Written by: Charles Taylor Matthews
First Approval Matters
One of the more misunderstood concepts in Louisiana workers’ compensation claims is the distinction between an injured worker’s right to an initial physician evaluation versus continued authorization of ongoing treatment. Many claims’ professionals understandably feel pressure to either approve treatment broadly to keep the file moving or deny treatment altogether until more information becomes available. Best practices often call for a more measured approach.
Under La. R.S. 23:1121(B)(1), an injured employee has the right to select one treating physician in any field or specialty without prior consent from the employer or insurer. Louisiana courts have reinforced this principle, in court decisions like Scott v. Packaging Corporation of America, recognizing the employee’s ability to obtain an initial physician evaluation, and the employer’s obligation to approve the initial evaluation, even if the claim is disputed for any reason (lack of accident, failure to report, intoxication, etc.), or risk incurring penalties and attorney fees when that right is improperly denied.
As a practical matter, this means that attempting to block an employee’s initial physician of choice can create unnecessary litigation, delay claim resolution, and increase exposure for penalties and attorney fees. However, and this is where many files begin to drift approval of an initial evaluation does not necessarily mean an employer has conceded causation, accepted all future recommendations, or waived the right to challenge ongoing medical treatment. That distinction matters, as too often, an initial office visit turns into a chain of referrals, diagnostics, injections, therapy, procedures, and surgical recommendations before the claim team pauses to evaluate whether continued treatment remains appropriate.
One approach that may be worth considering in disputed or developing claims is separating the employee’s statutory right to an initial evaluation from later treatment decisions.
For example:
- Allow the employee to exercise their initial physician choice under La. R.S. 23:1121;
- Authorize the initial evaluation only and obtain objective findings and recommendations;
- Evaluate whether additional investigation, records review, or an independent medical process is appropriate;
- Where supported by the facts and applicable procedures, consider utilizing available medical, such as Utilization Reviews and/or obtaining a Second Medical Opinion, prior to approving further treatment authorization.
This type of approach allows employers and insurers to remain compliant with Louisiana workers’ compensation obligations while preserving the ability to evaluate causation, necessity, and future exposure before treatment escalates.
Another practical consideration is internal communication.
Claims professionals should ensure that:
- Initial physician authorization decisions are clearly documented (Fully Completed 1121 form);
- Clearly documented 1010 form approving initial evaluation only;
- Defense counsel receives the initial medical records promptly;
- Follow-up treatment requests are reviewed independently and not treated as automatically approved.
Final Takeaways:
- The employee’s initial physician choice is often the beginning of the medical investigation—not the end of it.
- Approving the initial visit may satisfy a statutory obligation; however, approving anything that follows are separate decisions that deserve appropriate consideration for future impacts on the claim.
- Thoughtful claims handling early in the file can preserve defenses, reduce unnecessary disputes, and help control long-term medical exposure.