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How To Fill Your Prescription Under Workers' Compensation

Friday, February 7, 2014

If you have been injured on the job, you may require medication in order to heal and cope with pain. As you would expect, your medications will have to be filled by a pharmacy; but if you have filed for Workers’ Compensation  for your work-related injuries or illnesses, there are specific guidelines in which to have those prescriptions filled.

The following is a simple breakdown of the process in having your prescriptions filled by a pharmacy under Workers’ Compensation Law:

  • Filling Medications: You have a right to obtain medications that are needed for your work-related injury or illnesses under Workers’ Compensation Law. However, it is important to note that the law enables only insurance carriers and those who are self-insured to choose the pharmacies that you will be able to use in filling your prescription. In order for your prescription to be covered by the insurance carrier, you must use the designated pharmacy.
  • Insurance Carriers:  Under Workers’ Compensation Law insurers can choose the establishment in which your medications are to be filled. This includes pharmacies, mail-order pharmacies and pharmacy networks. Your insurance carrier will have to make you aware of the establishment they have chosen via written documentation. Under Workers’ Compensation Law, all insurance carriers are required to provide you with the name and location of the pharmacy. They must also disclose any other stipulations to having your medications filled. Insurance carriers are to assign a pharmacy that is in reasonable distance to you or that offer mail order service.
  • Insurance Carriers Controverts Claims: Under Workers’ Compensation Law, an insurance carrier or self-insured employer does not have to pay for your prescriptions or medical care if they have  contested the claim. Should your claim be recognized as work-related, then the carriers or self-insured employer will have to pay for medical treatment and medications.  In the event that your claim is controverted and the assigned pharmacy will not fill your prescriptions, you are able to use a pharmacy of your choice.
Attorney Bill Turley talks about reimbursement of medical expenses. 

  • Your Current Prescriptions:  Your insurance carrier cannot stop you from receiving the medications that you are currently taking. Under Workers’ Compensation Law, insurance carriers can only decide where your prescriptions will be filled, not what prescriptions you are allowed to take. If an insurance carrier denies payment for a specific drug your doctor has prescribed for your work-related illness or injury, then the Workers’ Compensation Board will make a decision in the dispute.
  • Reimbursement of Prescription Costs: There is no set time frame for which your carrier has to reimburse you for the cost of your prescriptions. However, under Workers’ Compensation Law, the carrier does have to pay any undisputed portion of any claim within 45 days of receipt, unless a claim is disputed. If a claim is disputed, the insurance carrier must still pay any undisputed portion of the claim within 45 days. They must also notify you that the claim is not being paid and the reason why.

Should you need more information about prescriptions under Workers’ Compensation Law or assistance in filing your Workers’ Compensation claim, contact us toll-free at 1-877- NY-DBLAW for a free claim evaluation.

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