Written By: Patrick Johnson
There is something to be said about the phrase, “Fake it until you make it.” In the world of adjusting, or even in the practice of law, you need to be aware that the attorney on the other side is trying to gauge your level of experience by any means possible. One of the most common ways to infer the strength of your opposition is simply whether they sound like someone familiar with a particular area of law. That is no less true in the world of adjusting claims. Often, we can tell the experience level of an adjuster in Louisiana workers’ compensation based on the way they refer to form numbers, their use of terms that do not appear in Louisiana compensation law, etc. Today, we are going to discuss some tips for not advertising that you may be new to Louisiana, or that Louisiana is merely one of many states that you are handling. You want to sound like an “old hand” in Louisiana workers’ compensation to prevent the claimant’s attorney from thinking that he can take advantage of your lack of knowledge.
Form/statute pronunciation
Save for a few outliers, most Louisiana State forms utilize a four-digit designation. We do not pronounce them as a four-digit number, however. We pronounce the form number as two, two-digit numbers. For example, an LWC-WC-1008 is not a “one thousand eight” form. If you use that description, the attorney on the other side will already begin to plan on how to take advantage of your lack of knowledge before your conversation is even concluded. Someone familiar with Louisiana comp would simply refer to that form as a “ten-oh-eight.” An LWC-WC-1002 is a “ten-oh-two” form. An LWC-WC-1020 is a “ten-twenty” form.
All the statutes that govern a workers’ compensation claim are found in Title 23 of the Louisiana Revised Statutes (LSA-R.S.), and in this section, each statutory provision has a four-digit designation as well. The statutes are referenced by the same pronunciation format. While LSA-R.S. 23:1223 can be spoken of as “Louisiana Statutes, Annotated, Revised Statutes, Title 23, section 1223” and be perfectly correct, even the attorneys do not get into that much detail. So, LSA-R.S. 23:1223 becomes “twelve twenty-three.” Although,, saying “title 23, section twelve twenty-three” is acceptable, but not nearly as common. Often, our actions in claims are guided by other provisions of law found in the Louisiana Code of Civil Procedure (LSA-C.C.P.). While it is unlikely that you will ever have to refer to these statutory provisions if encountered, many are three-digit sections, and they are pronounced in yet a different format. For example, LSA-C.C.P. art. 963 becomes “nine sixty-three” or “article nine sixty-three.”
“TPD” benefits
Any time we hear an adjuster refer to “TPD” benefits, we instantly recognize that the adjuster is either new to Louisiana or has more experience in another state, where that acronym is more common. Louisiana has four types of indemnity benefits, and Temporary Partial Disability (“TPD”) is not among them. TPD benefits are generally known as the type of benefits paid to an employee who has returned to work, but their work limitations are preventing them from earning as much money, and the TPD benefits are paid to compensate the claimant for their restricted wage earning capacity. In Louisiana, that form of benefit is called Supplemental Earnings Benefits (SEBs). Even though you may know that these two acronyms mean essentially the same things, the use of “TPD” will cause the claimant’s counsel to doubt your knowledge of Louisiana law, while the use of “SEBs” will not draw the same suspicion. Also, “SEBs” is spoken as individual letters and not as “sebs.” So, we would speak the actual letters separately – “S E B’s.”
SMO v. IME
Here in Louisiana, the employer/carrier’s medical expert is called a Second Medical Opinion, or an “SMO,” with each letter pronounced separately. In some other jurisdictions, and in longshore law, the employer/carrier’s medical expert is known as the Independent Medical Examination, or the “IME.” So while the SMO may technically be a medical examination that is independent of the claimant’s treating physician, an IME in Louisiana is a separate physician appointed either by the Office of Workers Compensation Medical Services or by the court. Just to illustrate how this can cause a problem, I recently had an adjuster new to Louisiana email the claimant’s counsel that she was denying treatment based upon “the opinion of the IME.” Opposing counsel then emailed me asking why he was not notified that we had obtained an IME. After a little investigation – as I was new to the claim – I realized that the employer/carrier had not obtained an IME opinion. The adjuster was referring to the SMO, but her background was from a state that described the employer/carrier’s expert as the IME. Although in the end the issue was resolved, the adjuster had essentially tipped her hand to the claimant’s counsel that she was new to Louisiana.
These are three of the most common tells relied upon by the claimant’s counsel to assess your knowledge of Louisiana workers’ compensation. Until you can handle Louisiana workers’ compensation claims like a thirty-year expert, you should at least take the opportunity to sound like an expert. That little bit of hesitation on the part of the claimant’s counsel can serve you well.
