Insurance Dispute Lawyer Blog
If you have been injured on the job, you might be entitled to workers’ compensation. In order to receive compensation, there are a number of procedural requirements with which you must comply.
Elaine Rodrigue worked as a paralegal for the school board in Lafourche Parish, Louisiana. While working, she tripped over a rug and had to have surgery. When she returned to work from her surgery, she was transferred to work at a metal building. While working there, Rodrigue was exposed to noxious odors and forms. After she left her job, her symptoms from the exposure continued to get worse.
Rodrigue filed a workers’ compensation claim against the school board. The Workers’ Compensation Judge ruled in favor of Rodrigue, finding her exposure to the noxious odors and fumes at work had caused her medical issues, so she could recover for her related medical expenses. The judgment included twenty items from Rodrigue’s doctor’s prescriptions that were a reasonable and necessary part of her treatment.
The school board filed a motion to modify the judgment, arguing it did not require Rodrigue to comply with procedural requirements for getting medical expenses approved. The court denied the school board’s request to modify the judgment but did require Rodrigue to submit bills directly to the school board from her medical providers.
On appeal, the school board argued the Workers’ Compensation Judge erred in holding the treatment Rodrigue’s doctor had prescribed was not subject to the review process in La. R.S. 23:1203.1 or the Medical Treatment Guidelines, which were established to help control high medical expenses. The school board argued any of Rodrigue’s future expenses should have been submitted for pre-authorization. Rodrigue argued the school board’s obligation to her was not based on the Louisiana workers’ compensation statutes, but rather the final judgment issued by the Workers’ Compensation Judge.
The appellate court agreed that the school board’s obligation to pay for the items from Rodrigue’s doctor’s prescriptions was from the trial court’s judgment, not from the workers’ compensation statutes. Additionally, Rodrigue had not made a new claim that fell outside the prior judgment’s scope.
The appellate court also addressed Rodrigue’s argument that the judgment incorrectly required her to submit bills from her medical providers directly to the school board. The school board argued if Rodrigue could keep paying expenses not generated by a healthcare provider and submit those bills directly to the school board for reimbursement, it would conflict with the Reimbursement Schedule in La. R.S. 23: 1034.2, which is intended to help control high medical costs. The court found the language in the judgment to be unclear, so it modified the language to clarify that the school board could adjust the cost of applicable medically reasonable and necessary items under the Reimbursement Schedule.
As seen here, judgments in workers’ compensation claims can sometimes have unclear portions. A good lawyer can help you navigate the often complex workers’ compensation system so you receive the damages you are entitled to if you have been injured on the job.
Additional Sources: Lafourche Parish School Board v. Elaine Rodrigue
Article Written By Berniard Law Firm
Additional Berniard Law Firm Article on Workers’ Compensation Claims: Workers’ Compensation Claim Denied For Failure To Seek Preapproval