(On-the-Job Injury or Illness)
- Q. Will I be able to get my prescription medicines filled for my work-related injury under the new Workers' Compensation Law?
A. Yes. The new law does not change your right to obtain the medicine you need for your work-related injury or sickness. The new law only allows insurance carriers and self-insured employers to designate the pharmacies you will use to have your prescriptions filled. This measure will not affect your ability to receive the prescription medications you need.
- Q. I just received a letter from my insurance carrier stating that I now have to obtain my prescriptions from the pharmacy of their choosing. Is this allowed under the law?
A. As of July 11, the Workers Compensation Law will allow insurers to designate the pharmacy, pharmacy network or mail-order pharmacy you use to get your medications. The insurer must notify you of this requirement, and must tell you in writing the local pharmacies you can use, along with their locations and addresses. It must also tell you how to fill and refill prescriptions through the mail, internet, telephone or other means.
Nothing in this law will prevent you from getting medicines when you need them. The network chosen by your insurer must include pharmacies that are either within a reasonable distance from you or that offer mail order service. Also, when there is a medical emergency and it is not reasonably possible to obtain the medicine you need immediately from the pharmacies in the chosen network, you can purchase the drugs elsewhere.
- Q. What do I do if the insurance carrier controverts my claim?
A. Under the old and new law, an insurance carrier or self-insured employer does not have to pay for medical treatment, including prescription drugs, while a claim is controverted. If the claim is established the carrier or self-insured employer will then have to pay for all medical treatment and medications for the work-related injury. If your claim is controverted and a network pharmacy will not fill your prescriptions, you may elect to use a pharmacy outside the designated network.
- Q. Can my carrier prevent me from getting the drugs I am currently receiving?
A. No. The law only governs where you will get your prescription filled. A carrier cannot tell you what drugs you must take. As before, that is between you and your doctor. If a carrier will not pay for a specific drug, the Workers' Compensation Board will decide the dispute.
- Q. How much time will the carriers have to reimburse me for my drug costs?
A. Currently, the law and regulations do not set a specific time, which sometimes led to long waits. Under the new law, the carrier must pay the undisputed portion of any claim (either for reimbursement or payment) within 45 days of receiving it, unless it disputes that the claim or that the prescribed medicine is for the work-related injury or illness. Even when a claim is disputed, the carrier must pay any undisputed portion within 45 days, and either notify you that the claim is not being paid, and why, or request reasonable additional information. The change to the law is effective on July 11, 2007.