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Workers' Compensation Blog

Are They Going to Stop My Pain Medicine?

Thursday, February 21, 2019

Current State of Affairs:

It is not a secret that there is an opioid crisis in this country. In recent months there has been a push by government to help cure this crisis. There are reports that pharmacies are in short supply of many opioid medications, and many doctors have refused to prescribe them at all anymore for fear of losing their medical license. There is no question that something has to be done, but the hope is that potential regulations and government referendums enact a holistic response to this epidemic. Sufferers need alternatives to pain pills and support to wean down from the addictive medicines.

Workers' Compensation and the Opioid Epidemic:

To an injured worker with extreme pain due to an accidental injury or an occupational disease the news can seem terrifying. Federal and state regulations seem to have taken an extreme attitude while examining doctors and dispensing pharmacies under a microscope. While regulations will have a beneficial impact on helping the crisis, the process in getting there may create greater hardship along the way. Many workers' compensation claimants do not know where to turn and are just waiting in fear that their medications will be cut off. Some insurance companies have stepped up and taken the problem head on. They have reviewed their client base and flagged those cases where the opioid level is very high and offered many kinds of treatment options to help a client manage their pain regimen.

However, other insurance companies are trying to cut medication doses that are not dangerously high and do not offer to pay for alternative treatments under the ‘guise' of helping the claimant get off their medications because they ‘care'. I have been in court too many times with issues of weaning off opioids, for the good of the claimant, and the insurance company is refusing to pay for alternative pain treatments or medications that are beneficial. This tactic goes against the very purpose that workers' compensation laws were enacted, but there is hope. The Workers' Compensation Commission understands that many injured workers' have severe injuries and will likely need to continue opioid use in lower dosages and will order alternative treatments and weaning programs in the appropriate circumstances.

What Should I Do if I am on Opioids?

The focus of late is to wean down not wean off and this should let injured workers' breathe a sigh of relief. Stopping narcotic medication ‘cold turkey' can cause grave implications on patients' organs as well as negative psychiatric effects due to the rapid increase in pain levels and withdrawal symptoms. Therefore, it is important to either participate in a proper weaning program or to work with your doctor to devise a safe and effective treatment plan. Without the proper support in place reducing these medications may feel impossible. The Center for Disease Control (CDC) categorizes a morphine equivalent dosage of opioids over 90mg as high and the recommendation is to wean down below 90mg.

The Workers' Compensation Commission has often ordered the insurance company to pay for alternative methods of pain management and outpatient weaning programs to support claimants' efforts in balancing an active lifestyle with lower levels of pain medications. The best thing to do is to talk to your pain management provider. Come up with a plan together to wean slowly down on your opioid use to find a manageable dose. Make sure that your pain management clinic is abiding by CDC guidelines in managing your opioid use and that your provider is communicating with your workers' compensation insurance provider so that you are receiving the authorization and approval for needed treatment. Many times insurance companies will deny benefits simply because the provider is not communicating the treatment plan with them or responding to inquiries.

Can I Choose My Own Pharmacy?

Thursday, February 14, 2019

If I can choose my own doctor can I choose my own pharmacy?

Several times a week we receive calls from clients that they are at their local pharmacy and their prescription was denied. This can often be the pharmacy that will not call the insurance adjuster, the insurance adjuster that does not respond or confusion over the mandatory waiting period to fill narcotic prescriptions. The result is frustration by all parties involved and an onslaught of misinformation ultimately resulting in the delay of much needed prescriptions.

What can I do to avoid this?

To alleviate this stress often clients will choose to use a mail order pharmacy. The mail order pharmacy usually takes the guess work out of why a prescription is denied. The mail order pharmacy is more likely to trouble shoot, call the adjuster directly and even reach out to doctors when a letter of medical necessity is required. Your local pharmacy may be too busy or overwhelmed to make all of these calls on your behalf. The downside is when you are filling opioids or narcotics such as oxycodone or oxycotin there are additional steps that may need to be taken.

With the many restrictions recently put in place to prevent opioid overdoses it may take an extra step or two depending on what medication you are taking. One of these restrictions is the requirement that the physical prescription must be sent to the pharmacy. These restricted medications are not permitted to be e-filed except in limited circumstances or with specific certifications. However, most mail order pharmacies have made it as easy as possible to alleviate the burden on the client. For example, they will provide UPS overnight envelopes to the doctor to overnight the prescription. Also, they recommend you see your doctor a few days before your refill is due and the doctor can post date the prescription, that way by the time the pharmacy receives the prescription it is on the day when the medication can be filled and the pharmacy will overnight the medication with no cost to you.

Can I choose my own pharmacy?

Over the past several years there have been frequent news worthy items regarding pharmaceutical contracts between insurance companies and pharmacies. These contracts allow a specific insurer to provide medications to the insured for less money if the specific pharmacy is used. Often the discount can be as great as 30% less the average wholesale price of the medication. Since the pharmacy is dealing on a very large scale they are able to provide this discount. Depending on the Insurance Company they will allow you to choose your pharmacy, but they will only pay out at the negotiated rate, very similar to doctor's taking the Maryland Workers' Compensation Rate.

While this issue is still being decided in the courts most insurance companies will payout at the charged rate by the pharmacy. It is best to find a mail order pharmacy that serves the Workers' Compensation community exclusively. Often they will forgive the amounts that the insurance company refuses to pay or that the commission will not award and always be aware that the pharmacy is not charging any additional filling fees.

Why is it taking so long for my medical bills to be paid?

Wednesday, October 10, 2018

HCFA Forms

Maryland Workers’ Compensation laws require that medical bills be submitted on HCFA forms. These are standard billing forms used by most insurance companies that have fields for the appropriate and necessary CPT (current procedures terminology) codes. However, some practitioners may not be aware that this is a requirement for workers’ compensation claims or that the bill may be denied if it is not submitted properly on the HCFA form. The adherence to this rule varies between insurance companies, however if your provider is having trouble getting bills paid then the first step should be to ensure that the bills are submitted on HCFA forms. As an easy reference the workers’ compensation website provides a blank downloadable HCFA form.

Itemized Billing

Another reason your workers’ compensation medical bills are not getting paid could be that the bill that was sent to the insurance company was not itemized with the proper CPT codes. The workers’ compensation carrier cannot pay bills that are not properly itemized with these specific codes, similar to the codes that a primary care physician would provide to a private insurance company. In addition, many carriers also require that each office visit note from the billed dates of service are provided with the bill. This requirement is to ensure that the visit was related to a compensable body part or condition. Where the system fails is when the carrier denies payment of the medical bills and does not site to the reason it is denied. Often it is a clear case of one department not providing the proper medical records to the carrier’s billing department. Instead of working together the billing department denies the payment of the bill. To resolve this confusion and to save time our firm often will attach the appropriate medical report when sending in any reimbursement or bill pay request even though the carrier may have previously received the report.

Collections Letters

When a medical bill has not been paid, for various reasons, the provider will often send the bill to a collections agency or will seek payment from the claimant. It is important to know that a provider has their own course of action within the workers’ compensation commission to collect on bills for approved medical treatment. This is done through submitting a C51 claim for medical services to the commission. The commission will then issue an order nisi to the carrier requiring payment of the bills. The provider can request penalties, fees and interest if the bill is unpaid for over 45 days and the carrier failed to provide written communication of the denial. In addition, a claimant may notify the collections agency or doctor’s office that under Sec. 9-660, Labor and Employment Article, MD. Ann. Code, medical expenses related to an accepted and related workers’ compensation claim should be directed to the workers’ compensation insurance carrier.

Contact your Attorney

Facilitating payment of medical bills is one of the services we provide to our current and past clients for workers’ compensation cases we have handled. If you have not filed a claim for medical services that you feel are related to a workers’ compensation claim please contact our office as soon as possible so that we may assist you before these bills effect your credit.

Advice for the Apprehensive Injured Worker

Wednesday, September 05, 2018

A few times a week I get a call from an injured worker who is considering filing a workers’ compensation claim but is concerned about the repercussions that may take place after filing.

While it is understandable, and in certain circumstances a very real concern that an employer may retaliate against an injured worker after a claim is filed, if you are injured on the job it is important to understand what rights you may be giving up if you let your concerns influence you to not file a workers’ compensation claim. You may be giving up more by deciding not to file a claim than you would even in the worst case scenario for employer retaliation: termination. (Maryland is an “at-will” employment state, meaning an employer can fire an employee for any non-illegal reason. However it is against Maryland law to fire an employee for filing a workers’ compensation claim).

By failing to file a claim you may be giving up compensation at 2/3s of your pre-taxed wages for the period of time you are unable to work while you recover from your work injury. For municipal workers, this benefit can often be paid at 100% of your wages. Often times this means exhausting your hard earned personal, vacation and/or sick leave when your employer or its insurer is the legally responsible for paying your wages for each day missed. This benefit becomes especially important if you are separated from your employment. Whether you are separated from employment or not, you are still entitled to compensation if you cannot do your job and your doctor agrees that you must be out of work.

Perhaps most importantly, Maryland law requires the Employer/Insurer to pay for all of medical treatment necessitated by your work injury. Maryland is unique in that you have the right to seek treatment with a doctor of your choice. And most important of all, there is no time limitation on your ability to seek treatment as a result of a work injury. (The right to fight for treatment never expires once a claim has been timely filed and accepted, however, there are no guarantees your employer or their insurer will authorize the treatment you wish to have – a good reason to consult with a legal professional). If you fail to timely file a claim with the Workers’ Compensation Commission, often times the insurance adjuster will take longer to authorize treatment or refuse to authorize your care altogether as there is no real motivation to do so. By successfully filing a claim, you’re guaranteeing at least the right to fight for your employer to pay for your lifetime medical care.

Compensation for permanent disability is the last main benefit available to those who are successful in filing a workers’ compensation claim. Often times the money received for an individual’s permanent disability does not truly compensate him/her for the affect their injury has had on their life - especially with more serious injuries. However, some compensation is certainly better than receiving no compensation at all. By failing to file a claim, you forgo this right altogether. Some other important benefits to filing a claim are medical mileage reimbursement, vocational rehabilitation and temporary partial disability – to name a few.

You work hard at your job every day, giving up precious time with your family to help further your companies’ goals. If you get hurt while on the job you owe it to yourself to protect both you and your family by filing a claim. You should not have to pay out of your own pocket for medical treatment, struggle to make your bills because you are incapable of earning wages, or worse yet be forced to suffer from a life altering disability without receiving any assistance to get you back on your feet.

So if you get hurt on the job – protect yourself and your family by filing your claim. And if you’re concerned about the potential repercussions of doing so, consult with legal counsel to make sure you understand not just what problems may arise if you do file your claim, but what problems may arise if you don’t.

Call attorney Charles Schultz, Esq. today at 410-769-5400.

Where Do I File My Workers’ Compensation Claim – Maryland or D.C.?

Monday, July 09, 2018

It is sometimes very obvious where an injured workers should file his workers’ compensation claim following an on-the-job injury.For example, if the injured worker lives in the District of Columbia, and has always worked for his employer in the District, and gets injured in the District, then the claim for workers’ compensation benefits naturally should be filed in the District.

However, the situation becomes a bit more complicated when the injured worker does not get injured in the state where he normally works, or when the injured worker performs work for the employer in more than one state.In this blog, I will give a few different scenarios that tend to occur, in order to figure out where your workers’ compensation claim should be filed.

Scenario #1: The injured worker regularly works in Maryland, but happens to travel to the District of Columbia for work, and happens to be injured while performing that work for the employer in the District.

In the first scenario, under 32-1503 of the District of Columbia Workers’ Compensation Act, the District will not have jurisdiction over this claim.Having only “casual, occasional, or incidental” employment in the District is not enough.The workers’ compensation claim in that scenario should be filed in Maryland.

Scenario #2: The injured worker and the employer are both residents of Maryland, but the injured worker was assigned to do work for the employer in the District of Columbia for an extended period of time (weeks and months) and was injured in the District.

In the second scenario, the claim may be able to be filed in either Maryland OR in DC, with one caveat.The DC Worker’s Compensation Statute says that, if both the injured worker and the employer are not residents of the District, and the contract for hire was entered into in another State (like Maryland) then even though the injured worker had performed work for the Employer for an extended period of time in the District, and was injured in the District, the injured worker MAY be able to file a claim for workers’ compensation benefits in the District, but only if, the employer has workers’ compensation coverage in the District.So, in that second scenario, if the employer had insurance cover in the District, the claim for workers’ compensation benefits can be filed in EITHER Maryland or the District.If the employer does not have workers’ compensation coverage in the District, then the claim would have to be filed in the State of Maryland.

Scenario #3: The injured worker is hurt in the State of Maryland while performing work for a District of Columbia Employer and normally works in the District of Columbia.

Under 9-203 of Maryland Workers’ Compensation Statute, Maryland shares the same principal as the District such that “casual, occasional, or incidental” work in Maryland, when the employment is located and performed primarily in another jurisdiction (like DC), will not be enough to enable the injured employee to file a workers’ compensation claim in Maryland.

Scenario #4: The injured worker performs work for the employer in Maryland, DC and Virginia, but gets injured in DC, but both he and his employer are residents of Maryland.

This last scenario occurs often with transit drivers.In this scenario, the injured worker is not an incidental, casual or occasional employee of the District, but rather, has worked for the employer in the District on a regular basis for years.In this fourth scenario, because both the injured worker and the employer are both residents of Maryland (with, for example, the employee picking up his bus to begin his bus route at the Maryland headquarters) the injured worker would be able to file his workers’ compensation claim in both Maryland AND the District of Columbia, if and only if, the employee can prove that he is not an incident employee in the District.If the injured worker can testify that works as much or (better yet) more often in the District than he does in Maryland or Virginia, and again, is hurt in the District, then his claim for workers’ compensation benefits could be filed in the District.However, if the evidence shows that the employee works only a small percentage of the time in District, and works primarily in Maryland and Virginia, then the District of Columbia would not accept his workers’ compensation claim and the State of Maryland would be his only option.

If any additional information is needed, I can be reached by email:lpisano@bsgfdlaw.com, or on my direct office number: 301-740-3304

Don't Forget The Mileage

Friday, June 15, 2018

The workers’ compensation process is not always a quick one, and in most cases, it is a slow and steady uphill battle. Oftentimes, it can take several months after you sustain a work injury before any workers’ compensation benefits kick in.  For this reason, it is important to stay organized from the beginning and to know exactly what benefits are available to you that can help offset some of the financial strain you may experience as a result of your work injury. One important benefit that can easily slip through the cracks is mileage and transportation reimbursement.

If your workers’ compensation claim is found to be compensable by the Workers’ Compensation Commission, in addition to benefits for medical treatment and for time you may miss from work as a result of your injury, you are also entitled to reimbursement for the reasonable cost of your transportation to and from treatment appointments.In some special cases, your employer may even provide treatment-related transportation for you through a transportation service.

What type(s) of transportation benefits are covered?

Under Maryland Workers’ Compensation law, an employer is responsible for the cost of transportation to and from medical appointments if the appointments are a result of the claimant’s work injury. This includes transportation to doctor’s visits or other appointments, including appointments or evaluations scheduled by the employer. Also, with the proper documentation, you are entitled to reimbursement for mileage, cab/Uber/Lyft fare, public transportation, parking, tolls, etc. (just to name a few). The most common type of transportation benefit we see however, comes in the form of mileage reimbursement.

What type(s) of benefits are NOT covered?

The law does not allow transportation reimbursement for appointments besides those related to your work-injury, trips to the pharmacy, or reimbursement for any gas used to travel to your appointments (even if related to your injury).

How is mileage reimbursement calculated?

Each year, the Commission sets the mileage reimbursement rate which is used to calculate reimbursement payments per mile traveled.The most recent mileage reimbursement rates are as follows:

  • 2018 - .545
  • 2017 - .535
  • 2016 - .54

For a list of the yearly mileage reimbursement rate dating back to 1980, click here.

To calculate your total mileage reimbursement, multiply the mileage reimbursement rate for that year by the total number of miles traveled.For example, if your doctor’s office is five (5) miles from your home, and you had a doctor’s appointment on January 1, 2018, multiply the mileage reimbursement rate by the total number of miles traveled to and from the appointment:

  • [.545 x 10 = $5.45]

In summary, mileage reimbursement is an important benefit of filing a workers’ compensation claim and can provide some relief from the financial burden of a work-related injury. It is extremely important that you document your travel accurately and submit mileage forms and supporting documentation to your attorney regularly. An easy way to keep track of your mileage is by using the Medical Travel Expense Form which can be found in the Document Center on our website.

If you have any questions related to mileage reimbursement or filing a workers’ compensation claim, do not hesitate to contact Kenrick Roberts today at 301-670-6552 or kroberts@bsgfdlaw.com.

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