Who decided whether a workers’ compensation medical director had a conflict in a treatment dispute?

Plain-English summary

Louisiana's workers' compensation office asked who decided whether its medical director or associate medical director had a conflict in a medical necessity dispute. The 2013 opinion concluded the office's director made the final conflict determination. The statutory definition of "director" and the conflict procedure pointed to the Director of the Office of Workers' Compensation Administration.

The AG did not give a list of circumstances that automatically created a conflict. It said that determination depended on the facts of each case, which the AG's office would not decide in an advisory opinion.

Currency note

This opinion was issued in 2013. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Historical summary

Workers' compensation administrators

The AG assigned the final conflict decision to the director specified in the statute. The quoted procedure required written communication about a potential conflict and a written determination within the stated statutory period.

Claimants and medical providers

The opinion did not declare any particular relationship or circumstance disqualifying. It treated those questions as fact-specific.

Common questions

Who decided a claimed conflict involving the medical director?

The AG said the Director of the Office of Workers' Compensation Administration held that authority.

Did the AG decide which relationships were conflicts?

No. It expressly declined that factual question and said each case depended on its own circumstances.

Could a party raise a potential conflict?

The statutory procedure quoted in the opinion allowed either party, the medical director, or the associate medical director to report a potential conflict in writing.

Background and statutory framework

Act 317 amended La. R.S. 23:1203.1. Its definition of "director" in subsection (A)(3) and its conflict procedure in subsection (J)(2) supplied the AG's answer to the authority question. The separate question about what facts created a conflict remained open.

Citations

• La. R.S. 23:1203.1 (A)(3): definition of the director.
• La. R.S. 23:1203.1 (J)(2): conflict procedure and decision authority.

Source

• Landing page: https://www.ag.state.la.us/Opinions
• Original PDF: https://www.ag.state.la.us/Opinion/Download/13-0121

Original opinion text

Best-effort transcription from a scanned PDF. Minor errors may remain — the linked PDF is authoritative.

~tat.e of IIIouisiana
DEPARTMENT OF JUSTICE
P.O. BOX 94005
BATON ROUGE
70804-9005
JAMES D. "BUDDY" CALDWELL
ATIORNEY GENERAL
AUG 1 6 2013
OPINION 13-0121

Mr. Wes Hataway
173-A WORKMEN'S COMPENSATION

Director
Office of Workers' Compensation
La. R.S. 23:1203.1 (A)(3); La. R.S. 23:1203.1 (J)(2)

Louisiana Workforce Commission
The Director of the Office of Workers' Compensation has the
1001 North 23 rd Street
authority to make a final decision on conflicts of interest involving
the medical director or associate medical director and the parties
Baton Rouge, LA 70804-4187
to a medical necessity dispute.

Dear Mr. Hataway:

Our office received your request for an opinion regarding possible conflicts of interest which may arise under Act 317 of the 2013 Regular Session of the Louisiana Legislature ("Act 317"). In order to properly ascertain the authority given in Act 317, you have requested an opinion of the Attorney General addressing the following questions:

(1) Whether the Director of the Office of Workers' Compensation has the authority to make a final decision on conflicts of interest involving the medical director or associate medical director and the parties to a medical necessity dispute?

(2) What situations would cause a conflict of interest to arise between the medical director and the parties in deciding a medical necessity dispute?

La. R.S. 23:1203.1 and La. R.S. 23:1203.1.1, as amended and enacted by Act 317, creates the positions of medical director and associate medical director. The medical director and associate medical director have the authority to resolve disputes involving medical necessity in workmens' compensation cases.

La. R.S. 23:1203.1 (J)(2), as amended, authorizes the director to make a determination as to whether a conflict of interest exists in deciding a medical necessity dispute, and states in pertinent part:

J. (2) If either party, the medical director, or associate medical director believes that a potential conflict of interest exists, they shall communicate in writing such information to the director, who shall make a determination

Page 2

OPINION 13-0121
Wes Hataway
Page 2

as to whether a conflict exists within two business days. The director shall notify in writing the patient, the physician, and if applicable, the attorney of his decision within two business days.

La. R.S. 23:1203.1 (A)(3), as amended, defines "director" as the Director of the Office of Workers' Compensation Administration.

When the provisions of La. R.S. 23:1203.1(A)(3) and La. R.S. 23:1203.1(J)(2) are read together, it is clear that the director referred to in La. R.S. 23:1203.1(J)(2) is the Director of the Office of Workers' Compensation Administration. 1 We are" of the opinion that the Director of the Office of Workers' Compensation Administration has the authority to make a final decision on conflicts of interest involving the medical director or associate medical director and the parties to a medical necessity dispute.
,
The determination of whether a conflict of interest arises between the medical director or associate director and the parties in deciding a medical necessity dispute is based on the specific facts of each individual case. Therefore, we are unable to provide you with an opinion on what factual situations would cause a conflict of interest to arise between the medical director and the parties in deciding a medical necessity dispute?

In conclusion, it is the opinion of this office that the Director of the Office of Workers' Compensation Administration has the authority to make a final decision on conflicts of interest involving the medical director or associate medical director and the parties to a medical necessity dispute. We hope that this opinion adequately addresses the legal issues you have raised. If our office can be of any further assistance, please do not hesitate to contact us.

With best regards,

JAMES D. "BUDDY" CALDWELL
ATIORNEY GENERAL

BY: ~9C~diJv
Madeline S. Carbonette
Assistant Attorney General

JDC:MSC:jv

1 La. C.C. Art. 13 requires that/aws on the same sUbject matter must be interpreted in reference to each other. 2 It is the policy of the Office of the Attorney General not to make determinations on factual matters. La. Atty. Gen. Op. Nos. 12-0185; 07-0111; 09-0141A; and 08-0334.