1. A. The following forms are prescribed for use pursuant to R.S. 23:1208(F):

   1. 1. LW-WC-1025.EE Employee Certificate of Compliance;
   2. 2. LW-WC-1025.ER Employer Certificate of Compliance;
2. B. Per R.S. 23:1208(G), the employee shall, upon reasonable request, report his other earnings to his employer's payor on LW-WC-1020, Employee's Monthly Report of Earnings, unless an employee has only received medical benefits.
3. C. Issues arising out failure to file these required forms are to follow procedures in R.S. 23:1201.1.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1208 and 23:1291.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Employment and Training, Office of Workers' Compensation, LR 17:359 (April 1991), amended by the Department of Labor, Office of Workers' Compensation, LR 22:222 (March 1996), amended by the Louisiana Works, Office of Workers' Compensation Administration, LR 52:501 (April 2026).