The Louisiana Request of Authorization Carrier or Self-Insured Employer Response is a form used by employers in Louisiana to respond to a request for authorization for medical services. It is used to provide information about the employer's self-insured status and the authorization of payment for medical services. There are two types of Louisiana Request of Authorization Carrier or Self-Insured Employer Response forms: Carrier Response and Self-Insured Employer Response. The Carrier Response form is used when the employer is not self-insured and the insurance carrier is responsible for payment. The Self-Insured Employer Response form is used when the employer is self-insured and is responsible for payment. The form includes information such as the employer's name, policyholder's name, policy number, self-insurance status, and authorization of payment for medical services. The form must be completed and returned to the requesting party in order to authorize payment for the medical services.