Louisiana Workers’ Compensation Misconceptions | Part 3: Medical Benefits

As we’ve discussed in earlier blog posts, when it comes to Louisiana Workers’ Compensation, legal misconceptions are quite common. And since we receive questions frequently, we decided to address the most common misconceptions our clients have to clarify any confusion. Follow along for the third topic in our multi-part series addressing these misunderstandings. In Part 3, we address Louisiana medical benefits misconceptions related to workers’ comp.

*If you missed Part 1 or Part 2 regarding misconceptions related to workers’ compensation claims or indemnity benefits, you can view them on our Blog.

MISCONCEPTION #1: I can see any doctor I want to see for any reason at any time in my workers’ compensation claim.

While you do have the right to chose your own doctor, you only get one choice in any one field of specialty, subject to few exceptions. With the delays and red tape involved in the workers’ compensation medical treatment guideline system in Louisiana, not all doctors will accept workers’ compensation insurance in Louisiana.

MISCONCEPTION #2: The workers’ compensation insurance company must approve any treatment my doctor asks for.

Any treatment your doctor asks for must be causally related to your accident. i.e., if you hurt your back in a work accident, the workers’ compensation company does not have to approve treatment to your foot. The treatment your doctor asks for must also be “medically necessary” under the medical treatment guidelines. All insurance companies send your doctor’s treatment request to Utilization Review to check whether the treatment complies with State Law.

MISCONCEPTION #3:

I can use whichever pharmacy I would like to use.

This is a widespread Louisiana Medical Benefits Misconception related to workers’ compensation. Unfortunately, the Louisiana Supreme Court decided that the employer and insurer can choose which pharmacy is used.

MISCONCEPTION #4: I get to chose my own doctor, and so, I don’t have to go to the doctor that the workers’ compensation company sends me to.

Because you can choose one doctor, the insurance company can choose a doctor as well. Injured workers must submit to examinations by insurance company doctors from time to time, as often as may be reasonably necessary, at reasonable hours and places, and during the pendency of his/her claim for compensation or during the receipt by him/her of payments. If you fail to attend an appropriately noticed appointment, your benefits may be suspended by the insurance company.

MISCONCEPTION #5:

If I refuse to undergo surgery, the workers’ compensation insurance company can cut me off to make me undergo surgery.

The insurance company cannot terminate your benefits for failing to go forward with surgery; however, what constitutes a “surgery” these days is up for interpretation in light of modern medical procedures. The Louisiana case law makes it very clear that the workers’ compensation insurance company cannot terminate your benefits for failing to go forward with “surgery.” Still, other cases have stated that the insurance company can terminate your benefits for failing to undergo Second Medical Opinion Exams, Physical Therapy, and Diagnostic Tests without good cause.