State of the States

Pennsylvania - In the case Workers First Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office, the court found that an employer cannot avoid liability for workers’ comp prescription expenses by settling with an injured worker. In this case, the employer and injured worker settled the claim, but the employer did not accept the injury as compensable.  The settlement went on to specifically free the injured worker from responsibility to cover the costs of prescriptions already dispensed and the employer refused to pay the pharmacy, arguing the claim was never accepted.

Texas - A week ago Friday, Kevin Leago, a Houston Fire Department Senior Captain officially won his appeal for workers’ comp after being denied for over a year. Leago developed neuroendocrine cancer and his city health insurance plan did not cover the care he needed. The employer argued that Leago’s illness was unrelated to his role as a firefighter and declined his request for benefits.

Arizona - In 2017, Arizona passed a bill to expand workers’ comp benefits for first responders that are suffering from cancer caused by workplace conditions. Two years later, firefighters are still struggling to get the benefits they need. A Phoenix-based radio station hosted an interview with Executive Director of the League of Arizona Cities and Towns, Ken Strobeck, who explained that municipalities are not ignoring the law, rather being very careful about determinations around approving workers’ comp benefits for cancerrelated claims. 

Colorado - On September 4,  the Colorado Division of Workers’ Compensation (DWC) will hold a hearing to discuss changes to the medical fee schedule and treatment guidelines. The DWC is planning on reducing conversion factors for surgery, radiology, pathology, medicine, and anesthesia.

Connecticut - Hartford Financial Services Group Inc. is using an artificial intelligence software to scan injured workers medical records and adjuster notes to find red flags in the hopes of preventing opioid addiction. Hartford CEO has stated that this software has helped decrease opioid prescribing in the last few years by 45%.

Industry News - Medical marijuana has become a controversial topic as healthcare providers and regulators are looking for an alternative treatment to opioids. Some medical experts are weighing in on the unknowns of medical marijuana as an unproven remedy.

By Danielle Jaffee

Courtesy of Injured Workers Pharmay Blog

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