Breaking News Regarding the Effective Date of the Louisiana Medical Treatment Guidelines from the Louisiana Supreme Court
On May 7, 2014, the Louisiana Supreme Court released two (2) rulings regarding the effective date of the Medical Treatment Guidelines (“MTGs”), and affirmatively ruled that the MTGs apply to any and all “requests for medical treatment and/or disputes arising out of requests for medical treatment arising after the effective date of La. R.S. 23:1203.1 and the medical treatment schedule, regardless of the date of the accident.” Therefore, the Louisiana Supreme Court has clarified that any dispute regarding workers’ compensation medical treatment that arises subsequent to the effective date of the medical treatment schedule, June of 2011, must comply with the MTGs.
While the MTGs were enacted to apply to all medical disputes arising after the enactment of the medical treatment schedule in June of 2011, and the Louisiana Legislature likely intended for them to apply to all disputes involving medical treatment regardless of when the work-accident occurred, over the last two (2) years, Louisiana appellate courts have inconsistently ruled that the MTGs only applied to work-accidents which occurred after the effective date of the MTGs.
On January 17, 2014, the Louisiana Supreme Court accepted writs of cases from the Louisiana Third and Fourth Circuit Courts of Appeal, which previously issued inconsistent rulings regarding the application of the MTGs. Thereafter, on May 7, 2014, the Louisiana Supreme Court affirmed the original decision by the Third Circuit, which held that the MTGs apply to all requests for medical treatment arising after the enactment of the MTG regardless of when the work-accident occurred, and reversed the Fourth Circuit case, which held that the MTGs only applied to work-accidents occurring after the enactment of the MTGs.
Thus, the issue regarding the application of the MTGs has been definitively clarified by the Louisiana Supreme Court, and all requests for non-emergency medical treatment over $750.00 by workers’ compensation claimants subsequent to June of 2011, regardless of the when the work-accident occurred, must comply with the MTGs.
This is an important decision by the Louisiana Supreme Court with far reaching logistical and strategic consequences in defending claims. While the MTGs may curtail the expenses of unnecessary medical treatment sought by claimants, employers should still be wary of placing full reliance on the Medical Director’s denial of medical treatment. As the application of the MTGs has been more frequently litigated, workers’ compensation judges and appellate courts have begun to carefully scrutinize and even overturn decisions by the Medical Director despite the high burden of proof required to do so. Thus, employers must be knowledgeable, proactive and comprehensive in their utilization of the MTGs and in supplying all relevant information, documents and medical records to the Medical Director to support their denial of medical treatment.