Lousiana workers' compensation

Reversal of Medical Director’s Approval in Louisiana

We recently received a letter from an attorney colleague of ours in Louisiana, Wayne Fontana with Roedel Parsons Koch Blache Balhoff & McCollister, informing us he recently received a judgement out of District 07 which overturned a medical director’s decision approving a $40,000 knee surgery.  Of note, the trial judge “specifically determined that the knee surgery was not in accordance with the medical treatment schedule and thereby overturned the medical director’s approval.”  It has historically been very difficult, if not impossible, to overturn the opinions of medical directors in Louisiana.  This has resulted, in our opinion, in inflated costs of future medical care as unapproved and unnecessary care has to be accounted for at the settlement of a workers’ compensation claim.  Once improper decisions are rendered by a medical director, decisions are typically made to not approach a settlement due to the increased cost to do so. Hello legacy claim.

This reversal is noteworthy as it could open the door for an increased number of successful, and medically appropriate, appeals.  Mr. Fontana said to us via email, “The more people who know that this medical director should be challenged and that, with the right case, his rubber stamp approvals can be reversed, the better.”  To our Louisiana clients, it would be a good idea to review prior unfavorable decisions from medical directors and investigate whether or not you might have a case for a successful appeal.

To view the letter from Mr. Fontana, please click here.

LASIE Looks to Build on Momentum Gained from Burgess Decision

Louisiana employers and workers’ compensation insurers received a bit of financial relief last summer when the Louisiana Supreme Court held that employers were free to choose which pharmacy injured workers are to use to fill their prescription medications related to their industrial injury.  The decision reached by the court in Burgess v. Sewerage and Water Board of New Orleans was a pivotal first step in reining in rising workers’ compensation costs in Louisiana.

Additionally, the Supreme Court recognized the possibility that even though medical fees may fall within the amounts established in the reimbursement schedule, they may also be declared unreasonable and not subject to compensation under certain circumstances.  This decision could very well leave the door open to future legal arguments against unreasonable medical services provided by outpatient facilities.  

On the heels of the Burgess decision, our good friends at the Louisiana Association of Self Insured Employers (LASIE) are hosting a seminar on Monday, April 16, 2018 in Baton Rouge to not only discuss the financial impacts the Burgess Decision has had on pharmacy costs in Louisiana over the past 9 months, but will also offer up valuable bits of information from attorneys in Louisiana on the practical implications this decision should have on a workers’ compensation program. For registration information on this seminar, please click here.