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Some important information about workers' comp and medication

Prescription drugs can play a major role in a successful recovery from a work-related injury. And fortunately, prescription medication is one of the benefits available through New York's workers' compensation program. But if you want to make sure that you have your pharmaceutical needs covered, you need to understand how the system works.

First, in order to get the medicine you need, you have to file a claim. Some insurance carriers have contracts with pharmacies or pharmacy networks. When this is the case, the insurance company is required to provide you with all the information necessary for you to pick up your medicine.

Once you file your claim for reimbursement or payment for your medicine, the insurance carrier has 45 days in which to pay the costs as outlined in the Pharmacy Fee Schedule. However, if the insurance carrier determines that the prescription is not intended to treat a work-related illness or injury, the claim may be denied. The carrier must let you or the pharmacy know that the claim is not being paid and why this is the case.

At this point, you may be held accountable for the costs of your medications. However, all is not lost. The insurance carrier may also ask you to provide more information that could help you establish your claim.

As we all know, prescription medication can be extremely expensive. But if it is necessary for your recovery, you should not have to do without. Nor should you have to pay for something that you are rightfully entitled to.

If you have filed for workers' compensation benefits, only to have some or all of your claim denied, you may want to seek the representation of a New York attorney who has experience helping injured workers get what they are owed.

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Success Stories

  • A 43 year old ironworker who fell four stories and sustained injuries to his ankle while installing a staircase settled his claim for $1,500,000.00. The accident was due to the failure of the building owner and general contractor to provide a safe place to work.
  • A construction worker operating an asphalt roller settled his case for $525,000.00 when the edge of the roadway he was paving collapsed into a trench being dug by a subcontractor causing him to sustain injuries to his leg.
  • A 54 year old commuter settled his case against the NYCTA for $1,200,000.00. when he tripped and fell on a subway platform due to the pavement being in disrepair, causing him to fall forward and to strike his head on a train pulling into the station.
  • The estate of a 64 year old woman received a settlement of $425,000.00 after she was struck and killed by a speeding tractor trailer while crossing the street at the intersection of Richmond Terrace and Port Richmond Avenue.
  • A $1,200,000.00 settlement was reached on behalf of a 54 year old man from Staten Island, New York, who, while in the course of his employment as a bus driver, was rear-ended on the Garden State Parkway and caused to suffer injuries to his back and neck as well as a fractured rib and fractured pelvis.
  • A 47-year-old building superintendent who sustained injuries to his head and right side of his body due to a tripping hazard at his job site received a settlement of $300,000.00 from the electrical company performing work at the site.
  • A 43 year old construction worker was caused to sustain injuries to his back, shoulder and hand when the elevator he was riding malfunctioned and dropped 8 floors. He received $350,000.00 in the settlement of his claim against the building owner, maintenance company and elevator company.
  • The administrator of the estate of a 69 year old man who suffered stage four pressure sores while a patient at a Queens nursing home settled the case for $400,000.00 after the man died.
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