AS PRESCRIBED BY LAW.
This
SUBPOENA
was issued by the Office of
						Workers' Compensation on the ______________ day of
						__________________________________, 20________.
______________________________________
J. KAREN BEVAN, RECORDS MANAGER
Office of Workers' Compensation
This
SUBPOENA
was ordered by
								  Attorney:
_________________________
I hereby certify I have served a copy of this
								  subpoena on all attorneys of record.
_________________________
						________________________
_________________________
Telephone:
(
						)
___________________
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6647 - Employer's Report of Injury/Illness; Form LWC-WC-IA-1

Current through Register Vol. 50, No. 6, June 20, 2024
Workers Compensation
- First Report
						of Injury or Illness
Click Here
						To View Image
Click Here
						To View Image
LWC-WC-IA-1-Rev 12/2012
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6649 - Disputed Claim for Compensation; Form LDOL-WC-1008

Current through Register Vol. 50, No. 6, June 20, 2024
Click here to view
						image
Click here to view
						image
Click here to view
						image
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6651 - Request for Compromise and Lump Sum Settlement; Form LDOL-WC-1011

Current through Register Vol. 50, No. 6, June 20, 2024
Click here to view
						image
NOTE: *Note from the Office of the State Register: The
						backside of Form LDOL-WC-1011, Request for Compromise or Lump Sum Settlement,
						was not included on the disk. This form will need to be scanned or obtained
						from the agency.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6655 - Employer's Report of Occupational Injury and Illness Quarterly Summary ; Form LDOL-WC-1017A

Current through Register Vol. 50, No. 6, June 20, 2024
EMPLOYEE'S QUARTERLY REPORT OF EARNINGS
You must submit this Report to your workers'
								  compensation insurer within 14 days. Your workers' compensation benefits may be
								  suspended if you do not timely submit this Report. You would be entitled to all
								  suspended benefits after this report is provided to your Insurer, if you are
								  otherwise eligible for benefits.
You do not have to file this report if you have
								  timely filed all necessary LDOL-WC-1020 Forms, or if you have only received
								  medical benefits.
DO NOT
leave any blanks on this
								  Report. Print or type all responses, and use N/A (not applicable) or -0- (zero)
								  where appropriate.
1. The information in this Report is true for
								  the period beginning
______________________________________
, 20
________
and ending, 20 .
2. The name and address of the employer that I
								  am receiving benefits from is:
								  _________________________________________________________
3. Did you work for this employer in the past
								  quarter?_____________________________________________________________________________
If yes, how much were your gross wages? $
								  ________________________________________
4. Did you work for any other employer in the
								  past quarter? If yes, the name and address of the employer is_______________ If
								  yes, how much were your gross wages? $__________
5. Did you have any earnings through self
								  employment in the past quarter? If yes, how much? $_____________
6. Did you receive any unemployment compensation
								  benefits in the past quarter?
__________
If yes, how
								  much? $______________
7. I received $
________________________
in old age benefits under
								  Title ll of the Social Security Act.
8. I received $ in Social Security Disability
								  Benefits or other disability benefits.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6657 - Employee's Monthly Report of Earnings ; Form LDOL-WC-1020

Current through Register Vol. 50, No. 6, June 20, 2024
EMPLOYEE CERTIFICATION
I certify that I can read the English language,
								  that I have this entire document and understand its contents, and that I
								  understand I am held responsible for this information. I certify my answers are
								  complete and true, and certify my compliance with the Louisiana Workers'
								  Compensation Act.
__________________ _________________
								  _______________
PRINT NAME SIGNATURE SOCIAL SECURITY NUMBER
______________________________________
()
ADDRESS CITY STATE / ZIP PHONE NUMBER
_____________________________________________
EMPLOYER NAME DATE
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6662 - Attorney Fee Notice of Lien ; Form LDOL-WC-1027

Current through Register Vol. 50, No. 6, June 20, 2024
Attached hereto and designated as "Attachment Number
						16."
DOCKET NO.:________________
CLAIMANT:
__________________________________
REPRESENTATIVES:|___________________
EMPLOYER:
________________________________________
NOTICE OF LIEN
Pursuant to
						Section
						5547(B) of the
						hearing rules of the Office of Workers' Compensation
						Administration,
____________________________________
serves notice upon this Honorable Court and all parties to the above entitled
						claim that (he/she/it) represented the claimant from
(date)
to
(date)
and hereby
						asserts a lien on the proceeds of the claim for unpaid attorney fees.
Respectfully submitted,
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6663 - Scheduling Order ; Form LDOL-WC-1028

Current through Register Vol. 50, No. 6, June 20, 2024
Attached hereto and designated as "Attachment Number
						17."
CLAIMANT DOCKET NUMBER:
OFFICE OF WORKERS' COMPENSATION
VERSUS
DISTRICT __ - _______________
EMPLOYER STATE OF
LOUISIANA
SCHEDULING ORDER
On ________________, a scheduling conference was held
						pursuant to
						Section
						6001 of the hearing rules of the
						Office of Workers' Compensation Administration.
PRESENT:
_______________________ representing
						________________________
_______________________ representing
						________________________
_______________________ representing
						________________________
IT IS ORDERED:
1. Amendment to pleadings:
2. Discovery anticipated by the
					 parties:
3. All amendments to
					 pleadings are to be filed by
____________________
4. The cut-off date
					 for discovery is
__________________________________________
5. All pre-trial
					 motions are to be filed by
6. The
					 pre-trial conference is scheduled on __________ at _____ M
7. The pre-trial mediation will be held on
________________________________
8. Trial is scheduled for
IT IS FURTHER ORDERED
that a pre-trial
						statement shall be filed ten days prior to the pre-trial conference. The
						attorneys who will try the case shall participate in the pre-trial conference
						unless prior to the conference the Judge grants permission for other
						representatives to attend. Whoever participates in the conference must be
						familiar with the case and have authority to discuss the possibilities of
						settlement and stipulations. ________________________,
LOUISIANA
, THIS _____
DAY OF
______________,
20_
_
__________________________
Judge
Office of Workers' Compensation
District _____
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6664 - Choice of Physician; Form LDOL-WC-1121

Current through Register Vol. 50, No. 6, June 20, 2024
Notice to Injured Workers
You have the right to choose your own doctor!
When you are injured at work or become sick because of
						something that happened at work, the law gives you the right to choose your own
						doctor in any field or specialty of medicine for medical treatment.
The law also allows your employer to have you see
						his/her doctor, but you do not have to agree to continue treatment with your
						employer's doctor unless that is what you want.
If you want your employer's doctor to continue treating
						you after your first visit with him/her, and after receiving this form, you may
						choose your employer's doctor as your treating doctor.
Once you choose either your employer's doctor or your
						own doctor as your treating doctor, you may not be permitted to choose another
						doctor in that same field or specialty to treat you for your injury or illness
						later on. However, you are not required to get your employer's approval to
						change to a doctor in another field or specialty of medicine [R.S.
						23:1121(b)(1)].
If your employer denies your right to choose your
						doctor, you have a right to a speedy hearing before a workers' compensation
						judge to resolve the denial of your right [R.S.
						23:1121(b)(1) and
						1124(b)].
I hereby choose my own doctor to treat me for my injury
						or illness:
Dr._____________________________________________
or
By signing this form, I state that I know about my right
						to choose my own treating doctor, and being so advised, I hereby accept and
						choose to continue treating with my employer's doctor:
Dr._____________________________________________
_____ ________________ ___________________
Date Signature of Employee Printed Name of
						Employee
_____ _______________ ______________________
Date Signature of Employee Printed Name of
						Employee
(Note: If the employee is illiterate or has a language
						barrier, an authorized representative of the employer/insurer shall attest by
						their signature that this form and right of physician choice has been
						reasonably explained to that employee prior to his/her signature on this form.
						Failure to do so can jeopardize the employer's/insurer's right to subsequently
						refuse consent to the employee's request for treatment by a different physician
						within the same field or specialty.)
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						23:1310.1.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6665 - Workers' Compensation Records Request Form; LWC-WC-1150

Current through Register Vol. 50, No. 6, June 20, 2024
Click
						here to view image
Click
						here to view image
AUTHORITY
						NOTE: Promulgated in accordance with
						R.S.
						23:1310.1 and
						R.S.
						23:1293.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 3 - Hearing Rules › Chapter 66 - Miscellaneous › Subchapter E - Forms › Section I-6667 - Employee Authorization for OWCA to Release

Current through Register Vol. 50, No. 6, June 20, 2024
Click
						here to view image
Click
						here to view image
AUTHORITY
						NOTE: Promulgated in accordance with
						R.S.
						23:1310.1 and
						R.S.
						23:1293.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-101 - Approval of Settlements; Requirements ; Computation of Time

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. Requests for approval of the settlement of
				a third-party claim for settlement amounts less than $50,000 shall be submitted
				by facsimile transmission or hand delivery to the offices of the Second Injury
				Board.
2. Requests for approval of
				all other settlements may be submitted by United States Postal Services,
				facsimile transmission or hand delivery to the offices of the Second Injury
				Board.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-103 - Domicile of Board, Time of Meeting, Special Meetings

Current through Register Vol. 50, No. 6, June 20, 2024
A. The board shall be domiciled in Baton
				Rouge, Louisiana. It shall hold its regular meeting on the first Thursday of
				each month. Special meetings may be called upon giving three days' advance
				notice thereof.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1372.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-105 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. By reference,
				all of the definitions set forth and contained in
				R.S.
				49:950 through
				49:966,
				inclusive, are incorporated herein, and for the purpose of hearings to be held
				hereunder, the following definitions shall prevail.
Applicant
- the employer or insurer making
				  claim for reimbursement from the Workers' Compensation Second Injury
				  Fund.
Board
- the Office of Workers' Compensation,
				  Second Injury Board.
Hearing
- a hearing called by the board
				  under the authority of
				  R.S.
				  23:1378, Subsection C.
Hearing Officer
- the chairman or vice
				  chairman or any other person determined by the board to be qualified to conduct
				  hearings on its behalf.
Insurer
- the workers' compensation
				  insurance carrier of an employer.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1376.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-107 - Presentation of Claim for Reimbursement from Second Injury Fund, Timely Filing Thereof

Current through Register Vol. 50, No. 6, June 20, 2024
A. Within one
				year after the first payment of either compensation or medical benefits, the
				employer or his insurer, whichever of them makes the payments or becomes liable
				therefor, shall notify the board in writing of such facts and furnish such
				other information as may be required for the board to determine if the employer
				or his insurer is entitled to reimbursement from the Workers' Compensation
				Second Injury Fund. No employer, insurer, servicing agent or self-insured
				association shall be reimbursed unless the board is notified within one year
				from the date of the first payment of either compensation or medical
				benefits.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1376.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-109 - Disposition of Claim

Current through Register Vol. 50, No. 6, June 20, 2024
A. The board shall
				conduct such investigations, order such hearings and take such other actions as
				it finds necessary to make an intelligent decision on the claim. At least 30
				days prior to the date of the board meeting at which a decision on the claim is
				to be made, all interested parties shall be notified of the following:
1. the date, time, place and purpose of the
				meeting;
2. that a formal hearing
				on the claim pursuant to the provisions of
				R.S.
				49:955 may be requested provided such request
				is made in writing and is received in the office of the board at least 10 days
				prior to the date of said meeting; and
3. that unless a formal hearing is requested
				as provided in
				§109.
				A 2, the board will render its decision on
				the claim at said meeting.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-111 - Commencement of Hearings

Current through Register Vol. 50, No. 6, June 20, 2024
A. As
				authorized by
				R.S.
				23:1378.C and these rules of practice and
				procedure, hearings may be instituted by the board on timely request by the
				applicant or, at any time, on the board's own motion. No request by the
				applicant for a hearing shall be effective unless it is made in writing and
				received in the office of the board at least 10 days prior to the date of the
				board meeting at which a decision on the claim is to be made as set forth in
				§109
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1376.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-115 - Notice

Current through Register Vol. 50, No. 6, June 20, 2024
A. The board shall
				notify the applicant at least 15 days prior to the hearing and such notice
				shall conform to the requirements of
				R.S.
				49:955.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1376.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part III - Workers' Compensation Second Injury Board › Chapter 1 - General Provisions › Section III-117 - Answer or Appearance

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				applicant may file an answer or otherwise make an appearance on or before the
				date fixed for the hearing.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  23:1376.