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Can The Employer's Work Comp Insurance Adjuster block prescription medication refills?
Anonymous10 views3 answers
My son had his first follow-up visit at the Urgent Care following his work related injury which occurred only 4 days ago. The physician then faxed the pharmacy for refills on my son's pain medication. When I went to pick up the prescription the pharmacist told me that they had been blocked from filling the prescription by the Employer Insurance Company. The pharmacist made several phone calls and was told that I had to call the Insurance adjuster. I called and she was already gone for the day so I spoke with an after hours person who stated that they could not authorize a refill because they had not yet obtained enough information on the injury from my son's employer. the pharmacist told me that they had never been blocked from filling a work comp prescription before.
I think you may be confused. The Adjuster did not say that the Pharmacist could not fill the Rx; she told the Pharmacist that they would not authorize PAYMENT right now. If you want to pay for his Vicodin or Darcocet, Billy can get his drugs.
The Insurance Company has 90 days to Accept/Deny the claim while it is under investigation. In the interim, there are Pharmacies that will fill the Rx on a Lien basis while the claim is pending. However, Billy will have to hire an Attorney, so the Pharmacist can secure his payment with the Attorney's assistance. Technically, the Insurance is responsible for up to 10,000 of Treatment until the Claim is denied. However, that is more the Pharmacist's problem than Billy's. Medical providers are prohibited from billing the Injured Worker unless notice of the Denial has been served on the IW by the medical provider prior. On the other hand "Bubba's Opium Emporium" has no obligation to medicate Billy unless you have Visa/MC for the cost. It gets kind of technical, but the short version is that Billy should lawyer-up if you don't want to pay out of pocket for his drugs.
Unless Billy is a Minor, you should let him hire an Attorney and manage his claim with legal assistance. You can actually enter an appearance as his Layman representative (WC is Administrative Law) but cannot receive a fee. However, just because you have the right to do it does not mean that it is the right thing to do. WC has become a very technical field, you are best served with a Certified Specialist in the area. Santa Ana is your venue if Billy still lives with you.
I hope it works out for him, but a Certified Specialist will make that more likely.
I agree with Mr. Corson.
Most likely, if this is a recent injury, the insurance company just hasn't gotten the file set up yet. Therefore, they don't know anything about the injury or treatment. It usually takes a few days.
Once the injured employee notifies his employer of the work injury, the insurance carrier has up to 90 days to investigate and decide whether to accept or deny the claim. During this period, they must pay the medical treatment bills up to a maximum of $10,000.00. If you or your son pay for the medications, you will get reimbursed. Maybe the Urgent Care can give your son a short supply of the medication.
Good luck.
