La. Admin. Code tit. 37 § III-1907

Current through Register Vol. 50, No. 11, November 20, 2024

Section III-1907 - Claims for Future Medical Care and Related Benefits

A. A patient, who is deemed to be in need of future medical care and related benefits pursuant to a final judgment issued by a court of competent jurisdiction or as agreed to in a settlement reached between the patient and the fund, may make a claim to the fund through the board for future medical care and related benefits as incurred by the patient and made necessary by the health care provider's malpractice.

B. If a patient's claim for future medical care and related benefits is disputed or payment of the amount thereof has been denied by the board, then the matter may be referred to the board for an administrative hearing.

C.

1. The following administrative hearing process shall be followed when such is requested by the claimant or the claimant's representative. The claimant desiring to institute a hearing shall prepare and file with the board a complaint setting forth:

a. the name and address of each respondent;

b. a statement, in ordinary and concise language, of the facts upon which the complaint is based, together with supporting evidentiary material, including but not limited to, whenever applicable, particular reference to the statute or statutes, or rules, regulations, and orders that the claimant alleges have been violated.

2. Such complaint will be sent to the general counsel for the board who will contact all parties to determine the date of the hearing. The hearing panel will consist of at least three board members. The parties may provide any evidence they deem necessary and may call witnesses to give testimony that bears upon the issues. A court reporter will be present to record the hearing and to administer the necessary oaths to any witnesses. Each party will be allowed to make a brief opening statement, present evidence and cross-exam any witnesses. The panel members will be allowed to ask questions of both parties and any witnesses. All parties will be allowed to make a closing statement. Following the closing statements, the panel members will meet in private to reach a decision. Findings of fact and decision of the panel will be put in written form and presented to the board in executive session for a final determination and vote. The final decision will be forwarded to the claimant or their representative and the fund's counsel.

3. Should the claimant or their representative disagree with the decision reached through the administrative hearing process, they may file a petition in the 19th judicial district court in accordance with §1931 of these rules.

La. Admin. Code tit. 37, § III-1907

Promulgated by the Office of the Governor, Patients' Compensation Fund Oversight Board, LR 19:1566 (December 1993), amended LR 27:1889 (November 2001), amended by the Office of the Governor, Division of Administration, Patients' Compensation Fund Oversight Board, LR 38:2546 (October 2012).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:1299.44(D)(3).