MEDICAL TREATMENT GUIDELINES

 

SUMMARY OF MEDICAL GUIDELINES PROCEDURE FOUND IN LOUISIANA REVISED STATUTE 23:1203.1

 

According to La. R.S. 23:1203.1, after a medical provider has submitted to the carrier a request for authorization of medical treatment and the information required by Louisiana Administrative Code, Title 40, Chapter 27, the carrier shall notify the medical provider of whether the request will be approved or denied within 5 business days of the request.

 

If there is any dispute as to whether the recommended treatment is in accordance with the medical treatment schedule, or whether a variance from the medical treatment schedule is reasonably required, any aggrieved party shall file, within 15 days, an appeal with the OWCA Medical Director on a form promulgated by the Director. 

 

Note:  A reasonable variance from the treatment schedule is treatment that, by a preponderance of scientific medical evidence, is reasonably required to cure or relieve the injured worker of the injury or occupational disease, but is different than that treatment set forth in the medical treatment schedule.

 

The Medical Director shall render a decision as soon as is practicable, but in no event, more than 30 days from the date of filing.

 

After a decision has been issued by the Medical Director, any party who disagrees with the decision may file a Form 1008, Disputed Claim for Compensation.