In Louisiana, the Workers’ Compensation Act allows injured employees to recover workers’ compensation benefits from their employer. This act establishes a medical treatment schedule and procedure under which an injured employee can request authorization for medical treatment from his or her employer. A recent decision of the Louisiana Third Circuit Court of Appeal discusses these specific procedures, and how injured employees may appeal denials of requests for medical procedures.
Jacquenette Guidry, a registered nurse, injured herself on her job at American Legion Hospital. Her orthopedic surgeon, Dr. Mark McDonnell, submitted a Form 1009 Disputed Claim for Medical Treatment seeking approval from the Office of Workers’ Compensation Medical Director to perform a lumbar surgical procedure Guidry. The Medical Director, denied the requested procedure in a Medical Guidelines Dispute Decision (“MGD”). The MGD stated that the documents presented by Dr. McDonnell did not support approval of the requested services. Specifically, the clinical findings, natural history of the disease, and diagnostic tests did not support the requested services.
Mr. Guidry appealed the Medical Director’s decision to the Office of Workers’ Compensation, putting forward a Form 1008 with an addendum outlining the reasons why the denial was erroneous. After a hearing, the Workers’ Compensation Judge (“WCJ”) held that there was clear and convincing evidence that the Medical Director erroneously denied Mr. Guidry’s request by failing to consider the guidelines under which the request was made. The WCJ overturned the Medical Director’s decision and approved the requested procedure.