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.
Often times the first thought that employees have after suffering an on the job injury is whether their injury will cause them to be looked upon negatively by their employer. It is common knowledge that an injury that requires medical treatment and lost time from work will cost the employer money, both by way of lost productivity and increased workers’ compensation premiums. When an employee is injured on the job and requires more than six calendar days of disability from work, or requires medical treatment, shall be entitled to workers’ compensation benefits that compensate the injured worker for the lost time and medical treatment. These benefits are typically paid for by the employer’s workers’ compensation insurer, but may be paid directly by the employer themselves if they qualify for “self- insured” status. Once an employer’s workers’ compensation insurer has paid benefits to a Massachusetts’ injured worker, that insurer will then subject the employer to an insurance premium adjustment based on cost incurred by the insurance company. This adjustment typically passes some or all of the cost of the injured workers’ compensation claim from the insurance company back down to the employer. Because workplace injuries can cause an employer to incur a substantial cost, often times injured workers may be reluctant to report injuries or seek medical treatment out of fear that they may alienate their employer or be terminated. Continue reading
There are many factors that determine the Lump Sum settlement value of a Massachusetts’ workers’ compensation claim. Some Massachusetts’ workers compensation claims may have no settlement value at all, while some may have a settlement value of several hundred thousand dollars (or more). While it is important to stress that each individual workers’ compensation claim must be evaluated individually, there are some important factors that determine if a claim has settlement value, and if so, the amount of that settlement value.
Each state administers its own individual system of workers’ compensation benefits. In Massachusetts, the workers’ compensation system is known as what is commonly referred to as a “wage loss” system. That is, if a work related injury or medical condition causes a period of disability from work that also causes wage loss, then the injured worker is entitled to weekly wage loss benefits. It should be noted that not all work related injuries (even if the injury prevents the injured worker from returning to the previous occupation that they were performing while they were injured) cause a wage loss. For example, a forty five year old employee with a master’s degree in computer science is laid off from his job as a computer software programmer where he was paid $78,000.00 per year, or $1,500.00 per week. In order to pay his bills while he looks for another job in the computer software field, he takes a job in the construction industry as a laborer. While working as a laborer, he strains his back. Although the injury isn’t serious enough to cause him to need back surgery, the injured worker is permanently disabled from working as a laborer where he was earning $1,000.00 per week. His treating doctor is of the opinion that he can return to work at a sedentary or light duty job. Because he is capable of earning more money as a computer software programmer, an occupation he is trained for, physically able to do, and pays him more money than the laborer job, he has no wage loss and would not be entitled to any weekly workers compensation after the point in time where his doctor cleared him to return to light duty work. Continue reading