Will Workers’ Compensation Benefits Cover the Cost of Prescription Medications?


Posted by: Chris

The workers’ compensation system was established to compensate employees who suffer work-related injuries and illnesses. Employees who qualify for benefits can receive up to 70% of their average weekly wages while they recover from their injury or illness. But, what about the other costs associated with an injury or illness—specifically prescription medications? Does the workers’ compensation system cover these costs for injured employees, too?

Injured employees should be reimbursed for all of their medical expenses—including prescription medication expenses. However, the employer’s insurance company may deny these payments in some cases. Here’s what you should know:

How Healthcare Providers Should Prescribe Medications

Doctors that treat injured workers should prescribe any medication that they believe to be medically necessary. If an injured worker’s condition can be treated with either an over-the-counter or prescribed medication, the doctor should choose the over-the-counter medication if it will not affect the worker’s recovery. The doctor should also prescribe generic medications instead of branded medications whenever it is appropriate to do so.

The Statement of Medical Necessity

All healthcare providers that treat injured workers may be asked to provide a statement to the worker’s insurance company that explains why the prescribed medications were medically necessary. In this statement, the healthcare provider needs to elaborate on how the prescription medications treat the injured worker’s condition and promote recovery. The healthcare provider should also include whether or not he has prescribed this specific medication to other patients before and how confident he is in its ability to assist with the injured worker’s recovery.

For example, let’s say a doctor prescribes an injured worker a medication and specifically tells the injured worker that he needs to get the branded medication as opposed to the generic kind. Branded medications are more expensive than generic medications, so the insurance company will most likely want to know why the healthcare provider made this decision. In this case, the doctor would need to write a statement that explains the differences between the generic and branded medication and why the branded medication would treat the worker’s condition better than the generic medication so he can justify his decision.

All prescription costs should be covered. But, if the insurance company does not believe the medications were necessary, it’s possible that they could deny payment for these expenses.

Have you been injured at work? Seek medical treatment first, then get in touch with the attorneys at Armstrong & Vaught, P.L.C. Our attorneys will stand by your side throughout the process of filing of recovering benefits after an injury to ensure you are fairly compensated. Please call us today at 918-582-2500, toll free at (800) 722-8880, or contact us online for a free consultation with an experienced attorney.