TOOLS & BENEFITS
Tools & Documents
Authorization for Release of Protected Health Information
Authorization for release of protected health information (HIPAA compliant) A copy of this authorization will suffice for the release of information and will have the same force and legal effect of the original.
Certificate of Compliance
Submit this form to your employer's workers' compensation insurer or to your employer within 14 days of its receipt. Your benefits may be suspended if you do not timely submit this. You would be entitled to all suspended benefits after this certification is provided to your insurer, if you are otherwise eligible for benefits.
Choice of Physician
When you are injured at work or become sick because of something that happened at work, the law gives you the right to choose your own doctor in any field or specialty of medicine for medical treatment.
Mileage Claim Form
Workers’ Compensation Mileage Claim Form. List trip(s) taken such as home to doctor, home to hospital, identify doctor, pharmacy, hospital by name and address and return home
Louisiana Workforce Commission
Workers' Compensation and additional links for more information.
Employee’s Monthly Report of Earnings
Your workers’ compensation benefits may be suspended if you do not timely submit this report.
Wage Benefits
To be eligible for wage benefits, the injured employee must be deemed disabled by a physician and must not have worked for a minimum of seven days.
Waiting Period: There is a seven-day waiting period in Louisiana. If the disability continues for 14 days, the injured employee will be entitled to wage benefits for the first seven days.
Initial Payment: The first payment of wage benefits is due to the injured employee on the 14th day following knowledge/proof of disability.
Percentage of Wages: Wage benefits are based on your average weekly wage and are subject to a minimum and maximum rate determined by the Department of Labor. Wage benefits are not subject to federal, state, social security or medicare taxes.
Medical Benefits
If an employee sustains an injury or illness arising out of and during the course of employment, workers’ compensation will cover reasonable and medically necessary treatment for an injury. Injured employees are not responsible for any copays and should not have any out-of-pocket expenses. All claims for medical benefits are forever barred unless within one year after the accident or death, the parties have agreed upon the payments to be made for medical benefits, or unless within one year after the accident, a formal claim has been filed.
Choice of Physician: The injured employee has the right to select one treating physician in any field or specialty, which is deemed medically necessary. After the initial choice, the employee shall obtain prior consent from the insurer for any change of treating doctor within that same field or specialty.
Mileage Reimbursement: The injured employee is entitled to reimbursement of mileage expenses associated with the medical treatment of the claim. To be reimbursed, you must submit a mileage reimbursement form monthly. The employee will be reimbursed within 60 days of receipt of the form.
Prescriptions: RMS uses a Pharmacy Benefits Manager to provide prescription benefits to injured employees. RMS will issue a prescription card to the injured employee for use at pharmacies to avoid any out-of-pocket expense for the injured employee.
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