Prescription medicine coverage is an important part of the Texas Workers’ Compensation program. If you are covered by workers’ compensation, then you are entitled to have your medical costs paid for all work injuries. You are also entitled to coverage for all illnesses that occurred because of your job duties. As long as you report your injuries or illness within 30 days, you should get full coverage and not have to pay for your medical treatment or prescription medication.
Although workers’ compensation coverage for prescription drugs and medications is available as part of your work injury benefits, there are specific guidelines for the types of medications that will be covered. A Texas workers’ compensation lawyer at Abbott and Associates, L.L.C. can help you to understand what benefits you are entitled to and will help to ensure you get the full benefits that you deserve.
The Rules for Workers’ Compensation Coverage for Prescription Drugs and Medications
The rules for workers’ compensation coverage for prescription drugs and medications are set forth in Texas Administrative Code Sections 134.500 through 134.550. The Texas Department of Insurance summarizes some of the rules associated with getting prescription drugs covered.
According to the Texas workers’ comp law, initial pharmaceutical coverage provides payments for pharmaceutical drugs during the seven days after the injury, regardless of whether there are issues related to liability for the injury or illness. The date of the injury is not counted as one of the seven days. Both prescription and non-prescription medications provided by the treating doctor should be covered.
After the initial seven day period, prescriptions continue to be covered as long as the workers’ compensation insurer accepts that the employee’s claim is valid because the injuries are work-related. However, Texas law requires treating physicians to prescribe generic medications and over-the-counter alternatives to prescription medications whenever it is appropriate to do so and will not compromise the care of the patient.
When patients must pay for out-of-pocket medications as a result of their workplace injury, Texas Administrative Code Section 134.504 provides a process that the injured worker can follow in order to get the costs for medication reimbursed.
Medication can be very expensive, so it is important that you get all available workers’ compensation coverage for prescription drugs and medications if you have been hurt at work. This means that you must ensure you conform not just with requirements for notifying your employer of your workplace injury but also with requirements for seeking treatment. If your employer has a network of physicians, you may be required to get your medical care from a doctor within this network in order for prescriptions the doctor writes to be covered.
A Texas workers’ compensation lawyer at Abbott and Associates, L.L.C. can provide you with legal help making your workers’ compensation claim and can assist you if any of the prescription drug benefits you are entitled to are being improperly denied. Call today to learn more about your legal options for getting workers’ compensation coverage for prescription drugs and medications.