REGULATORY ACTIVITY:

• Published in the March State Register notice of intent to amend certain portions of the Louisiana Administrative Code, Title 40, Labor and Employment, Part III, Workers’ Compensation Second Injury Board, Chapter 5 regarding forms.  This Rule is promulgated by the authority vested in the director of the Office of Workers’ Compensation found in R.S. 23:1291 and R.S. 23:1378(A). To view the notice of intent and proposed rule, go to http://www.doa.la.gov/Pages/osr/reg/Regs2018.aspx and click on the March Icon.

REGULATORY ACTIVITY:

• Published in the February Register information regarding the workers' compensation average weekly wage.  To view the register, go to http://www.doa.la.gov/Pages/osr/reg/Regs2018.aspx.

LEGISLATIVE ACTIONS:

• House Bill 35
  The enacted legislation provides to the offset of disability retirement benefits of members of the firefighters’ retirement system based on receipt of workers’ compensation benefits. Effective Date August 15, 2017.

REGULATORY ACTIVITY:

• A notice was published March 13, 2017: “Pursuant to a judgment signed by 19th Judicial District Court Judge Donald Johnson on March 2, 2017, the OWCA was:

  Enjoined, restrained, and prohibited from applying and/or enforcing the statutes and regulations which establish the system for the administrative determinations of form 1009 claims for medical benefits for injured workers by a medical director employed by the Office of Workers’ Compensation of the Louisiana Workforce Commission and administrative appeals therefore to Office of Workers’ Compensation judges. The enjoined statutes and regulations are as follows:
  La. R.S. 23:1203.1 (J) (1), (K), (M);
  2. La. R.S. 23:1314 (D) – E (1) inclusive;
  3. 40 LAC 2715(B) (3), (d), (e), (f); and
  4. 40 LAC 2715(E) (2), (F), (H), (I), (J), (K) and (L).

  The OWCA filed a Suspensive Appeal, which was granted on March 9, 2017. Therefore, pending further action of the Appellate Court, the 1009 review process has resumed effective March 10, 2017, and will continue to operate as usual and as it had prior to the injunction.”

• Another notice was published on March 15, 2017: “Due to the recent decision in Barber, et al. v. LWC, et al., 621,071, Sec. “26”, 19th Judicial District Court, rendered by Judge Donald R. Johnson on March 2, 2017, the Office of Workers’ Compensation Administration has determined that it would be in the best interest of all parties to halt the rule making process initiated by a Notice of Intent to revise 40 LAC § 2328, 2715, 2718 and 40 LAC § 5507 published in the Louisiana Register on February 20, 2017.”

REGULATORY ACTIVITY:

• The Louisiana Workforce Commission gave notice of its intent to amend certain portions of the Medical Guidelines contained in the Louisiana Administrative Code, title 40, Labor and Employment, Part I, Workers’ Compensation Administration, Subpart 2, Medical Guidelines, Chapters 23 and 27, regarding implementation of medical treatment guidelines.  This Rule is promulgated by the authority vested in the director of the Office of Workers’ Compensation found in R.S.  23:1291 and R.S. 23:1310.1(C).  Public Hearing:  A public hearing will be held on March 31, 2017, at 9:30 a.m., at the LaSalle Building, 617 North Third Street, First Floor, in the LaBelle Hearing Room in Baton Rouge, LA. The public is invited to attend.

FEE SCHEDULE NEWS:

• The state has posted corrections for two radiology codes, 72149 and 72170 in their October Register.  These code corrections are retroactive to June 20, 2016.

REGULATORY ACTIVITY:

• Published workers’ compensation benefit limits effective September 1, 2016.   The new rates are:
  • State Wide Average Weekly Wage $876.00
  • Maximum Compensation Rate $657.00
  • Minimum Compensation Rate $175.00.
• In addition, the commission published the new travel reimbursement effective July 1, 2016.  The new travel reimbursement is $0.51 per mile.

LEGISLATIVE ACTIONS:

• House Bill 865
  Provides relative to licensing of insurance producers, including producer licensing requirements for business entities. Specifies that a resident individual shall pass an examination for each line of insurance that an applicant seeks to transact in this state.  Further requires that an applicant shall pass the examination with a score of at least 70%. Present law requires a business entity acting as an insurance producer to obtain an insurance producer license. Also requires that every member, partner, officer, director, stockholder, and employee of the business entity personally engaged in this state in soliciting or negotiating policies of insurance shall be registered with the Dept. of Insurance (DOI) under such business entity’s license. Further requires each such person to also qualify as an individual licensee for any line of insurance the business entity is licensed to transact. Specifies that licensing of any limited liability company or limited liability partnership as an insurance producer is subject to prior approval of the commissioner of insurance. Proposed law retains requirement that a business entity acting as an insurance producer obtain an insurance producer license. However, provides that every member, partner, officer, director, and person who controls directly or indirectly 10% or more of the applicant shall be registered with DOI under such business entity’s license. Adds a requirement that every individual who is personally engaged in soliciting or negotiating policies in this state shall be registered with the DOI under such business entity’s license and shall also qualify as an individual licensee for any line of insurance that the business entity is licensed to transact. Further authorizes the commissioner of insurance to require that such registered individuals submit fingerprints.  Present law requires each licensee to notify the commissioner of any alteration in his residential, mailing, or business address within 30 days of the alteration or receive a $50 penalty per violation.  Proposed law instead requires each licensee to notify the commissioner of any change of address, legal name, or information submitted on the application within 30 days of the change or receives a $50 penalty per violation. Adds  the  following as grounds  for license denial, nonrenewal, or revocation by the commissioner: If the producer is a business entity, refusing to remove or discharge a person registered pursuant to present law who has been convicted or pleaded nolo contendere to any felony, participated in a pretrial diversion program pursuant to a felony charge, suspension and deferral of sentence, and probation pursuant to the Code of Criminal Procedure, or been convicted of any misdemeanor involving moral turpitude or public corruption.  If the producer is a business entity, refusing to remove or discharge any person registered pursuant to present law who has had an insurance producer license revoked or suspended or is found to have violated any provision of the Insurance Code.  Present law prohibits any insurer or insurance producer from paying   any money or commission or brokerage, or giving or allowing any valuable consideration or compensation to any person or business entity not duly licensed as an insurance producer, nor to an insurer not licensed to do business in this state, for or because of service rendered or performed in this state in selling, soliciting, negotiating, or effecting a contract of insurance on any property or risks, or insurable interests, or business activities located within or transacted within this state. Further provides that this prohibition shall not apply to the owners of an insurance agency.  Proposed law provides that this prohibition shall not apply to the owners of a business entity licensed as a producer so long as that entity has complied with the provisions of present law and the owners are not persons who: Have been convicted or pleaded nolo contendere to any felony, participated in a pretrial diversion program pursuant to a felony charge, suspension and deferral of sentence, and probation pursuant to the Code of Criminal Procedure, or been convicted of any misdemeanor involving moral turpitude or public corruption.  Have had an insurance producer license revoked or suspended or are found to have violated any provision of the Insurance Code.  Effective Date June 2, 2016.
• Senate Bill 44
  Present law provides that when an injury has occurred to an employee which is subject to the payment of workers’ compensation benefits but such action was caused, in whole or in part, by a party who other than the employer or employee, (commonly referred to as a “third party” but referred to in the statute as “third person”) who has a legal liability to pay damages, the employee may file a lawsuit in district court to recover damages for the injury. Present law provides that when an injury occurs to an employee and a third party is liable, in whole or in part, the workers’ compensation insurer or group self-insurance fund may file suit against the third party to recoup the workers’ compensation benefits paid to the employee but the employer must notify the employee of the suit against the third party.  Present law provides that when an injury occurs to an employee and a third party is liable, in whole or in part, the employee may file suit against the third party for damages but must notify the workers’ compensation insurer or group self-insurance fund when any workers’ compensation benefits which have been paid to or on behalf of the injured worker.  Present law provides that if a settlement occurs or a judgment is obtained against the third party and the employee receives funds from the third party, the employer or insurer shall receive a dollar-for- dollar credit for workers’ compensation benefits paid against the full amount paid in settlement or judgment, less attorney fees and costs paid by the employee in prosecution of the third party claim. Present law requires the employee to obtain written approval from the employer or workers’ compensation insurer before such settlement or compromise is obtained by the employee. Present law provides an insurer shall grant its insured a dollar-for-dollar credit for any amount on any claim paid on the employer’s behalf and recovered in the current year, less any reasonable expenses incurred in the recovery by the insurer, in an action or compromise.  Proposed law retains present law but provides that the credit shall be used by the insurer in the calculation of the loss experience modifier specifically promulgated by and in accordance with the rules of the National Council on Compensation Insurance (NCCI), to be applied in determining the annual premium paid by the employer for workers’ compensation insurance. Proposed law provides that the group self-insurance fund shall apply the loss experience modifier authorized by present law applicable to group self-insurance funds.   Effective Date August 1, 2016.
• Senate Bill 266
  Present law requires all business entities applying to do business as independent adjusting companies to provide a listing of all executive officers and directors of the applicant and of all executive officers and directors of entities owning and any individuals owning, directly or indirectly, 10% or more of the outstanding voting securities of the applicant. Provides that in order to make a determination of eligibility, the commissioner may require all executive officers and directors to submit addresses, social security numbers, criminal and administrative history, fingerprints, background checks, and biographical statements. Proposed law changes “owning” to “controlling” and defines “control” to have the same definition as in present law (R.S. 22:691.2).  Present law provides for reciprocity for licensed claims adjusters for those from states that require licensure. Proposed law deletes present law and provides for the designation of La. the home state for licensure for nonresident adjusters from states that do not require licensure and provides that the adjusters meet all of the requirements required of La resident adjusters. Present law provides that an individual who applies for a claim adjuster license in La. who was previously licensed as a claim adjuster in another state based on a claim adjuster examination shall not be required to complete an examination. Provides that this exemption is available only if the person is currently licensed in that state or if the application is received within 12 months of the cancellation of the applicant’s previous claims adjuster license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state, or the state’s producer database records or records maintained by the National Association of Insurance Commissioners (NAIC), its affiliates, or subsidiaries, indicate that the adjuster is or was licensed in good standing.  Proposed law deletes present law.
  • Present law provides that an individual licensed as a claims adjuster in another state based on a claims adjuster examination who moves to this state shall make application within 90 days of establishing legal residence to become a resident claims adjuster licensee pursuant to present law (R.S. 22:1665). Provides that no examination is required of that individual to obtain a claims adjuster license. Proposed law limits this exemption from examination requirements to a person who is currently licensed in another state or if the application is received within 90 days of the cancellation of the applicant’s previous claims adjuster license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state’s producer database records or records maintained by the National Association of Insurance Commissioners (NAIC), its affiliates, or subsidiaries, indicate that the adjuster is or was licensed in good standing.
  • Present law provides that an individual who applies for a claims adjuster license in La. who was previously licensed as a claims adjuster in La. shall not be required to complete an examination. This exemption is available only if the application is received within 12 months of the cancellation of the applicant’s previous claims adjuster license in La. and if, at the time of cancellation, the applicant was in good standing in La., and had passed the required examination. Proposed law changes the exemption time frame from 12 to 24 months.
  • Proposed law permits the commissioner to waive the workers’ compensation examination requirement for an individual who has three years of verifiable experience adjusting workers’ compensation claims within the preceding five years, provided the application is received on or before August 1, 2017. Proposed law provides that a claims adjuster may receive qualification for a license in one or more of the following lines of authority: Property and casualty, Workers’ compensation, Crop and Any limited line for which the commissioner issues a limited license.
  • Present law provides that a claims adjuster whose license has lapsed may, within 12 months from the expiration date of the renewal, reinstate the license upon approval of the commissioner. Provides that a penalty in the amount of double the unpaid renewal fee shall be required for the reinstatement of the claims adjuster license. Provides that reinstatement shall be effective on the date the commissioner of insurance approves the request for reinstatement. Proposed law deletes present law and provides that a licensed claim adjuster who allows his license to lapse may, within two years from the expiration date of the license, reinstate the same license upon proof of fulfilling all continuing education requirements through the date of reinstatement and upon payment of all fees due. Provides that if the license has been lapsed for more than two years, the applicant shall fulfill the requirements for issuance of a new license.
  • Present law provides that the commissioner may place on probation, suspend, revoke, or refuse to issue, renew, or reinstate a claims adjuster’s license or may levy a fine not to exceed $500 for each violation up to $10,000 aggregate for all violations in a calendar year, unless a fine is established by separate statute Title 22 authorizing a greater penalty, or any combination of actions, for any one or more of the following causes: (1) Providing incorrect, misleading, incomplete, or materially false information in the license application. (2) Violating any state insurance law or regulation or a subpoena or order of the commissioner of insurance or of another state’s insurance commissioner. (3) Obtaining or attempting to obtain a license through misrepresentation or fraud. (4) Improperly withholding, misappropriating, or converting any money or property received in the course of conducting insurance business. (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance. (6) Conviction of a felony related to the adjustment of insurance claims. (7) Admitting to or committing fraud or unfair trade practices. (8) Using fraudulent, coercive, or dishonest practices. (9) Demonstrating incompetence, untrustworthiness, or financial irresponsibility while conducting business. (10) Denial, suspension, or revocation of an insurance license, or its equivalent, in any other state, province, district, or territory.  (11) Forging a name on an application for insurance or any document related to an insurance transaction.  (12)  Cheating, including improperly using notes or any other reference material, to complete an examination for an insurance license.  (13) Knowingly accepting insurance business from an individual who is not licensed but who is required to be licensed by the commissioner of insurance.  (14) Failure to comply with an administrative or court order imposing a child support obligation. (15) Failure to pay state income tax or comply with any administrative or court order directing payment of state income tax.  (16) Violating R.S. 22:1674(F).  (17) Failure to complete assignment of adjustment of a claim in a thorough and timely manner, including submission of the adjustment of a claim to the party which made that assignment.  Proposed law retains present law and adds the following reasons:  (1) Providing incorrect, misleading, incomplete, or materially false information in the license renewal application.  (2) Violating the insurance laws or regulations of the United States or any other jurisdiction. (3) Intentionally misrepresenting the terms of an actual or proposed insurance binder rider, or plan, including all forms or documents that are attached, or will be attached, to an actual or proposed insurance contract, binder, rider, plan, or application for insurance.  (4) Conviction of or    a nolo contendere plea to any felony, participation in a pretrial diversion program pursuant to a felony charge, suspension and deferral of sentence and probation pursuant to Article 893 of the Code of Criminal Procedure or similar law of another state, or conviction of any misdemeanor involving moral turpitude, or public corruption, or the adjustment of insurance claims. (5) The refusal to submit physical evidence of identity or the conviction of a felony, in accordance with R.S. 22:1922(B) and (C).  (6) Employing or allowing to associate with his business, in any manner, any person engaged in the business of insurance who has been convicted of a felony under the laws of this or any other state, the United States, or any other jurisdiction. As used in proposed law, “business of insurance” means the writing of insurance or the reinsuring of risks by an insurance producer or insurer, including all acts necessary or incidental to such writing or reinsuring, and the activities of persons who act as, or are, officers, directors, agents, or employees of producers or insurers, or who are other persons authorized to act on behalf of such persons. (7) The conviction of a felony involving dishonesty or breach of trust pursuant to 18 U.S.C. §1033 and §1034, without written consent from the commissioner of insurance pursuant to 18 U.S.C. §1033, or any successor statute regulating crimes by or affecting persons engaged in the business of insurance whose activities affect interstate commerce. The above provisions are effective August 1, 2016.  Present law provides an exemption from licensure for workers’ compensation adjusters.  Proposed law repeals that exemption effective August 1, 2017.  Effective Date August 1, 2016.