Jul 2023

Will Worker’s Compensation Pay For My Prescriptions in Massachusetts?

prescription medication, pad, and stethoscope; Massachusetts workers' compensation lawyer

Suffering an injury or illness while on the job can impact your life physically, emotionally, and financially. Workers’ compensation benefits are supposed to cover all of your medical expenses, but injured workers may still have concerns. For example, will the prescription medications I need be covered?

A lawyer can guide you through the claims process

Under Massachusetts workers’ compensation laws, injured workers are entitled to medical benefits that cover reasonable and necessary medical treatment related to their work-related injury or illness. This includes coverage for prescription medications that are deemed essential for the recovery and rehabilitation process.

But it can get complicated.

The coverage of prescription medications in a workers’ compensation claim varies depending on the specific circumstances of the injury and the treatment plan prescribed by your doctor. If you’re unsure about the coverage for your prescription medications or need assistance with your claim, consult an experienced workers’ compensation attorney right away.

What’s covered under workers’ compensation laws

Before obtaining prescription medications through workers’ compensation, your healthcare provider must obtain pre-authorization from the insurance carrier. This process involves submitting a written request and medical documentation justifying the medical necessity of the prescribed medication.

For a prescription to be covered under workers’ compensation, it must be considered reasonable and necessary for treating the work-related injury or illness. This means that the medication should be directly related to the medical treatment plan and tailored to your specific needs.

In some cases, the insurance company may suggest or require the use of less expensive alternative medications that provide similar therapeutic benefits. You have the right to discuss treatment options with your doctor and can appeal this decision.

The insurance company will periodically review the medical treatment and prescriptions provided. Your doctor must support the medical necessity of the prescribed medications to ensure ongoing coverage.

A lawyer can assist you in understanding your rights and options regarding the insurance company’s suggestions or requirements for alternative medications.

Seeking legal representation

An experienced attorney can help you navigate the claims process in Massachusetts to ensure you get the prescription medication and other medical care that you need. A lawyer can:

  • Explain the pre-authorization process, the criteria for medical necessity, and the potential coverage of alternative medications.
  • Work with your doctor to ensure that all necessary paperwork is submitted correctly and promptly to the insurance company.
  • File an appeal on your behalf if your medication request is denied and provide additional evidence supporting the medication’s necessity.
  • Negotiate with the insurance company to ensure that you receive appropriate coverage and timely access to necessary medication.
  • Ensure you receive all of the medical treatment you need for your injury or illness in addition to prescription medication and work to prevent delays or disruptions in treatment.
  • Monitor reviews to ensure that the insurance company continues to cover necessary prescription medications.

Get an experienced attorney on your side

Having an experienced workers’ compensation lawyer by your side can provide peace of mind during a difficult time. Your lawyer can handle your claim so you can focus on your recovery and well-being.

At The Law Offices of Deborah G. Kohl, we understand the importance of receiving proper care for your work-related injury or illness. That includes being able to take the medication your doctor prescribes. If you’ve been hurt on the job in Massachusetts, we can help. Contact us now to schedule a free consultation.

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