Alaska Supreme Court Decision: Prescriptions and Workers Compensation

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Some insurance companies provide an "prescription card" to the injured worker to facilitate the filling of prescriptions.  The injured worker is then required to go to one of the pharmacies which accept the card, present it and, in theory, the prescription would be filled immediately.

It doesn't always work.   Frequently the pharmacist will tell the injured worker that the prescription must be "pre-approved" by the insurance company and that it called for authorization. This means waiting 3 days or more to get the prescription filled.

Then the injured worker calls the insurance company to complain and is told that the insurance company does not have a duty to pre-approve prescriptions and if the injured worker is having difficulty with the card, he can pay for the medications himself and submit a request for  reimbursement and wait 30 days for the reimbursement.

Two obvious problems with the insurance companies' instructions: first, the injured worker probably can't afford the prescriptions. Second, and most importantly, that is not the law.

Recently I won a case before the Board, King v UTI, in which the Board said that the prescription must be filled "promptly" and "promptly" means when the prescription is presented to the pharmacy.

The Alaska Supreme Court agreed last week in the decision of Harris v M-K Rivers. In that case, a man who was rendered paraplegic needed a special kind of bed for his bedsores.  The insurance company refused to pre-authorize it so he didn't get it.  The Supreme Court held that because the insurance company did not have a good faith basis to controvert the bed, and failing to pre-authorize the bed essentially prevented him from getting it and because of that penalties should be assessed against the insurance company.

If you're having problems with your prescriptions or any other questions or concerns regarding your workers compensation claim, call me, Keenan Powell.   I have more than 30 years experience fighting for the rights of injured Alaskans. Consultations are FREE.  Call 258-7663.