The Louisiana Workforce Commission’s Office of Workers’ Compensation Administration (OWCA) hosted a “Town Hall Meeting” at the Port of New Orleans on Tuesday focusing on the Medical Treatment Guidelines and related processing issues. The meeting was one of a series that will be held in locations around the state.
OWCA Director, and former Chief Workers’ Compensation Judge, Sheral Kellar moderated the discussion by taking questions from the assembled stakeholders. OWCA Medical Director Dr. Jason Picard, new Chief Workers’ Compensation Judge Diane Lundeen, and OWCA Medical Services Section Nurse Brenda Ganache were also present to answer questions. The goal of the meeting was ostensibly to air grievances about bureaucratic failures in the workers’ comp system, without giving specifics, so that the Office knows what to work on in the future. However, the as Director Kellar explained, “We want to solve problems, and we may give some answers that you won’t like.”
Tacit denials under fire, system “needs teeth”
Trey Mustian, an attorney representing injured workers, first spoke about one of the major issues of the day, arguing that tacit denials (in which a company or employer fails to provide an answer to a request for medical treatment within 5 days) must be addressed further in the statute or in the rules.
“The carrier just lets five days go by and does nothing, and then the appeal period starts whether the doctor realizes it or not […] There’s no consequence for the carrier for failing to notify us,” Mustian said. He commented further that the tacit denial problem folds into a further conundrum for plaintiff attorneys who are forced to appeal within 15 days, a time frame which he argued is far too short. He later stated that he feels thirty days would be more reasonable.
Troy Prevot, Administrator of LCTA Workers’ Comp, agreed with Mustian on the tacit denial inaction in his commentary to the OWCA, saying that there is simply “no excuse” for a carrier to not respond to requests for medical treatment within the five allotted days, but that as he understands it, such lapses are more common among out of state carriers and third party administrators.
Several stakeholders at the meeting said that the statute “needs teeth” in the Medical Treatment Guidelines area, and Director Kellar noted the concern, offering the idea that a failure to respond (tacit denial) or continual denials of treatment contained within the Guidelines without adequate reasoning might be subject to the “arbitrary and capricious” standard used to award penalties and attorney’s fees once a case gets to court.
Kellar acknowledges Barber case
Other questions centered around the makeup of the Workers’ Compensation Advisory Council (one attendee encouraged the Office to consider adding a physical therapist and/or a vocational rehabilitation counselor to the list of parties) and whether prescription drugs count as medical treatment.
On the prescription drug issue, Kellar and Chief Judge Diane Lundeen explained that not all appeals courts have addressed the conflict, and until they split the Office will likely not clarify its stance.
During the meeting, which lasted roughly two hours and was attended by about 50 people, Director Kellar also stated the goals for the upcoming months and years of her administration that led to the creation of the Town Hall Meetings. “We want to address some of the issues that were raised in the Barber litigation,” she explained, “This is an effort to allow you guys to be a part of the solution to assist us in keeping our eyes on the ground and to see what we can’t see because we’re so close to it.”
The remaining meetings will be held at the following locations and times:
September 16th – LWC Business and Career Solutions Center
1162 Oliver Rd. Suite 9
Monroe, LA 71201
September 26th – Picard Center for Child Development and Lifelong Learning
200 E Devalcourt St.
Lafayette, LA 70506
September 27th – Reeves Uptown Catering
1639 Ryan St.
Lake Charles, LA 70601
September 28th – Central Louisiana Business Incubator Center
1501 Wimbledon Blvd.
Alexandria, LA 71301
September 30th – Louisiana Department of Insurance
Plaza Hearing Room
1702 N. 3rd St.
Baton Rouge, LA 70802