La. R.S. § 23:1378 Determination of Liability of Fund

• Library: Louisiana Statutes
• Edition: 2023
• Currency: Current with changes from the 2023 Legislative Session
• Year: 2023
• Citation: La. R.S. § 23:1378

A. An employer operating under the provisions of this Chapter who knowingly employs, re-employs, or retains in his employment an employee who has a permanent partial disability, as defined in R.S. 23:1371.1, shall qualify for reimbursement from the Second Injury Fund, if the employee incurs a subsequent injury arising out of and in the course of his employment resulting in a greater liability due to the merger of the subsequent injury with the preexisting permanent partial disability. The employer or, if insured, his insurer shall pay all benefits provided in this Chapter, but the employer or, if insured, his insurer thereafter shall be reimbursed by the Second Injury Fund for all indemnity and medical benefit payments as follows:

<TABLE border="1"> <TR> <TD> <para>Date of Injury</para></TD> <TD> <para>Reimbursement Schedule</para> </TD> </TR> <TR> <TD> <para>Before July 1, 2004 on/ after July 1, 2009, but before July 1, 2010</para> </TD> <TD> <para>INDEMNITY</para> <para> * TTD/SEB/PTD After the first 104 weeks of payment of benefits</para> <para>* Death benefits after the first 175 weeks of payment of benefits</para> <para> MEDICAL</para> <para>* 50% of all reasonable and necessary medical expenses actually paid which exceed $5,000.00, but no less than $10,000.00</para> <para>* 100% of all reasonable and necessary medical expenses actually paid which exceed $10,000.00</para> </TD> </TR> <TR> <TD> <para>On/after July 1, 2004 &amp; before July 1, 2009</para> </TD> <TD> <para>INDEMNITY</para> <para>* After the first 130 weeks of payment of benefits</para> <para> MEDICAL</para> <para> * 100% of all reasonable and necessary medical expenses actually paid which exceed $25,000.00.</para> </TD> </TR> <TR> <TD> <para>On/after July 1, 2010</para> </TD> <TD> <para>INDEMNITY</para> <para> * After the first 104 weeks of indemnity</para> <para> MEDICAL</para> <para>* 100% of all reasonable and necessary medical expenses actually paid which exceed $25,000.00, including reasonable and necessary Vocational Rehabilitation expenses, if such expenses are directly related to services provided in the actual retention or reemployment of employees</para> </TD> </TR> </TABLE>

(1) Such payments shall be reimbursed provided they are submitted to the board within one year of the approval for reimbursement or within one year of the payment of such weekly compensation payments, whichever occurs later.

(2) No employer or insurer shall be entitled to reimbursement unless it is clearly established that the employer had actual knowledge of the employee's preexisting permanent partial disability prior to the subsequent injury. For injuries occurring after December 31, 2010, actual knowledge shall be established only by any one of the following circumstances:

(a) The employee's preexisting permanent partial disability was caused by a compensable workers' compensation accident or occupational disease while employed by the same employer seeking reimbursement from the Second Injury Fund.

(b) Prior to the second injury, the employee disclosed to the employer the employee's preexisting permanent partial disability on a form promulgated by the office of workers' compensation.

(c) The employer employs, retains, or re-employs employees from the PPD employee registry maintained by the Louisiana Workforce Commission and which is created and maintained in accordance with rules promulgated by the office of workers' compensation.

(d) The employer provides an affidavit, on a form promulgated by the office of workers' compensation, which shall set forth all of the following:

(i) An attestation as to hire and fire authority as defined in R.S. 23:1371.1.

(ii) An attestation as to how and when knowledge was acquired.

(iii) An attestation as to the actual permanent partial disability existing.

(iv) An attestation of how the permanent partial disability, if not a presumed condition as listed in Subsection F of this Section, was a hindrance and obstacle to employment.