Does Workers' Compensation Cover Prescriptions?
If you have been injured at work, you may need ongoing medical treatment – including prescription medications. Sometimes, those prescriptions can be expensive. Often, those who have been injured at work wonder if workers' compensation will cover the cost of those prescriptions. The good news is that if the prescription is for a work-related injury, workers' compensation should indeed cover it. Let's take a closer look together at how that coverage works, and what you should expect.
A CLOSER LOOK AT COVERAGE
First and foremost, it is important to understand that workers’ compensation is a “no-fault” system. This essentially means that if you can prove, through the evidence you present, that your injury was work-related, you should receive coverage for that injury. Generally, the medical benefits provided by workers’ compensation are intended to cover any of an employee’s reasonable medical expenses that pertain to the work-related injury. These expenses will often include the cost of prescription medications, or other medical supplies available at a pharmacy.
FILLING YOUR PRESCRIPTIONS – A FEW HELPFUL TIPS
Here are a few helpful things to keep in mind as you seek to fill your prescriptions and seek the treatment that you need:
- Your medical provider will likely either provide you with a prescription slip that you can personally take to the pharmacy, or call your prescription into the pharmacy for you. Be sure to speak with your medical provider to be sure that you understand their procedures for having prescriptions filled.
- Your employer’s workers’ compensation insurer may require you to use only certain pharmacies, so it’s important to be certain that you know which pharmacies are approved.
- Ideally, if the doctor who is providing treatment for your work-related injury writes the prescription, the cost should be covered by workers’ compensation insurance, and the pharmacy should not charge you a co-pay. If, however, your benefits have been denied and you are seeking treatment while you are opposing the denial, you may have to pay out-of-pocket during that time. If your claim is successful and the insurer begins to pay benefits, you will likely be able to be reimbursed. For this reason, it’s important to keep all paperwork and receipts related to prescriptions.
Depending upon your condition and the circumstances of your injury, there may be additional information that will be helpful as you seek to have your prescriptions filled. For that reason and many others, consulting with an attorney who knows and understands workers’ compensation law will be essential.
POTENTIAL LIMITS ON WORKERS’ COMPENSATION PRESCRIPTIONS
While prescriptions related to a work injury should generally be covered by workers’ compensation, it is important to keep in mind that they must always be reasonably related to the workplace injury. There may be certain circumstances in which an insurance company questions the validity of one of the prescriptions, and whether it is truly related to the injury. In other cases, the insurance company may resist refilling a prescription too many times, believing that the refills are no longer reasonably needed to treat the injury in question. In still other situations, an insurer may resist paying for a name-brand medication when a generic one is available, or paying for the most expensive wheelchair when a less expensive model is available.
If you find yourself in one of these situations, you may need to obtain a written explanation from your medical provider, setting forth the reasons why the prescription continues to be necessary, or the particular medical supply is needed. After obtaining that explanation, you should provide it to your employer and/or its workers’ compensation insurer to seek reconsideration of the denial. In these circumstances, it can also be extremely helpful to seek the advice of an attorney who knows and understands workers’ compensation law.
RODEN LAW – YOUR WORKERS’ COMPENSATION ATTORNEYS
In an ideal world, everything with your workers' compensation claim will go smoothly. You would receive the prescriptions you need, and the treatment you need for your injury without difficulty. Unfortunately, however, things aren't always ideal. Sometimes, even when you have a legitimate, work-related injury for which you deserve care and compensation, there are roadblocks placed in your path. At Roden Law, we're here to help you move forward and to fight for the benefits you deserve. Give us a call today. We look forward to speaking with you soon.