LAC 40:I.911. Employee Notice

A. It shall be the employer's duty to advise employees and keep posted at some convenient and conspicuous point in his place of business a notice reading substantially as follows. LOUISIANA WORKS OFFICE OF WORKERS' COMPENSATION ADMINISTRATION POST OFFICE BOX 94040 BATON ROUGE, LA 70804-9040 1. Reporting Injury a. You should report to your employer any occupational disease or personal injury that is work related, even if you deem it to be minor. b. In case of occupational disease, all claims are barred unless the employee files a claim with his employer within six months of the date that: i. the disease manifests itself; ii. the employee is disabled as a result of the disease; and iii. the employee knows or has reasonable grounds to believe that the disease is occupationally related. 2. In case of death arising from an occupational disease, all claims are barred unless the dependent(s) files a claim with the deceased employee's employer within six months of: a. the date of death; and b. the date the claimant has reasonable grounds to believe that the death resulted from an occupational disease. 3. Filing Notice. In case of accidental injury or death arising out of and in the course of employment, an injured employee, or any person claiming to be entitled to compensation either as a claimant or as a representative of a person claiming to be entitled to compensation, must give notice to the employer within 30 days of the injury. If notice is not given to the employer within 30 days, no payments will be made under the law for such injury or death. 4. The above mentioned claims should be filed with the employer at the address shown below. 5. Physician Notice. In the event you are injured, you are entitled to select a physician of your choice for treatment. The employer may choose another physician and arrange an examination which you would be required to attend. 6. Formal Claim. In order to preserve your right to benefits under the Louisiana Workers' Compensation Law, you must file a formal disputed claim, LW-WC-1008, with the Office of Workers' Compensation Administration within one year after the accident if payments have not been made or within one year after the last payment of weekly benefits. 7.a. Per R.S. 23:1304, this notice shall be given by delivering it or sending it by certified mail, return receipt requested, to: ________________________________ Employer Representative ________________________________ Employer/Business Name ________________________________ Address ________________________________ City ________________________________ State and Zip 8. Per R.S. 23:1305, failure to give notice may not harm the employee if the employer knew of the accident or if the employer was not prejudiced by the delay or failure to give notice. Inaccuracies in this notice of disease, injury, or death regarding the time, place, nature, or the cause of injury or otherwise will not be held against the employee unless the employer can show harm from being misled about the facts. 9. If you desire any information regarding your rights and entitlement to benefits as prescribed by law, you may call or write to the Office of Workers' Compensation Administration at the above address, or telephone (225) 342-7555. 10. This notice should be posted conspicuously in and about the employer's place(s) of business. 11. If the employer is insured, then include the name and address of the insurance company. 12. If the employer fails to keep such a notice posted, the time in which the notice of injury shall be given shall be extended to 12 months from the date of the injury.