The Blog

Will the workers compensation insurance carrier pay for a de-tox program if I become addicted to the narcotic pain medication that I’m taking for my work injury?

The short answer is yes though this issue will most likely result in litigation. Section 306 (f) of the Pa WC Act holds the employer or their workers’ compensation carrier liable for the payment of ALL reasonable, necessary and casually related medical expenses incurred for the treatment of a work injury. Any treatment that the carrier feels isn’t reasonable and  necessary is subject to Utilization Review ( URO ). This means that your employer can ask the Bureau of Workers’ compensation in Harrisburg to choose an independent physician of the same or similar specialty to review the treatment at issue and determine whether it’s reasonable and necessary. The issue of whether the treatment is casually related to the accepted work injury can only be determined by a Workers’ Compensation Judge through a Petition to Review Medical Treatment.

The thing that makes de-tox programs different is the question… Are de-tox programs really TREATMENT for the work injury? Some suggest that de-tox programs are not treatment for the work injury but rather for an abuse of prescription medication that has nothing to do with the injury. The ABUSE of the medication that caused the addiction and the need for de-tox technically has nothing to do with the work injury, unless you look at it from a practical standpoint especially in an individual who never had substance abuse issues before their injury. That practical standpoint is this… If it wasn’t for the work injury, the injured worker would not have been on narcotic pain medication and never would have had the opportunity to abuse the medication.  Also, workers’ compensation carriers need to consider the alternative. If they don’t agree to pay for a de-tox program, the abuse of the medication will likely continue and, it will be harder to prove that an addict is recovered from a work injury or, even worse, the abuse could result in death and the payment of death benefits.

Banks Law encourages their clients to seek help whenever they feel that they’ve become addicted to narcotic medication taken for their work injury. We would rather battle the insurance company to force them to pay for rehab than risk a much worse outcome.

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Who is eligible for death benefits under the PA WC Act?

Generally speaking, a dependent of the deceased injured worker is entitled to death benefits under Section 307 of the Pa WC Act. Dependents usually include widows or widowers and children of the deceased worker. But, under some circumstances it can also include a mother, father or, even a brother or sister.

The injured worker’s death must have occurred within the course and scope of his employment before the right to death benefits is triggered. Then the status of the dependent is determined at the time of the injured worker’s death. Dependency is presumed if the wife and children were living with the deceased worker at the time of death. The eligibility of a mother, father, brother or sister is only activated if there is no widow or widower and, no dependent children.

The amount of the death benefit is specifically outlined in Section 307 of the Act. The amount varies depending on which dependent is available to receive the death benefit and, the number of children who are dependents of the deceased worker.

There are limits on the length of time a widow or widower can receive death benefits, as well as the length of time the deceased worker’s children can receive death benefits, though there is a special exception for disabled children.

There is also a funeral expense allowance of up to $3,000.00.

This is just a broad overview of death benefits available under the Pa WC Act. Anyone who believes that they might be entitled to death benefits, MUST speak with an experienced workers’ compensation lawyer so that you fully understand your rights. After all, you owe it to your deceased loved-one to get every benefit available under the Act for this ultimate tragedy.         

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What you should do if your employer or the workers’ compensation insurance carrier starts sending you things in the mail?

The law gives your employer 21 days after receiving notice of your work injury to investigate the injury and decide whether to voluntarily accept it as a compensable injury and start paying you wage loss benefits. The employer is obligated to file either a Temporary Notice on Compensation Payable ( TNCP ) if they decide to accept the claim for 90 days in order to complete their investigation of the claim or, a Notice of Compensation Payable ( NCP ) if they made the decision to accept the claim. If the employer is denying the claim, they should issue a Notice of Denial ( NCD ) which then puts the burden on you to file a Claim Petition and prove your entitlement to workers’ compensation benefits. The law requires your employer to issue these various Notices so you know shortly after your injury how your employer is processing your claim and, if they deny it, a petition for compensation can be filed in less than a month of the injury.   

You should discuss these Notices and anything else that you receive in the mail about your workers’ compensation case with your lawyer as soon as possible. Some things that you might receive are time sensitive and require an immediate response. Most of what you receive will likely be foreign to you, especially if you have never had a workers’ compensation claim before, so you’ll want an experienced workers’ compensation attorney to explain the paperwork. Don’t ignore any paperwork that you receive about your workers’ compensation case. If you do, it could have serious consequences and you could lose your right to compensation.

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