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Q
What can I do if my employer refuses to pay for my prescriptions as part of my workers’ compensation claim?

A

Workers' comp should cover prescriptionsWhen you are injured on the job, it can become frustrating and depressing to discover that your employer or the workers’ compensation insurance company is disputing your right to medical care or prescription medications that your doctor says you need. In New Jersey, you have a right to receive all necessary and reasonable medical treatment for your injuries on the job and have bills for this care paid through your employer’s workers’ compensation insurance company. Medical treatment includes receiving prescriptions you need. What can you do if your employer refuses to pay for medications you think you need?

Steps You Can Take If Your Employer’s Insurance Company Refuses to Pay for Your Medicine

While you have the right to receive the medical treatment you need, your employer’s workers’ compensation insurance company has the right to pick the doctors you can obtain treatment from. In addition, you will need to follow any procedures for obtaining needed prescriptions, such as using certain pharmacies or mail order companies.

However, you have legal remedies if the insurance company refuses to pay for medications you need. You can take one of these steps to appeal the decision:

  • File a claim petition. This proceeding is a formal hearing process like a trial where an administrative judge would make a decision on your petition if you are unable to resolve it before your trial.
  • File an application for an informal hearing. This is a more informal hearing where you and the insurance company try to resolve your disputes with the help of an administrative judge. If you are unable to do so, you can still file a Claim Petition.
  • Motion for medical benefits. If you need your prescriptions or other medical treatment promptly, you can file a Motion for Medical Benefits and/or Temporary Benefits. A hearing will generally be scheduled within 30 days of your filing of the motion.

An experienced workers’ compensation attorney can advise you which appeal option is better for your situation, help you file your petition, application, or motion, and represent you at your hearing. He can also advise you if your employer is failing to pay for other medical treatments you have a right to receive and the proper amount of wage loss benefits. If you need to fight to get prescription coverage or any other workers’ compensation benefits under New Jersey law, start an online chat to schedule your free case evaluation.

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