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Does Workers’ Compensation Cover Prescriptions?

June 19, 2018

When you are in pain, you often need medication to deal with the pain – and to help your body heal. Given the nature of your insurance plan, you may be able to have this medication covered.

But if the pain is due to a work-related injury or illness, the simple task of getting relief through medication can be complicated if you have filed for workers’ compensation. This leaves many to wonder, does workers’ compensation cover prescriptions?

Having Workers’ Compensation Prescriptions Filled

As an individual who was injured on the job, you have the right to obtain medications to assist with pain resulting from the injury. However, the insurance carrier working with the workers’ compensation claim is required to choose the pharmacy that will be filling the prescription. This is the only way that the prescription will be covered by insurance.

Unfortunately, there can be hang-ups along the way, as the insurance carrier may provide a prescription card to take to the pharmacy, or require a more complex pre-approval process. Basically, this is a gated system to make sure the medication is approved ahead of time. While this makes sense, data can often get confused when running through multiple parties during this process. This can lead to great frustration and needless time without the medication needed by the individual. And, it may take time for your claim to be approved.

Purchasing Medication Before Approval

While an individual can always purchase the medication ahead of time, there is no guarantee that it will be approved. Paying out of pocket with no guarantee of a repayment is not an ideal situation, as medications are often very expensive.

Individuals in this predicament often resort to mail-order pharmacies that at times don’t require pre-approval. But again, this is not a solution for everyone, as mail-order pharmacies that don’t require pre-approval could cause issues with reimbursement.

Contested Claims and Prescriptions

If the insurance carrier has contested your claim, they are also not required to pay for the medication. This unfortunately leads to more down time waiting for the approval before getting a confirmation of approval for the medication. Any undisputed portion of the claim must get reimbursement within 45 days. Even if a portion is being disputed, there is still a scenario where some is undisputed, which sets the 45 day reimbursement into play.

Current Medications Prior to Filing

If you are currently taking medications prior to filing a claim, and the medication is due to a work-related injury or illness, the insurance carrier cannot stop you from receiving the medications you are already taking. If your doctor has prescribed the medication for a work-related injury or illness, the Workers’ Compensation Board will need to make a decision if there is a dispute.

While it can be difficult getting the medication you need for your work-related injury and waiting for a workers’ compensation claim to be approved, it’s important to note that you are not alone. The professionals at Tabak Law can help you out at any stage of your case – even if you have been denied benefits and prescription medication. Simply fill out the form below or call 844-432-0114 to receive free advice. There is no obligation.

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