Compensation insurers challenge physician dispensation policy

A group of Florida workers’ compensation insurers are challenging the legitimacy of a state policy they say requires them to authorize doctors and other providers to dispense medication to injured workers.

Insurers said in a challenge filed last week with the Administrative Hearing Division that the Workers’ Compensation Division is enforcing a two-year-old unadopted rule.

The DWC stated in a March 2020 bulletin that payers are not permitted to deny authorization of prescription drugs solely because they were dispensed by the treating physician.

Injured workers have the right to have prescriptions issued by a practitioner, the bulletin said. And Florida law explicitly authorizes the distribution of drugs to injured workers and provides a methodology for determining reimbursement.

“Thus, the failure to authorize and/or reimburse prescription drugs solely because the drug is or will be dispensed by a licensed Florida dispenser instead of a pharmacist, interferes with the full, free, and absolute choice of the ill or injured employee and, therefore, is against the law,” the division said.

Insurers are asking the division to strike down what they call an unadopted agency rule.

“The DWC has not completed rulemaking to adopt this policy as a rule, but nonetheless applies this statement to all workers’ compensation carriers,” the challenge reads. “DWC further requires compliance with this statement by all carriers and advises carriers through its jurisdictional orders that carriers who fail to comply will be subject to penalties and penalties of up to $100,000.”

The insurers filing the challenge are Normandy Insurance Co., Zenith Insurance Co., Bridgefield Employers Insurance Co., Bridgefield Casualty Insurance Co., BusinessFirst Insurance Co. and RetailFirst Insurance Co.

WorkCompCentral is a sister publication of Business Insurance. More stories here.

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