Employer's Duties to Report Accidents and Pay Benefits

Medical Only Claims
There is no duty to report these claims to the Office of Workers' Compensation (OWC).

Lost Time Claims
The employer must report accidents involving death or lost time to the insurer and the OWC within ten (10) days of actual knowledge that the injury has resulted in death or lost time in excess of one week [La. Rev. Stat. 23:1306]. The form to be used is the "Employer's Report of Occupational Injuries or Disease", LDOL-WC-1007.

Payment of Weekly Benefits
Death benefits are to be paid to the dependents within fourteen (14) days of the employer's knowledge of the compensable death [La. Rev. Stat. 23:1201 B]. Death benefits are to be reported to the OWC on LDOL-WC-1010.

Temporary total disability and permanent total disability benefits are to be paid within fourteen (14) days of the employer's knowledge of the disability [La. Rev. Stat. 23:1201 B]. The report of payment to the OWC is to be made with form LDOL-WC-1002. If the disability continues beyond six weeks, then benefits are owed for the first week of disability.

Supplemental earnings benefits are to be paid fourteen (14) days after the employer has knowledge of a compensable supplemental earnings benefit claim [La. Rev. Stat. 23:1201 C]. Employer KNOWLEDGE of the wage loss is established by the employee reporting the wage loss to the employer (see form in Part II Adjusting Tools). Without knowledge of the wage loss, the employer has no duty to pay supplemental earnings benefits. It is recommended that the employer provide the employee with the form and notify the employee of his duty to send the report to the employer at the end of every month in which he has a compensable wage loss. The report of payment to OWC is to be made with form LDOL-WC-1002.

Termination of Benefits
When weekly or supplemental earnings benefits are stopped, the employer must report the termination of benefits to the OWC on form LDOL-WC-1003. Reduction of benefits from temporary total to supplemental earnings benefits are reported on form LDOL-WC-1002.

Payment of Medical Benefits
Medical benefits must be paid within sixty (60) days after the employer has received a written demand for payment [La. Rev. Stat, 23:1201.2]. Under the provisions of the Utilization Review Rules, the health care provider must give the employer sufficient information regarding the nature of the treatment and the diagnosis so that the employer can make a determination as to whether the treatment is related to the job accident [UR Rules, Section 2717]. Fees of health care providers are limited to the amount allowed under the reimbursement schedule established by the OWC [La. Rev. Stat. 23:1034.2].

Penalties
Failure to pay or late payment - The penalty for failure to pay or late payment of indemnity or medical benefits is 12% of the amount owed or $50 per day (not to exceed $2, 000) WHICHEVER IS GREATER. There are no penalties assessed against an employer who has "reasonably controverted" the claim for benefits [La. Rev. Stat. 23:1201].

Attorney's Fees
In addition to the penalties, an employer who has failed to pay indemnity or medical benefits after sixty (60) days of receipt of written demand will be required to pay "reasonable attorney's fees" if the failure to pay is found to be arbitrary, capricious or without probable cause". [La. Rev. Stat. 23:1201.2].