Insurance Dispute Lawyer Blog
In the realm of workers’ compensation, ensuring injured employees receive necessary medical treatment can sometimes be a battle. A recent Louisiana Court of Appeal decision, Deubler v. Bogalusa City Schools, highlights the complexities surrounding the Louisiana Medical Treatment Guidelines and the process of obtaining authorization for treatment. This case serves as a reminder of the importance of adhering to these guidelines while also recognizing the need for flexibility when circumstances warrant it.
Irvin Deubler, an employee of Bogalusa City Schools (BCS), suffered a lower back injury at work. He was receiving workers’ compensation benefits and sought treatment from Dr. Flagg for his chronic pain. Dr. Flagg recommended an MRI and a psychological evaluation to determine if Deubler was a candidate for a spinal cord stimulator (SCS) trial, a potential treatment option for his pain.
BCS’s insurer, LUBA Casualty Insurance Company, denied these requests, prompting Dr. Flagg to appeal to the Office of Workers’ Compensation (OWC). The OWC’s associate medical director approved the requests, but LUBA and BCS further appealed to the OWC judge.
The OWC judge upheld the associate medical director’s decision, and the Court of Appeal affirmed this ruling. The court emphasized the role of the Medical Treatment Guidelines in determining appropriate medical care for injured workers. It also highlighted the process for obtaining a variance from these guidelines when necessary.
Things to Know:
- Medical Treatment Guidelines: Louisiana has established Medical Treatment Guidelines to ensure efficient and timely medical care for injured workers. These guidelines create a rebuttable presumption as to what treatments are considered necessary.
- Variances from the Guidelines: If a healthcare provider recommends treatment that deviates from the guidelines, they can seek a variance by demonstrating to the OWC medical director that the variance is reasonably required to treat the worker’s injuries.
- Burden of Proof: The initial burden of proof lies with the injured worker to show the medical necessity of the requested treatment. If the OWC medical director approves a variance, the burden shifts to the employer/insurer to prove, by clear and convincing evidence, that the decision was not in accordance with the law.
- Appellate Review: The court’s decision is subject to review by the Court of Appeal, which applies the manifest error standard. The appellate court will only overturn the OWC judge’s decision if there is no reasonable factual basis for it.
Implications for Injured Workers and Employers
The Deubler case highlights the importance of understanding and navigating the Medical Treatment Guidelines in Louisiana workers’ compensation cases.
For injured workers, it’s crucial to work closely with your healthcare provider to ensure your treatment requests are supported by medical evidence and comply with the guidelines or justify a variance. If your requests are denied, you have the right to appeal and present additional evidence to the OWC.
For employers and insurers, it’s essential to be familiar with the Medical Treatment Guidelines and understand the process for challenging treatment requests. While the guidelines provide a framework for medical care, they are not absolute, and variances can be granted when medically necessary.
Navigating the complexities of workers’ compensation law can be challenging. If you’re an injured worker or an employer facing a dispute over medical treatment, seeking legal advice from an experienced workers’ compensation attorney is crucial to protect your rights and ensure a fair outcome.
Additional Resources:IRVIN DEUBLER VERSUS BOGALUSA CITY SCHOOLS & LUBA CASUALTY INSURANCE COMPANY
Written by Berniard Law Firm
Other Berniard Law Firm Articles on Workers Compensation: Permanently Disabled Individual Not Acting Under Scope of Employment In Workers’ Compensation Case and When a Workplace Injury Crosses State Lines: Navigating the Complexities of Workers’ Compensation and Tort Liability