BATON ROUGE – About $2.5 million in potential litigation costs have already been saved as a result of the Louisiana Workforce Commission’s implementation of medical treatment guidelines for workers’ compensation, the agency announced Monday.
The guidelines are a set of treatment protocols for injured workers that are based on best medical evidence. If the recommended care falls within the guidelines, it should be approved automatically by the employer or insurance carrier. If it falls outside the guidelines, an insurance carrier can deny it. The worker or his treating physician can appeal the denial to the LWC’s medical director, who can uphold the denial or, based on the specifics of the case and his medical judgment, he can approve the treatment. His decisions can be appealed in court.
Prior to the implementation of the medical guidelines on July 15, all medical disputes were litigated in court, where they would take an average of 15 months to resolve.
In contrast, as of September 30, 98 medical disputes were submitted to the medical director, where they were resolved in an average of 5 days. None of those determinations were appealed, and the window to appeal has closed. This new method of resolving disputes has eliminated the need for depositions, independent medical exams, second medical opinions, court reporters and attorney fees in each of those cases. Those costs typically cost in the neighborhood of $25,000 per case.
According to the Commission, the medical treatment guidelines benefit everyone in the workers’ compensation system. For employers and insurers, the guidelines assure that the recommended treatment is recognized by the medical community as proper and necessary. For workers and medical providers, the guidelines remove unreasonable delays in getting approval for treatment.
“This is a game-changing reform that is already showing great results,” LWC Executive Director Curt Eysink said. “The benefits will grow exponentially over time as we are able to study the effects on the quality and cost of health care and how much faster injured workers are able to return to gainful employment.”
Source: LA Workforce Commission