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.