TITLE 23. LABOR AND WORKERS' COMPENSATION

CHAPTER 10. WORKERS' COMPENSATION

PART II. BENEFITS

SUBPART A. GENERAL PROVISIONS

23:1201  Time and place of payment;  failure to pay timely;  failure to authorize;  penalties and attorney fees

A. (1) Payments of compensation under this Chapter shall be paid as near as may be possible, at the same time and place as wages were payable to the employee before the accident;  however, when the employee is not living at the place where the wages were paid, or is absent therefrom, such payments shall be made by mail, upon the employee giving to the employer a sufficient mailing address.  However, a longer interval, not to exceed one month, may be substituted by agreement without approval of the director.  An interval of more than one month must be approved by the director.

(2) Notwithstanding the requirement to make payments by mail in Paragraph (1) of this Subsection, electronic transfer of funds, including but not limited to direct deposit or use of a debit card, is an appropriate method of payment of compensation under this Chapter.  Where a payor or insurer elects to issue debit cards and makes weekly payments by way of electronic funds transfers, an injured worker represented by an attorney may elect to have his weekly indemnity check deposited directly into his attorney's trust account.  Where such an election is made, the payor or insurer shall provide notice by way of email only to the injured worker's attorney containing a list of all claims and amounts included in the direct deposit within forty-eight hours of the direct deposit.

B. The first installment of compensation payable for temporary total disability, permanent total disability, or death shall become due on the fourteenth day after the employer or insurer has knowledge of the injury or death, on which date all such compensation then due shall be paid.

C. Installment benefits payable pursuant to R.S. 23:1221(3) shall become due on the fourteenth day after the employer or insurer has knowledge of the compensable supplemental earnings benefits on which date all such compensation then due shall be paid.

D. Installment benefits payable pursuant to R.S. 23:1221(4) shall become due on the thirtieth day after the employer or insurer receives a medical report giving notice of the permanent partial disability on which date all such compensation then due shall be paid.

Subsec. E effective until July 1, 2013

E. Medical benefits payable under this Chapter shall be paid within sixty days after the employer or insurer receives written notice thereof.

Subsec. E effective July 1, 2013

E. (1) Medical benefits payable under this Chapter shall be paid within sixty days after the employer or insurer receives written notice thereof, if the provider of medical services is not utilizing the electronic billing rules and regulations provided for in R.S. 23:1203.2.

(2) For those providers of medical services who utilize the electronic billing rules and regulations provided for in R.S. 23:1203.2, medical benefits payable under this Chapter shall be paid within thirty days after the employer or insurer receives a complete electronic medical bill, as defined by rules promulgated by the Louisiana Workforce Commission.

F. Except as otherwise provided in this Chapter, failure to provide payment in accordance with this Section or failure to consent to the employee's request to select a treating physician or change physicians when such consent is required by R.S. 23:1121 shall result in the assessment of a penalty in an amount up to the greater of twelve percent of any unpaid compensation or medical benefits, or fifty dollars per calendar day for each day in which any and all compensation or medical benefits remain unpaid or such consent is withheld, together with reasonable attorney fees for each disputed claim;  however, the fifty dollars per calendar day penalty shall not exceed a maximum of two thousand dollars in the aggregate for any claim.  The maximum amount of penalties which may be imposed at a hearing on the merits regardless of the number of penalties which might be imposed under this Section is eight thousand dollars.  An award of penalties and attorney fees at any hearing on the merits shall be res judicata as to any and all claims for which penalties may be imposed under this Section which precedes the date of the hearing.  Penalties shall be assessed in the following manner:

(1) Such penalty and attorney fees shall be assessed against either the employer or the insurer, depending upon fault.  No workers' compensation insurance policy shall provide that these sums shall be paid by the insurer if the workers' compensation judge determines that the penalty and attorney fees are to be paid by the employer rather than the insurer.

(2) This Subsection shall not apply if the claim is reasonably controverted or if such nonpayment results from conditions over which the employer or insurer had no control.

(3) Except as provided in Paragraph (4) of this Subsection, any additional compensation paid by the employer or insurer pursuant to this Section shall be paid directly to the employee.

(4) In the event that the health care provider prevails on a claim for payment of his fee, penalties as provided in this Section and reasonable attorney fees based upon actual hours worked may be awarded and paid directly to the health care provider.  This Subsection shall not be construed to provide for recovery of more than one penalty or attorney fee.

(5) No amount paid as a penalty or attorney fee under this Subsection shall be included in any formula utilized to establish premium rates for workers' compensation insurance.

G. If any award payable under the terms of a final, nonappealable judgment is not paid within thirty days after it becomes due, there shall be added to such award an amount equal to twenty-four percent thereof or one hundred dollars per day together with reasonable attorney fees, for each calendar day after thirty days it remains unpaid, whichever is greater, which shall be paid at the same time as, and in addition to, such award, unless such nonpayment results from conditions over which the employer had no control.  No amount paid as a penalty under this Subsection shall be included in any formula utilized to establish premium rates for workers' compensation insurance.  The total one hundred dollar per calendar day penalty provided for in this Subsection shall not exceed three thousand dollars in the aggregate.

H. (1) Upon making the first payment of compensation and upon modification or suspension of payment for any cause, the employer or insurer shall immediately send a notice to the office, in the manner prescribed by the rules of the director, that payment of compensation has begun or has been suspended, as the case may be.  After February 1, 2013, a payor, which shall mean that entity which is responsible by law or contract for the payment of benefits or medical expenses incurred by the claimant as a result of an injury covered by this Chapter, shall do all of the following:

(a) Prepare a notice of payment.  The form for the notice of payment shall be promulgated by the office pursuant to the Administrative Procedure Act.

(b) Send the notice of payment to the injured employee, or the employee's representative, with the first payment of compensation.

(c) Send the notice of payment to the injured employee, or the employee's representative, within ten days of a suspension or modification to compensation for any cause or within ten days of the suspension or modification of the supplemental earnings benefit.

(d) Send a copy of the notice of payment to the office within ten days from the date that the original notice of payment was sent to the injured employee or the employee's representative.

(2)(a) The injured employee or the employee's representative who disagrees with any information provided on the notice of payment shall, in writing, notify the payor of the basis for disagreement and provide the amounts believed appropriate.

(b) The payor, within five business days of receipt of the notice of disagreement, shall do one of the following:

(i) Send a revised notice of payment along with a revised payment in accordance therewith to the injured employee or the employee's representative.

(ii) If the payor believes that the amount determined in the original notice of payment was correct, then the payor shall file a request for preliminary determination, on a form to be promulgated by the office, and shall provide a copy to the injured employee or the employee's representative.

(c) The preliminary determination shall be performed by the director's designee, who shall be a workers' compensation judge specifically assigned to handle preliminary determinations.  Such preliminary determination hearing shall occur within fifteen days of the filing of a request.

(d) The injured employee, the employee's representative, the payor and the employer, which includes the direct employer of a statutory employee pursuant to R.S. 23:1061, shall participate in a preliminary determination hearing by phone.  The workers' compensation judge may require any of these parties to produce relevant records necessary for the determination of compensation provided for in the notice of payment.  No later than thirty days from the filing of the request for a preliminary determination, the workers' compensation judge shall provide, in writing, a recommended amount of compensation.

(e) The payor shall, within ten calendar days of the mailing of the recommendation from the workers' compensation judge, either mail to the injured employee or the employee's representative a revised notice of payment with the recommended amount if such recommended amount is different from that which was previously provided on the initial notice of payment, or notify the injured worker or the employee's representative in writing that the payor does not accept the recommendation.  No disputed claim for compensation regarding the amount of compensation due shall be filed until the provisions of this Subsection have been exhausted unless such a disputed claim is in regard to a payor's failure to provide a notice of payment as required by this Subsection.  A payor who provides the compensation amounts due as recommended by the workers' compensation judge shall not be subject to any penalty and attorney fees regarding such calculation of the compensation due and payment provided with the revised notice of payment.

(f) A payor who provides the compensation amounts due as recommended by the workers' compensation judge's preliminary recommendation and who disagrees with such preliminary recommendation shall file a disputed claim for compensation within fifteen days of mailing the revised notice of payment and compensation amount due.

(3) Within fourteen days after the final payment of compensation has been made, the employer or insurer shall send a notice to the office, in the manner prescribed by the rules of the director, stating:

(a) The name of the injured employee or any other person to whom compensation has been paid, or both.

(b) The date of injury or death.

(c) The dates on which compensation has been paid.

(d) The total amount of compensation paid.

(e) The fact that final payment has been made.

I. Any employer or insurer who at any time discontinues payment of claims due and arising under this Chapter, when such discontinuance is found to be arbitrary, capricious, or without probable cause, shall be subject to the payment of a penalty not to exceed eight thousand dollars and a reasonable attorney fee for the prosecution and collection of such claims.  The provisions as set forth in R.S. 23:1141 limiting the amount of attorney fees shall not apply to cases where the employer or insurer is found liable for attorney fees under this Section.  The provisions as set forth in R.S. 22:1892(C) shall be applicable to claims arising under this Chapter.

J. Notwithstanding the fact that more than one violation in this Section which provides for an award of attorney fees may be applicable, only one reasonable attorney fee may be awarded against the employer or insurer in connection with any hearing on the merits of any disputed claim filed pursuant to this Section, and an award of such single attorney fee shall be res judicata as to any and all conduct for which penalties may be imposed under this Section which precedes the date of the hearing.

Amended by Acts 1954, No. 723, § 1;  Acts 1983, 1st Ex.Sess., No. 1, § 1, eff. July 1, 1983.;  Acts 1985, No. 926, § 1, eff. Jan. 1, 1986;  Acts 1988, No. 938, § 1, eff. Jan. 1, 1990;  Acts 1989, No. 24, § 1;  Acts 1992, No. 1003, § 1, eff. Jan. 1, 1993;  Acts 1995, No. 1137, § 1, eff. June 29, 1995;  Acts 2003, No. 1204, § 1;  Acts 2010, No. 3, § 1, eff. May 11, 2010;  Acts 2012, No. 652, § 1, eff. July 1, 2013;  Acts 2012, No. 860, § 1.