Pennsylvania Court Opens Door to Civil Suits

The Pennsylvania Supreme Court has opened the door for medical providers and others involved in the workers’ compensation system to go outside that system to hold employers and insurers accountable when they violate state law and their contractual obligations by not paying for injured workers’ covered medical expenses or their lost wages.
In considering whether a healthcare provider can sue an insurer in civil court for unpaid medical bills incurred by injured workers receiving WC benefits, the Pennsylvania Supreme Court left a lower court ruling intact.
As a result of the decision, injured workers and claimants may also be able to take insurers to court when they don’t receive the benefits due to them under the state’s WC Act and as ordered by a WC judge, the Appeals Board or a civil judge.
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The National Federation of Independent Businesses is seeking input from small businesses in Illinois on that state’s Workers’ Compensation Commission (IWCC) increased employer surcharges assessed to cover the agency’s projected budget shortfalls.
“NFIB, working with other business groups, will be pushing for workers’ compensation reforms to head off higher employer assessments,” the group said in its online, 14-question survey.
The Illinois General Assembly voted for modest adjustments to the employer assessments and indicated that it would reopen the debate next year regarding workers’ compensation funding, reforms, and benefits.
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Managing the rising costs of high-impact drugs in workers’ compensation demands a multi-faceted approach. Proactive identification, evidence-based clinical controls, and robust data analytics are crucial to ensure both cost-effectiveness and optimal patient outcomes.
That’s the key takeaway from the latest podcast of the Enlyte Drug Trends Report..
On the episode, Gauging the Impact of High-Impact Drugs in Workers’ Comp, Cameron Hannum, senior clinical account pharmacist with , highlighted the rising costs of “high-impact” drug classes in workers’ compensation.
These classes, including topical analgesics, compound kits, combo packs, and specialty medications, are characterized by low utilization but disproportionately high expenses.
Specialty medications present management challenges, he said. Their complex distribution channels, high costs, and potential for both direct and indirect relation to workplace injuries necessitate careful oversight.
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Mental health challenges are more likely to be an outcome — rather than a cause — of work injuries, according to recently published research by Canadian academics.
The researchers, Steve Granger, an assistant professor of management at Concordia University, and Nick Turner of the University of Calgary, said the interconnected nature of work injuries and mental health challenges reinforces the importance of prevention.
“The evidence suggests that the relationship between preceding work injuries and later mental health challenges is more robust than the evidence from mental health challenges to later work injuries,” they said.
They also noted the necessity for comprehensive rehabilitation approaches that integrate both physical and psychological care.
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