reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-306 - Electronic Medical Billing and Payment Companion Guide

Current through Register Vol. 50, No. 6, June 20, 2024
A. Introduction and Overview
1. HIPAA
a.
				  The Administrative Simplification Act provisions of the federal Health
				  Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) include
				  requirements that national standards for electronic health care transactions
				  and national identifiers for health care providers (provider), health plans,
				  and employers be established. These standards were adopted to improve the
				  efficiency and effectiveness of the nation's health care system by encouraging
				  the widespread use of electronic data interchange in health care. Additional
				  information regarding the formats adopted under HIPAA is included in Chapter 2.
				  Although workers compensation is excluded from HIPAA, these national standards
				  encourage use of electronic medical billing for workers compensation claims in
				  Louisiana.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-307 - Billing Code Sets

Current through Register Vol. 50, No. 6, June 20, 2024
A. Billing codes
				  and modifier systems identified below are valid codes for these workers'
				  compensation transactions, in addition to any code sets defined by the
				  standards adopted in
				  Section
				  305
1. "CDT-4 Codes"-codes and nomenclature
				  prescribed by the American Dental Association.
2. "CPT-4 Codes"-the procedural terminology
				  and codes contained in the "Current Procedural Terminology, Fourth Edition," as
				  published by the American Medical Association and as adopted in the appropriate
				  fee schedule contained in Title 40 of the Louisiana Administrative
				  Code.
3. "Diagnosis Related Group
				  (DRG)"-the inpatient classification scheme used by CMS for hospital inpatient
				  reimbursement. The DRG system classifies patients based on principal diagnosis,
				  surgical procedure, age, presence of co-morbidities and complications, and
				  other pertinent data.
4.
				  "HCPCS"-CMS' Healthcare Common Procedure Coding System, a coding system which
				  describes products, supplies, procedures, and health professional services and
				  which includes the American Medical Association's (AMA's) Physician "Current
				  Procedural Terminology, Fourth Edition," (CPT-4) codes, alphanumeric codes, and
				  related modifiers.
5. "ICD-9-CM
				  Codes"-diagnosis and procedure codes in the International Classification of
				  Diseases, Ninth Revision, Clinical Modification published by the United States
				  Department of Health and Human Services.
6. "ICD-10-CM/PCS Codes"-diagnosis and
				  procedure codes in the International Classification of Diseases, Tenth Edition,
				  Clinical Modification/Procedure Coding System maintained and published by the
				  United States Department of Health and Human Services.
7. "NDC"-National Drug Codes of the Food and
				  Drug Administration.
8. "Physical
				  Therapy"/"Occupational Therapy Codes: Codes specified in Title 40 of the LAC
				  covering physical therapy and occupational therapy services.
9. "Revenue Codes"-the four digit coding
				  system developed and maintained by the National Uniform Billing Committee for
				  billing inpatient and outpatient hospital services, home health services, and
				  hospice services.
10. "National
				  Uniform Billing Committee codes"-code structure and instructions established
				  for use by the National Uniform Billing Committee (NUBC), such as occurrence
				  codes, condition codes, or prospective payment indicator codes. These are known
				  as UB 04 Codes.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-309 - Electronic Medical Billing, Reimbursement, and Documentation

Current through Register Vol. 50, No. 6, June 20, 2024
A. Applicability
1. This Section outlines the exclusive
				  process to exchange electronic medical bill and related payment processing data
				  for professional, institutional/hospital, pharmacy, and dental services. This
				  Section does not apply to requests for reconsideration or judicial appeals
				  concerning any matter related to medical compensation or requests for
				  informational copies of medical records.
2. Unless exempted from this process in
				  accordance with Subsection B of this Section, insurance carriers or their
				  agents shall:
a. accept electronic medical
				  bills submitted in accordance with the adopted standards;
b. transmit acknowledgments and remittance
				  advice in compliance with the adopted standards in response to electronically
				  submitted medical bills; and
c.
				  support methods to receive electronic documentation required for the
				  adjudication of a bill, as described in
				  Section
				  315 of this Chapter.
3. If a health care provider
				  elects to utilize electronic medical bill submission, then the healthcare
				  provider shall:
a. exchange medical bill data
				  in accordance with the adopted standards;
b. submit medical bills as defined by
				  Section
				  305. A of this
				  Chapter, to insurance carriers that have established connectivity to the health
				  care provider's system or clearinghouse;
c. submit required documentation in
				  accordance with Subsection E of this Section; and
d. receive and process any acceptance or
				  rejection acknowledgment from the insurance carrier.
4. Insurance carriers must be able to
				  exchange electronic data by July 1, 2013 unless exempted from the process in
				  accordance with Subsection B of this Section.
5. The insurance carrier's failure to comply
				  with any requirements of this rule shall result in an administrative violation
				  under LAC 40:109.A.
6. Health care
				  providers who elect not to utilize electronic medical billing pursuant to
				  Section
				  305. A.1 of this
				  Chapter shall submit paper medical bills for payment pursuant to Title 40 of
				  the Louisiana Administrative Code.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-311 - Employer, Insurance Carrier, Managed Care Organization, or Agents' Receipt of Medical Bills from Health Care Providers

Current through Register Vol. 50, No. 6, June 20, 2024
A. Upon receipt of medical bills submitted in
				  accordance with Sections 305, 307, and 309 of this Chapter, an insurance
				  carrier shall evaluate each bill's conformance with the criteria of a complete
				  medical bill.
B. The received date
				  of an electronic medical bill is the date all of the contents of a complete
				  electronic bill are successfully received by the insurance carrier.
C. The insurance carrier may contact the
				  medical provider to obtain the information necessary to make the bill complete.
1. Any request by the insurance carrier or
				  its agent for additional documentation to pay a medical bill shall:
a. be made by telephone or electronic
				  transmission or through web portal access if available unless the information
				  cannot be sent by those media, in which case the sender shall send the
				  information by mail or personal delivery;
b. be specific to the bill or the bill's
				  related episode of care;
c.
				  describe with specificity the clinical and other information to be included in
				  the response;
d. be relevant and
				  necessary for the resolution of the bill;
e. be for information that is contained in or
				  in the process of being incorporated into the injured employee's medical or
				  billing record maintained by the health care provider; and
f. indicate the specific reason for which the
				  insurance carrier is requesting the information.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-313 - Communication between Health Care Providers and Insurance Carriers

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
				  communication between the health care provider and the insurance carrier
				  related to medical bill processing shall be of sufficient specific detail to
				  allow the responder to easily identify the information required to resolve the
				  issue or question related to the medical bill. Generic statements that simply
				  state a conclusion such as "insurance carrier improperly reduced the bill" or
				  "health care provider did not document" or other similar phrases with no
				  further description of the factual basis for the sender's position do not
				  satisfy the requirements of this Section.
B. Utilization of the ASC X12N Reason Codes,
				  or as appropriate, the NCPDP Reject Codes, by the insurance carrier when
				  communicating with the health care provider or its agent or assignee, provides
				  a standard mechanism to communicate issues associated with the medical
				  bill.
C. Communication between the
				  health care provider and insurance carrier related to medical bill processing
				  shall be made by telephone or electronic transmission unless the information
				  cannot be sent by those media, in which case the sender shall send the
				  information by mail or personal delivery.
D. The insurance carrier's failure to comply
				  with any requirements of this Rule shall result in an administrative violation
				  LAC 40:109.A.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1203.2.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-315 - Medical Documentation Necessary for Billing Adjudication

Current through Register Vol. 50, No. 6, June 20, 2024
A. Medical
				  documentation includes all medical reports and records permitted or required in
				  accordance with Title 40 of the Louisiana Administrative Code.
B. Any request by the insurance carrier for
				  additional documentation to process a medical bill shall conform to the
				  requirements of
				  Section
				  311. C of this
				  Chapter.
C. It is the obligation of
				  insurance carriers to furnish its agents with any documentation necessary for
				  the resolution of a medical bill.
D. Health care providers, health care
				  facilities, third-party biller/assignees, and claims administrators and their
				  agents must comply with all applicable federal and state rules related to
				  privacy, confidentiality, and security.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1203.2.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-317 - Compliance and Penalty

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any
				  electronically submitted bill determined to be complete but not paid or
				  objected to within 60 days shall be subject to penalties per R.S.
				  1201(F).
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1203.2.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 3 - Electronic Billing › Section I-319 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This Chapter
				  applies to all medical services and products provided on or after July 1, 2013
				  for medical services and products provided prior to July 1, 2013, medical
				  billing and processing shall be in accordance with the rules in effect at the
				  time the health care was provided.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1203.2.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-701 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				  this Section of administrative rule is to implement the provisions of
				  R.S.
				  23:1226 and establish guidelines for the
				  rehabilitation of the occupationally disabled employee.
B. The purpose of the Rehabilitation Program
				  is to coordinate and assure the most efficient and timely delivery of the
				  multiple services often necessary to restore the occupationally disabled
				  employee to employment as soon as possible after the injury.
C. There are two major overlapping and
				  interrelated components of the rehabilitation process:
1. vocational restorative services;
				  and
2. reemployment
				  services.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-703 - Statutory Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A.R.S.
				  23:1226.A requires that when an employee has
				  suffered an injury covered by Chapter 10, R.S. 23 which precludes the employee
				  from earning wages equal to wages earned prior to the injury, the employee
				  shall be entitled to prompt rehabilitation services provided by the
				  carrier/employer.
B.R.S.
				  23:1226.B requires that in considering the
				  goal of returning a disabled worker to work with a minimum of retraining, the
				  first appropriate option listed therein is to be chosen.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-705 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. For purposes of
				  this Section the following definitions apply.
Evaluation
- any testing, analysis or
					 assessment of the occupationally disabled employee's physical and/or vocational
					 capabilities used to determine the need for and practicability of
					 rehabilitation services to restore the employee to gainful employment.
Private Agencies
- companies which provide
					 vocational rehabilitation services for a fee.
Reemployment Services
- services used to
					 reemploy the occupationally disabled employee in a suitable, gainful occupation
					 as adjusted by his/her physical and vocational ability at that time.
Rehabilitation
- the restoration of an
					 occupationally injured or diseased employee to employment as soon as possible
					 after the injury.
Rehabilitation Services
- vocational
					 and/or reemployment services necessary to restore an occupationally disabled
					 employee, as nearly as possible, to his/her pre-injury status.
State and Federal Agencies
- those
					 agencies which provide vocational education paid for with tax money.
Suitable Employment
- employment or
					 self-employment, after rehabilitation which is reasonably attainable and which
					 offers an opportunity to restore the individual as soon as practical and nearly
					 as possible to his average earnings at the time of this injury including any
					 sheltered employment, odd-lot or employment while working in pain.
Vocational Restorative Services
-
					 vocational services needed to restore the occupationally disabled employee to
					 his/her pre-injury employment or if that is not possible to that which he/she
					 enjoyed prior to the occupational injury or disease. Such services include but
					 are not limited to, the following: psychological and vocational evaluations,
					 counseling and training services.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-707 - Responsibility to Provide Service

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  It is the responsibility of the carrier/employer to select a vocational
				  counselor to evaluate and assist the employee in his job placement and/or
				  vocational training.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-709 - Use of Resources

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  carrier/employer may utilize programs provided by state and federal agencies
				  for rehabilitation services when conveniently available or may utilize any
				  public or private agency cooperating with such state and federal agencies. In
				  the absence of such programs, the carrier/employer shall provide rehabilitation
				  services with available private agencies.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-711 - Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. A rehabilitation
				  dispute or claim can be filed on Form LDET-WC-1005 by the employee, employer or
				  carrier when rehabilitation services are not voluntarily offered or accepted.
				  The hearing officer may consider written vocational rehabilitation evaluations
				  and plans prepared by a private or public rehabilitation provider or counselor
				  and/or may refer the employee to a qualified physician and/or approved
				  facility, individual, institution or organization for the evaluation of the
				  practicality, advisability and necessity of rehabilitation services to restore
				  the employee to suitable gainful employment. Any evaluation ordered by the
				  hearing officer shall be completed in 45 days from the receipt of the referral
				  from the hearing officer, with the expense of such evaluation to be borne by
				  the employer/carrier.
B. If
				  rehabilitation services are deemed practical and advisable, they shall be
				  ordered at the expense of the carrier/employer subject to the reimbursement
				  schedule for rehabilitation services promulgated at the time of the filing of
				  the claim or dispute.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-713 - Adjudication by Hearing Officer

Current through Register Vol. 50, No. 6, June 20, 2024
A. Prior
				  to the hearing officer finding that an occupationally disabled employee is
				  permanently and totally disabled, the hearing officer shall determine whether
				  there is reasonable probability that, with appropriate rehabilitation services
				  which may include training and/or education, the occupationally disabled
				  employee can achieve suitable gainful employment and whether it is in the best
				  interest of such individual to undertake such rehabilitation
				  services.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-715 - Duration

Current through Register Vol. 50, No. 6, June 20, 2024
A. When it appears
				  that appropriate training and/or education is necessary and desirable to
				  restore the occupationally disabled employee to suitable gainful employment,
				  the employee shall be entitled to 26 weeks of training and/or education and an
				  additional 26 weeks if deemed necessary and proper by the hearing officer.
				  However, no carrier/employer shall be precluded from continuing such
				  rehabilitation beyond such period on a voluntary basis. An occupationally
				  disabled employee must request and begin rehabilitation within two years from
				  the date of termination of temporary total disability as determined by the
				  treating physician.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-717 - Cost of Rehabilitation Services and Supplies

Current through Register Vol. 50, No. 6, June 20, 2024
A. When appropriate training and/or education
				  is deemed necessary, the rehabilitation services provided shall include the
				  cost of training, tuition, books, tools and/or equipment.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-719 - Location of Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. If
				  rehabilitation requires residence at or near the facility or institution away
				  from the occupationally disabled employee's customary residence, reasonable
				  costs of his/her board, lodging and travel shall be paid for by the
				  employer/carrier. A retraining program shall be provided at facilities within
				  the state when such facilities are available.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-721 - Penalty for Refusal

Current through Register Vol. 50, No. 6, June 20, 2024
A. Although an
				  occupationally disabled employee is entitled to rehabilitation as a right or
				  benefit, when he/she agrees to a rehabilitation program, dedication to the
				  completion of that program is expected.
B. Demonstration of a lack of responsibility
				  by the occupationally disabled employee in following through with the
				  rehabilitation plan or refusal to accept rehabilitation as deemed necessary by
				  the hearing officer shall result in a 50 percent reduction in weekly
				  compensation, including supplemental earnings benefits pursuant to
				  R.S.
				  23:1221(3), for each
				  documented week of the period of refusal.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-723 - Payment of Temporary Disability

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Temporary disability benefits paid pursuant to
				  R.S.
				  23:1221(1) shall include
				  such period as may be reasonably required for training in the use of artificial
				  members and appliances and shall include such period as the employee may be
				  receiving training or education under a rehabilitation program approved by the
				  hearing officer.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 7 - Rehabilitation Services › Section I-725 - Approved List of Rehabilitation Providers

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Office of Workers' Compensation
				  Administration will maintain a current listing of rehabilitation counselors
				  licensed to practice rehabilitation services in the state of Louisiana. This
				  listing will be available upon request.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1226.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 9 - Safety Requirements › Section I-901 - Statutory Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A.R.S.
				  23:1291.B.(4), as amended, requires every
				  Louisiana employer of more than 15 employees to provide, if self-insured, or is
				  provided by the carrier, if privately insured, plans for implementation of a
				  working and operational safety plan. The plans shall be made available for
				  inspection by the director upon request. The plan shall be privileged and
				  confidential pursuant to
				  R.S.
				  23:1293, provided that the operational safety
				  plan may be subpoenaed from the employer who shall certify under oath that it
				  is a duplicate of the plan submitted to the director.
B. In order to ensure adequate safety
				  resources for Louisiana employers and employees, the director shall maintain a
				  list of safety professionals/engineers from the private sector, which shall be
				  available upon request by any Louisiana employer.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1291.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 9 - Safety Requirements › Section I-905 - Availability of Safety Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  director shall maintain a list from the private sector of safety practitioners
				  who meet the criteria as set forth in the definition of a safety
				  professional/engineer in
				  §903 This list
				  shall be made available to any Louisiana employer upon request.
B. In-house safety staff shall be a full-time
				  employee(s) whose primary function within the organization includes work of
				  progressive importance and achievement towards accident prevention.
C. Insurance carrier safety staffs are
				  full-time employees whose primary functions include safety engineering
				  services.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1291.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 9 - Safety Requirements › Section I-909 - Submission of Safety Plan

Current through Register Vol. 50, No. 6, June 20, 2024
A. Safety
				  plans shall be submitted to the director upon request.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1291.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 9 - Safety Requirements › Section I-911 - Employee Notice

Current through Register Vol. 50, No. 6, June 20, 2024
A. It shall be
				  the employer's duty to advise employees and keep posted at some convenient and
				  conspicuous point in his place of business a notice reading substantially as
				  follows.
LOUISIANA DEPARTMENT OF LABOR
OFFICE OF WORKERS' COMPENSATION
ADMINISTRATION
POST OFFICE BOX 94040
BATON ROUGE, LA 70804 -9040
1. Notice of Compliance to Employees
a. You should report to your employer any
				  occupational disease or personal injury that is work related, even if you deem
				  it to be minor.
b. In case of
				  occupational disease, all claims are barred unless the employee files a claim
				  with his employer within six months of the date that:
i. the disease manifests itself;
ii. the employee is disabled as a result of
				  the disease; and
iii. the employee
				  knows or has reasonable grounds to believe that the disease is occupationally
				  related.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 9 - Safety Requirements › Section I-913 - Lost Time Injury Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A. Within 10
				  days of actual knowledge of injury to an employee which results in death or in
				  lost time in excess of one week after the injury, the employer shall report
				  same to the carrier, if any, and to the office on Form LDET-WC-1007.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1306.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1101 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				  these rules is to establish and implement effective injury control measures for
				  employers in high rate classifications with insurance experience modifier rates
				  of 1.5 or greater.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1103 - Forms; Preparation and Adoption; Use

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Office of Workers' Compensation shall
				  prepare and adopt such forms for use in workers' compensation cost containment
				  as it may deem necessary and advisable. Whenever the Office of Workers'
				  Compensation's forms are prescribed and are applicable, they shall be used. A
				  photo ready copy of any form may be procured upon request to the
				  office.
B. The following forms have
				  been adopted by the Office of Workers' Compensation Administration for use in
				  implementation of the Workers' Compensation Cost Containment Act.
FORMS
LDOL-WC-Form No. 1021
Application for Attendance at Cost Containment
								Meeting
LDOL-WC-Form No. 1022
Certificate of Attendance
LDOL-WC-Form No. 1023
Application for Implementation of Occupational
								Safety and Health Program
LDOL-WC-Form No. 1024
Certificate of Satisfactory Implementation of
								Occupation Safety and Health Program
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1105 - Cost Containment Meeting

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				  number of statewide meetings shall be held between June and September of each
				  year. A notice of all the meetings scheduled for that year shall be sent to all
eligible employers
as defined in
				  R.S.
				  23:1176. Eligible employers who have not
				  qualified for a reduction in the prior three years shall be sent by certified
				  mail return receipt requested at least 30 days prior to the first scheduled
				  meeting.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1106 - Experience Modifier Rates

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				  employer's eligibility shall be based on its experience modifier rate of
				  December 31 of the prior year.
B.
				  The incentive discount provided in
				  R.S.
				  23:1178.C shall be based on the employers
				  next effective experience modifier rate after its certified attendance at a
				  cost containment meeting. The certificate of attendance as issued by the
				  Department of Labor, Office of Workers' Compensation, shall be valid only
				  during the period of the employer's next effective experience modifier rate
				  following its certified attendance at a cost containment meeting.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1107 - Application for Attendance at Cost Containment Meeting

Current through Register Vol. 50, No. 6, June 20, 2024
A. A verified application Form LDOL-WC-Form
				  No. 1021 together with proof that the attendee is a person in a position of
				  authority within the company must be received 15 days prior to the scheduled
				  meeting to guarantee consideration. Proof may include but shall not be limited
				  to a verified job description, annual report to Secretary of State, copy of the
				  preprinted tax form or act of partnership. Notice shall be given five days
				  prior to the meeting if the office finds that the designated attendee is not a
				  person in a position of authority within the company.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1109 - Proof of Attendance ; Certificate

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to obtain a certificate of
				  attendance, LDOL-WC-Form No. 1022 at a cost containment meeting, the attendee
				  must have qualified as a designated representative as defined in
				  R.S.
				  23:1176(1). At the meeting
				  the designated representative shall submit pictured identification and sign the
				  roles of attendance. The certificate shall thereafter be mailed to those
				  eligible employers who have not qualified for a reduction in the prior three
				  years. Any application received within 15 days prior to a meeting may not be
				  considered.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1111 - Failure to Attend; Fines

Current through Register Vol. 50, No. 6, June 20, 2024
A. After
				  the last scheduled meeting of a year the director upon verification of notice
				  and failure to attend shall send a notice of fine to all eligible employers as
				  provided in
				  R.S.
				  23:1178.D.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1113 - Application for Participation in the Occupational Safety and Health Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. Only eligible
				  employers who have certificate of attendance Form LDOL-WC-Form No. 1022 issued
				  within the last four years may apply for participation in the Occupational
				  Safety and Health Program.
B. An
				  application for participation in the Occupational Safety and Health Program
				  shall consist of the following:
1. a properly
				  completed Form LDOL-OWC 1023;
2. a
				  copy of the applicant's OSHA 200 log from the previous year;
3. a sworn statement that:
a. the company has written safety programs
				  and training documentation as required by OSHA standards relevant to its
				  facility for at least a six-month period;
b. the applicant's lost workday incident rate
				  is less than the national average for its respective Standard Industrial
				  Classification (SIC) code; and
c.
				  the applicant company has experienced no fatalities within the 24 months
				  immediately preceding the date of the application; and
4. any additional information which the
				  Occupational Safety and Health Section of the Office of Workers' Compensation
				  Administration deems necessary to evaluate the application.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1115 - Report to the Employer

Current through Register Vol. 50, No. 6, June 20, 2024
A. Upon
				  completion of surveys of all existing sites of a business, OSHA shall issue to
				  the employer an official inspection report with identified hazards and safety
				  program deficiencies and a timetable for taking corrective actions.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1117 - Standard for Satisfactory Implementation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The standards used by the Office of
				  Workers' Compensation Administration, OSHA section, in determining a
				  participant's satisfactory implementation of the Occupational Safety and Health
				  Program shall be those provided in Title 29 of the Code of Federal Regulations,
				  Sections 1910 and any regulations of ANSI, NEC and NFPA applicable to the
				  participant.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1119 - Inspections

Current through Register Vol. 50, No. 6, June 20, 2024
A. When the
				  official inspection report contains any recommendation for correction of
				  hazards or program deficiencies the employer must submit proof of compliance.
				  The OSHA section may require a follow up inspection to verify satisfactory
				  implementation.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1121 - Certificate of Satisfactory Implementation

Current through Register Vol. 50, No. 6, June 20, 2024
A. A certificate of satisfactory
				  implementation LDOL-WC-Form No. 1024 shall be issued only to those eligible
				  employers who have not qualified for a reduction pursuant to
				  R.S.
				  23:1179.C in the prior three years.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1178.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1123 - Cost Credit Earned from Satisfactory Implementation

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any safety and health hazard survey of the
				  work place by the OSHA section consultants, including an evaluation of the
				  employer's safety and health program and on-site interviews with employers and
				  employees under
				  R.S.
				  23:1179, shall be on-site inspections. All
				  permanent, temporary, and multiple work sites shall be subject to
				  inspection.
B. The on-site
				  inspection of each eligible employer who has attended an authorized cost
				  containment meeting shall be made in two phases; namely, the initial phase and
				  the follow-up phase. The OSHA section shall not determine whether an eligible
				  employer has satisfactorily implemented the OSHA section's occupational safety
				  and health program until the initial and follow-up phases are completed. The
				  effective date of qualification or disqualification of such eligible employer
				  shall be the date of the report issued after the initial and follow-up phases
				  are completed.
1. The initial phase shall be
				  the first of any safety and health hazard surveys of the work place by the OSHA
				  section, including an evaluation of the employer's safety and health program
				  and on-site interviews with employers and employees by the OSHA section. The
				  effective date of the completion of the initial phase shall be the date that
				  the correction of hazards report is received by the OSHA section. The
				  correction of all hazards identified during the on-site visit shall be made
				  within six months of the visit.
2.
				  The follow-up phase shall be a safety and health hazard survey of the work
				  place by the OSHA section, including an evaluation of the employer's safety and
				  health program and on-site interviews with employers and employees by the OSHA
				  section. This follow-up phase shall be conducted no earlier than six months
				  after the initial phase is completed.
3. Notwithstanding the provisions of
				  §1123.
				  B 2, the follow-up phase may be conducted
				  earlier than six months after the initial phase is completed if the company has
				  had an operational safety plan in effect for the prior 12 months, and if the
				  company has satisfied all elements of management commitment and planning,
				  hazard assessment, hazard correction and control, and safety and health
				  training, as provided in Form Consultation-33, for the prior 12
				  months.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1125 - Qualification for Cost Credit under R.S. 23:1179

Current through Register Vol. 50, No. 6, June 20, 2024
A. Employers shall be eligible for a
				  reduction in their experience modifier rate pursuant to
				  R.S.
				  23:1179 when all of the following conditions
				  are met:
1. satisfactorily implementation of
				  the OSHA section's occupational safety and health program when the initial and
				  follow-up phases are completed;
2.
				  a loss work day incident rate less than the national average for their
				  respective SIC, as indicated on their completed OSHA 200 Form for the prior
				  calendar year; and
3. no fatalities
				  within the 24 months immediately preceding the initial inspection or, in the
				  case of a reapplication, within the 24 months immediately preceding the date of
				  the reapplication.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1127 - Reapplication after Failure to Qualify

Current through Register Vol. 50, No. 6, June 20, 2024
A. An employer that fails to qualify for the
				  reduction in the experience modifier rate under
				  R.S.
				  23:1179 because of a determination that the
				  employer has not satisfactorily implemented the OSHA section's occupational
				  safety and health program or because of its loss work day incident rate, shall
				  be allowed to reapply for the reduction in the experience modifier rate after
				  12 months from the date of the final report.
B. An employer that fails to qualify for the
				  reduction in the experience modifier rate under
				  R.S.
				  23:1179 because of a fatality shall be
				  allowed to reapply no earlier than 24 months from the date of the
				  fatality.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1179.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1129 - Employer Eligibility for Safety and Health Program Assessment

Current through Register Vol. 50, No. 6, June 20, 2024
A. Comprehensive
				  program assessment shall be accomplished by category and by order that
				  applications are received.
1. Category I
				  shall consist of sites which have 250 employees or less, and 500 or less total
				  employees at all sites controlled by the employer based on the average level of
				  employment during the most recent 12 months. Sites operated by governmental
				  agencies are specifically excluded.
2. Category II shall consist of all sites
				  which do not meet the criteria of Category I.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 11 - Workers' Compensation Insurance Cost Containment › Section I-1131 - Discount Application Period

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  The incentive discount provided in
				  R.S.
				  23:1179.B shall be based on the employer's
				  next effective modifier rate after its certified satisfactory implementation of
				  an approved occupational safety and health program. A certificate shall be
				  issued by the Office of Workers' Compensation evidencing the satisfactory
				  implementation of an occupation safety and health program. Such certificate
				  shall be valid only during the period of the employer's next effective modifier
				  rate after its certified satisfactory implementation of the approved
				  occupational safety and health program.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 23:1179.
Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 1 - General Administration › Chapter 15 - Drug Testing Programs in Job Related Accident Cases › Section I-1501 - Introduction

Current through Register Vol. 50, No. 6, June 20, 2024
A. The following
				  represents the text of the Office of Workers' Compensation Administration's
				  scientific and technical guidelines for accident-related drug testing programs,
				  as directed by Act 454 of the Regular Session of 1989. These guidelines address
				  the mandatory scientific and technical requirements of drug testing protocols,
				  including collection of specimens, chain of custody and laboratory analysis.
1. Laboratories may not deviate from the
				  provisions of these guidelines without the written approval of the director of
				  the Office of Workers' Compensation Administration, or his designee.
2. These guidelines are to be effective
				  immediately upon promulgation. Laboratories currently operating drug testing
				  programs are to bring their programs into compliance within 180 days of
				  promulgation.
3. The director of
				  the Office of Workers' Compensation Administration or his designee may
				  routinely update these guidelines for the purpose of conforming them to
				  advances in technology or providing additional guidance.