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Medical Treatment Guidelines Apply to all medical treatment after July 13, 2011

Medical Treatment Guidelines Apply to all medical treatment after July 13, 2011

On May 7, 2014, The Supreme Court of Louisiana issued a decision holding that La. R.S. 23:1203.1 (AKA “Medical Treatment Guidelines”) apply to all requests for medical treatment made after July 13, 2011(the effective date of the statute), regardless of the accident date.

The Supreme Court reviewed the facts of Church Mut. Ins. Co. v. Dardar, 2012-0659 (La. App. 4 Cir. 6/26/13), 119 So. 3d 967. In that case, plaintiff injured her back on October 21, 1999. An indemnity settlement was approved on January 30, 2008, reserving Ms. Dardar’s rights to future medical treatment. In 2012, claimant filed a 1008 alleging that her employer failed to authorize various medical treatments. Her employer responded with an exception of prematurity arguing that claimant failed to follow the Medical Treatment Guidelines and submit a LWC Form 1009 to the Medical Director prior to filing the disputed claim.

Claimant argued that the guidelines did not apply to her Disputed Claim as her injury occurred in 1999, prior to the enactment of the law.  The Workers’ Compensation Judge disagreed and ordered that the request be resubmitted within thirty days according to the medical treatment guidelines. The Judge held that the version of the Medical Treatment Guidelines in effect at the time the treatment was requested should be applied.

The Fourth Circuit’s Ruling

The Fourth Circuit reversed the OWC holding that the law in effect at the time of the injury should apply.

The Fourth Circuit decision was appealed and the Supreme Court agreed with the employer and the OWC holding that Medical Treatment Guidelines are a “procedural vehicle” which do not impinge on or lessen the substantive right to necessary medical treatment. As such, the medical treatment guidelines apply to all requests for medical treatment and disputes arising out of requests from medical treatment arising July 13, 2011, regardless of the date of the accident.

Third Circuit Also Ruled on Medical Treatment Guidelines

A factually similar case entitled Cook v. Family Care Services, Inc. was decided by the Third Circuit, however; the Third Circuit concluded that the Medical Treatment Guidelines did apply retroactively. Thus, the Cook decision was affirmed by the Supreme Court on the same day the Church decision was reached.

Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.