1010 forms are boring and difficult
by Roberto Costales on 04/05/13
In Louisiana workers compensation, you are entitled to $750 dollars of non-emergency medical care with a physician. If you need to get more than that amount of money is medical care, then you (or your lawyer) better familiarize yourself with a 1010 form.
The 1010 form is a relatively recent development in Louisiana law. It is essentially a pre-approval form. Say you get hurt at work and go the doctor. He or she takes a look at your knee and figures out that you probably have a torn meniscus ligament. In order to confirm this assumption, they need to send you to go get an MRI of the knee.
If that MRI is going to run more than $750 bucks, then the doctor needs to turn in a 1010. The 1010 is a form created by the Office of Workers Compensation here in Louisiana. It makes the doctors and their staff spend valuable time during the day, which they could be using to treat patients, filling out paperwork. The paperwork explains what the treatment or test being requested is, and what medical basis there is for the treatment or test.
Not only does the doctor need to put in the 1010 what the medical basis for the test is, he or she needs to put that basis in the language which the people who approve the 1010 can understand: the Medical Guidelines language. Essentially, the guidelines give different criteria for why and when all medical treatments and procedures are appropriate in any given situation. See my others posts for more on that boring subject.
Here's the thing that stinks though: a lot of doctors have already spent most of their lives learning medicine. They don't have time to learn the language of the Medical Treatment guidelines too. Let me give an example:
Let's say Tom is world-renowned orthopedic surgeon. He has operated on the torn meniscus of professional athletes and celebrities all over the world. Tom has probably treated this particular problem thousands and thousands of times. He has so much experience with this injury that he can spend thirty seconds with a patient and know if that's the problem or not.
Let's say Tom sees Sandy about here knee, and, like always, figures out from the tell tale signs that Sandy has a torn meniscus. And so Tom sends in a 1010 form to the insurance company requesting an MRI so he can see how bad it is, and what the next step should be. Let's also say that Tom just turns in the 1010 without talking about the Medical Treatment Guidelines. Even though Tom knows for sure that this is the problem because he is a master doctor, the insurance company is still going to deny the 1010.