LA OWCA Second Injury Board Knowledge Questionnaire WARNING 2026

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  1. Click ‘Get Form’ to open the LA OWCA Second Injury Board Knowledge Questionnaire in the editor.
  2. Begin by entering your employer's name in the designated field at the top of the form.
  3. Fill in your personal details, including your name, date of birth, gender, and last four digits of your Social Security number.
  4. Provide your home address and telephone number. Ensure all information is accurate to avoid any issues.
  5. In the medical conditions section, check all applicable boxes for conditions you currently have or have had previously. Use the Explanation Page for additional details.
  6. Complete the surgical treatment section if applicable, indicating any surgeries you've undergone along with approximate years.
  7. Answer the follow-up questions regarding activity restrictions and current treatments. Be thorough and honest as this impacts your workers' compensation benefits.
  8. Finally, sign and date the form at both employee and employer witness sections to validate it before submission.

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A secondary injury is a medical condition that develops as a direct result of the original work-related injury or from the treatment for that injury. These injuries can occur weeks, months, or even years after the initial incident.
The two kinds of temporary disability benefits are temporary total disability, or TTD, and Temporary Partial Disability (TPD). The maximum time that an injured worker can receive such temporary disability payments is 104 weeks over a time period of 2 to 5 years.
The Fund is a state agency which reimburses employers or, if insured, their insurance carriers for part of the workers compensation costs in certain instances when an employee with a pre-existing permanent partial disability is injured on the job. Who Administers The Fund?

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The Second Injury Fund (SIF) is a state program that will make contributions toward your disability benefits in the event your previous injuries and disabilities, along with your current workers compensation injury, render you entirely and permanently disabled.
Second-injury funds collect assessments on employers and carriers. They generally pay the difference in health and disability benefits costs between a workplace injury incurred by a healthy employee and the added cost resulting from a pre-existing condition.
If youve been injured on the job and have been approved for treatment under the Workers Compensation statute by your employer, and then you re-injure yourself as a result of the initial injury, you should still receive medical benefits for the second, related injury.

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