Articles Posted in Health Insurance and Workers’ Compensation

While the overall intention of Governor Baker’s opioid bill appears to be positive for those in Massachusetts dealing with chronic pain and opioid dependency, it contains a section that would be harmful to injured workers who rely on Massachusetts’ workers’ compensation insurance to pay for their prescription medication.  Section 39 of the Governor’s opioid bill would establish drug formularies in all workers’ compensation cases (not just those involving the prescription and use of opioids) and for all medications.  Section 39 of House Bill No. H-4033 states:

SECTION 39. Chapter 152 of the General Laws is hereby amended by inserting after the following section:

             Section 13 ½. The department shall establish a formulary of clinically appropriate medications, including opioids and related medications, and shall promulgate regulations for the administration of this formulary.  In establishing the formulary, the department shall consult with the health care services board and the drug formulary commission established in section 13 of chapter 17 of the General Laws.  The formulary shall be based on well-documented, evidence-based methodology, and the department shall include as part of the formulary a complete list of medications that are approved for payment under this chapter, and any specific payment, prescribing, or dispensing controls associated with the drugs on the list.  The department shall review and update, if necessary, the formulary at least once every 2 years.

          Massachusetts’ workers’ compensation insurance pays for any medical treatment, tests, procedures and prescription medication that is “reasonable, necessary” and “causally related” to your work injury.  The workers’ compensation insurer will not automatically pay for these medical benefits.  Your medical provider MUST follow certain guidelines in order for the workers’ compensation insurer to pay for your medical treatment or prescriptions.  Here is the general process for your medical provider to follow in order to get your medical treatment and prescription medication approved by workers’ compensation: Continue reading

In this Massachusetts’ workers’ compensation claim, an injured union sheet metal worker represented by Carney Law Firm was awarded Section 34A permanent and total disability benefits.  The injured worker, represented by Attorney Brendan G. Carney, initially injured his left knee at work in 1980.  He had left knee surgery and returned to work shortly thereafter.  Then in 1998, while working on a pitched roof, the worker felt a sharp pain in his left knee.  He underwent arthroscopic surgery, and returned to work once again after a few months of disability as he recovered from this second left knee surgery.  He continued to work as a sheet metal roofer, and then in 2008 his left knee pain returned.  He worked through pain, aided by injections, for four more years when his doctor told him he needed a total knee replacement.  Because by this point he had worked enough years to qualify for a retirement pension through his union, he retired from work because of his left knee condition.   Although his left knee symptoms were clearly all related to his history of work injuries, the worker was not aware that he was entitled to workers’ compensation benefits.  He consulted with another attorney who was not sure whether there was a viable workers’ compensation claim.  That prior attorney contacted our firm for guidance. After a thorough investigation of the injured workers’ medical and employment history, Carney Law Firm agreed to pursue the case.  A claim for Section 34 temporary total disability benefits and payment for medical treatment, and then later a claim for Section 34A permanent and total disability benefits were then pursued by our firm. Continue reading

Unfortunately for injured workers in Massachusetts, the short answer to this question is “yes”.  Although Massachusetts General Laws Chapter 152, Section 75B(2) provides a legal remedy to injured workers who are fired in retaliation for filing a workers’ compensation claim, the law does not provide any protection for injured workers’ to protect their ongoing health insurance paid for by their employer.  The exception to this is that most union member’s are subject to collective bargaining agreement provisions (negotiated by their respective labor unions) that provide ongoing health insurance coverage for injured workers for a certain period of time during a period of disability from work.  However, most non-union employees have no protection at all.  Although the general answer to the question posed by this blog is “Yes”, there are some federal laws that may protect an injured workers’ ongoing entitlement to health insurance coverage. Continue reading