Peggy Edwards, et al. v. Louisiana Workforce Commission, et al.

Under the Louisiana workers’ compensation statute, workers injured on the job are entitled to appropriate employer-funded medical care, which is usually provided through an insurance carrier retained by the employer. If an insurance carrier does not pre-approve treatment requested or by the worker’s medical provider, the worker’s claim for payment is adjudicated by a state agency. Under the governing regulations, the insurance carrier in opposing a claim for payment may introduce any evidence it chooses to justify refusing to pay for the treatment at issue. The question presented is: Does the Louisiana administrative system for adjudicating medical claims by injured workers violate due process

1. by denying the claimant an opportunity, at the initial agency decision stage, to offer either evidence or argument in response to the carrier’s evidence,

2. by requiring a claimant challenging an adverse initial agency decision to show by clear and convincing evidence that the decision was erroneous, and in many cases by forbidding the claimant to adduce responsive evidence at this stage as well.