In Pennsylvania, the Workers’ Compensation Act does not require a workers’ compensation insurance carrier to “pre-approve” payment of medical treatment, which includes prescription medications.
All too often our Erie, PA workers’ compensation attorneys have seen first-hand the frustration and despair an injured worker experiences when trying to have a work-related prescription filled at their local pharmacy. Customarily, when the local pharmacy receives a prescription that should be covered under a workers’ compensation claim, the first thing the pharmacy will do is call the workers’ compensation insurance carrier. The pharmacy will only fill the prescription if the workers’ compensation adjuster confirms that it will, in fact, pay for the prescription, “pre-approving” the payment of the medical treatment.
As there is no requirement that an adjuster “pre-approve” payment of medical expenses, the workers’ compensation insurance carrier is well within its legal rights not to promise the pharmacy in advance to pay for a prescription before it has been properly billed by the pharmacy. If the pharmacy fails to obtain “pre-approval,” or is unable to even speak with the adjuster, it will not fill the prescription or will only do so if the injured worker pays for the prescription out of pocket and/or the prescription is billed through the injured worker’s personal health insurance, leaving injured workers without the medications they need.
In order to ensure that an injured worker has their prescriptions promptly filled and billed appropriately we recommend injured workers utilize pharmacy companies that specialize exclusively in filling prescriptions for injured workers. These pharmacy companies that specialize in filling workers’ compensation prescriptions do not typically have brick and mortar locations. They will instead have the prescriptions overnighted to your residence. If the prescriptions are time sensitive and having them overnighted to your residence is not acceptable these companies have relationships with brick-and-mortar pharmacies that will permit you to pick-up your prescription from that pharmacy.
Most importantly, these pharmacy companies know and understand appropriate billing procedures under Pennsylvania’s Workers’ Compensation Act. As such, these companies do not seek “pre-approval” before filling your work-related prescription, instead these companies will promptly fill your prescription and then bill the workers’ compensation insurance carrier.
Who will fill my workers’ compensation prescriptions without pre-approval?
Although, there exists a number of pharmacy companies that specialize exclusively in filling prescriptions for injured workers, our office has worked extensively and have had good experiences with Injured Workers Pharmacy, LLC.
If you are having difficulty with the workers’ compensation insurance carrier not promptly filling or paying for your work-related injury prescriptions, contact our Erie, PA Workers’ Compensation Attorneys for a free consultation to discuss your legal rights and options.
You were involved in a car accident that wasn’t your fault and now you’re getting a $900.00 bill in the mail for an ambulance ride. Why should you have to pay it and what if you don’t have insurance? These are questions that our Erie, PA car accident lawyers get asked all the time, and they stem from how confusion laws concerning car accidents can be.
In Pennsylvania, one’s own car insurance ordinarily pays for medical treatment arising out of a car accident, regardless of fault. There are, of course, exceptions, but normally you aren’t forced to pay out of pocket and your health insurance company isn’t the primary payer unless the medical payments coverage on your policy is exhausted. If you receive a medical bill in the mail after a car accident in Pennsylvania, you should probably forward this bill to your own insurance company before writing a check.
That said, if you were injured in a car accident, this isn’t something you should be handling on your own anyway. Anything you do and any paper you sign could potentially jeopardize your rights to make a recovery for pain and suffering, lost wages, and other out-of-pocket expenses you’ve incurred as a result of this crash. Before doing anything, you should contact a Pennsylvania personal injury lawyer immediately for a free consultation.
Our Erie, PA law firm helps injured victims obtain compensation for their injuries after a car accident. In addition to helping our clients obtain settlements and verdicts, we help facilitate medical payments through auto insurance as part of our representation. Additionally, we only charge our fee on a portion of the recovery we make. If we don’t get you a settlement, we don’t charge a fee. Anybody can afford our services. If you were hurt in an accident, call our office for a free consultation at 814-5-452-6232. We’re located a block west of the Erie County Courthouse and have been helping victims throughout Northwestern Pennsylvania since 1985.
I received a letter from Optum. What do I do?
After you get medical treatment for an injury rather than a chronic illness, it’s not uncommon to receive a letter from a third-party subrogation company, such as Optum (or The Rawlings Company, Equian, First Recovery Group, etc.), on behalf of your health insurance company. Optum (or one of these other companies) is probably calling you to find out how you got hurt. If your injuries possibly give rise to a personal injury claim or a potential lawsuit (for example, a car accident, a work injury, a slip-and-fall accident, etc.), Optum wants to know, because it’s their job to find out if your health insurance company might have a right to be reimbursed out of your settlement. If you received a letter from Optum after an accident, you should call our law firm immediately at 1-800-999-0750.
Should I reply to Optum’s letter or call them back?
Optum cannot make you sue somebody if you don’t want to sue them! That being said, you should still talk to a personal injury attorney before talking to Optum. You need to know your rights (and responsibilities) regarding this accident, your health insurance policy, your medical treatment, and your medical bills. Our personal injury law firm offers a free consultation that can be either over the phone or in person! Give us a call today at 814-452-6232.
DO NOT FORGET: If you were hurt because of someone else’s negligence, you should immediately give Optum’s letter to your attorney! If you have a lawyer, you should not be contacting Optum directly. You want your personal injury lawyer to know about Optum’s letter, because failure to properly consider your health insurance’s lien against your settlement could potentially have devastating consequences to both your case and your finances. The last thing you want is to settle your case for so little that you can’t pay back Optum, should they be entitled to some of the money!
If you were hurt in an accident but don’t have a lawyer, you should hire a personal injury attorney to contact Optum on your behalf. Our personal injury lawyers work on contingency and only get paid if we get you a financial recovery. We represent injured victims throughout Western Pennsylvania, from Pittsburgh, to Erie, and all the way to Bradford and Smethport.
What if I don’t want to sue the person who hurt me?
In Pennsylvania, Optum can’t make you sue somebody if you don’t want to sue them! That said, it is still a good idea to talk to a personal injury attorney before talking to Optum. You need to know your rights and responsibilities regarding this accident, your health insurance policy, your treatment, and your medical bills. Our law firm offers a free consultation that can be either over the phone or in person—you decide! Give us a call today at 814-452-6232.
In Pennsylvania, the “household exclusion” is a clause that insurance companies began using in the 1990’s in auto insurance policies to limit the amount of uninsured motorists (UM) and underinsured motorists (UIM) coverage they had to provide after claims made by their insureds after a car accident. Under the Motor Vehicle Financial Responsibility Law (MVFRL), any relatives who live in the same residence could seek benefits from policies issued to other “resident relatives” in the household. While the MVFRL clearly stated this, insurers used these clauses to deny claims against the policies of the other household members that would have been permissible under the MVFRL.
While the language of the exclusion could vary, it essentially prevented injured household members from seeking underinsured motorists benefits from other policies applicable in the household, unless they were insured under the same policy. As an example, suppose mom and dad each have a vehicle and they are insured under a policy with Erie, which includes stacked UIM benefits. Their daughter, a college student still has a permanent residence in the household, and she has her own car which is insured with Progressive.
By applying the household exclusion, Erie could deny any claim against the parents’ UIM coverage if daughter was involved in an accident while driving her own vehicle because their vehicles were insured under a different policy from their daughter. In fact, if a parent was in daughter’s vehicle at the time of the accident, they would most likely have not been able to file a claim against their own UIM coverage.
In January 2019, the Supreme Court of Pennsylvania issued an opinion in Gallagher v. Geico Indemnity Co., which held that household exclusion clauses were no longer enforceable in Pennsylvania as they were contrary to the express provisions of the MVFRL. Hence, a person seriously injured in an auto accident has a right to seek benefits from the policies of any resident relatives at the time of their accident. This can involve complicated legal questions regarding “residency” and damages and you should seek legal advice in attempting to pursue such a claim.
In fact, if you were in an accident within the last 4 years, and you were advised that you could not pursue a claim against UM (uninsured motorists) or UIM benefits because of the applicability of a household exclusion, you should contact our car accident lawyers immediately, as you may still be able to pursue claims for additional UM or UIM benefits. Our office offers free consultations and doesn’t take a fee unless we make you a recovery.
I received a letter from The Rawlings Company. What do I do?
After you get medical treatment for an injury, it’s not uncommon to get a letter from a third-party subrogation company, like The Rawlings Company (or Equian, Optum, First Recovery Group, etc.), on behalf of your health insurance company. The Rawlings Company is most likely reaching out to you to discover out how you got hurt. If your injury possibly gives rise to a personal injury claim or a potential lawsuit (for example, a car accident, a work injury, a slip-and-fall accident, etc.), The Rawlings Company’s job is to find out, because your health insurance company might be legally entitled to reimbursement out of your personal injury settlement or verdict. If you received a letter from The Rawlings Company after an accident, you should call our law firm immediately at 1-800-999-0750.
Should I respond to The Rawlings Company’s letter or call them back?
Whether or not you’re legally required to respond to The Rawlings Company after getting their letter is going to be written in your insurance policy with your health insurance company. In all likelihood, this is a document you probably never read. With that in mind, if you weren’t hurt in manner as to give rise to a compensable legal claim, you’re probably safe to call and let them know, at which point they should leave you alone.
If you were hurt in an accident that gives rise to any type of legal claim, you should immediately give The Rawlings Company’s letter to your attorney! If you already retained a lawyer, you should never contact The Rawlings Company directly. Additionally, you want your personal injury attorney to know about The Rawlings Company’s letter, because any failure to consider your health insurance’s lien against your settlement might have catastrophic consequences to both your case and your finances!
If you were hurt in an accident (at work, in a slip-and-fall, in a car, et cetera) but don’t have a lawyer, you should hire a personal injury attorney to contact The Rawlings Company on your behalf immediately. Our personal injury lawyers work on contingency and only get paid if we get you a financial recovery. We represent injury victims throughout Western Pennsylvania, from Pittsburgh, to Erie, and all the way to Bradford and Smethport! If you’re not from Pennsylvania, we might be able to help you find a local lawyer who can helo.
What if I don’t want to file a lawsuit against the person who caused my injury?
The Rawlings Company cannot force you to sue somebody that you don’t want to sue. However, it’s always a good idea to at least speak with a personal injury attorney before you talk to The Rawlings Company. You need to know your rights and responsibilities regarding this incident, your medical treatment, and your medical bills. Our law firm offers a free consultation that can be either over the phone or in person—you decide! Give us a call today at 814-452-6232.
We’re happy to announce that our own partner, Attorney Matthew Lager, returned to Penn State Law yesterday as a guest lecturer in the law school’s Workers’ Compensation course. Attorney Lager provided the students with a Claimant’s Attorney’s perspective on Pennsylvania Workers’ Compensation law, and the realities of representing injured workers. Attorney Lager delivered a similar lecture to Penn State Law students in 2017, and was happy to be invited back this year to deliver a presentation.
Are you an injured worker looking for legal help?
If you have been injured at work and are looking for an attorney to help you in your workers’ compensation claim, call 814-452-6232 to book a free consultation with Attorney Matt Lager. He’s happy to help and doesn’t charge any fee without a recovery.
Signing a Medical Authorization for the Insurance Company after an Accident
As Pennsylvania personal injury lawyers, our new clients frequently ask us if they must sign a medical authorization for the insurance company after a car accident, after a work injury, or after a slip-and-fall accident. Given the numerous types of insurance claims out there, there is no universal answer, which is why it is always best to call an attorney to discuss your rights before giving the insurance company what they want. Sometimes the insurance company is entitled to a medical release or authorization, and sometimes they’re just trying to pressure you to give them more than they’re permitted by law. If an insurance company is requesting that you sign an authorization for your private medical records, you should call our law firm at 1-800-999-0750 to speak with an attorney for free.
Medical Authorizations and Insurance Claims for Negligence (Car Accidents, Slip-and-falls, etc.)
In Pennsylvania, if you’re making an insurance claim for compensation, lost wages, medical bills, pain and suffering, et cetera, against someone else’s insurance company, you do not normally need to sign an authorization for the other insurance company to fish through your medical records to look for reasons not to pay your claim. That said, the insurance company does need relevant medical records to determine the extent of your injuries and fairly evaluate your claim. With this, there is a delicate balance that must be struck, which is why you should always hire a personal injury law firm to represent you in your case. Our lawyers front expenses for medical records (which can cost hundreds of dollars), review your records, and provide the insurance company with reasonable, relevant medical records to support your claim. When the insurance company fights for more and starts issuing subpoenas, we fight to protect your privacy. If an insurance company is requesting that you sign an authorization, you should call our law firm at 1-800-999-0750 to speak with an attorney for free. Not only will we protect your privacy, we’ll help you fight for a fair outcome.
Medical Authorizations and First-Party Insurance Claims (PIP, MedPay, UM/UIM Benefits)
In Pennsylvania, when you’re making a claim for your own insurance coverage, completely different rules might apply. In many insurance policies, individuals seeking their own first-party coverage (like Personal Injury Protection / PIP, Med Pay, Uninsured and Underinsured Motorist Benefits) contractually agree to provide their insurance company with executed authorizations such that their own insurer can gather whatever records they deem “reasonable” and “necessary.” While this discretion isn’t infinite, it is extremely broad. Failure to comply, in some instances, can result in a denied claim or worse. If your own insurance company is requesting that you sign an authorization, you should call our law firm at 1-800-999-0750 to speak with an attorney for free. We’ll review your policy and make sure your rights are protected.
Medical Authorizations and Workers’ Compensation Claims
In Pennsylvania, after a work injury, it seems like everybody wants to comb through your medical records to blame your injury on something (or someone) else. Even without you signing an authorization, treatment paid by workers’ compensation is normally exempted from HIPAA, which permits your medical providers to give your work-accident-related medical records to the workers’ compensation insurance carrier along with your accident-related bills. This exemption, however, isn’t unlimited. You do NOT need to sign authorizations for Nurse Case Managers (and, if you have been contacted a nurse case manager, you should read this article and call us immediately) and workers’ compensation insurance carriers are not permitted to embark on fishing expeditions throughout your entire medical history. Such behavior is especially important to avoid, given the close relationship between the workers’ compensation carrier and your employer. Why should your boss get to know about your medical history? If a workers’ compensation insurance company is demanding that you sign an authorization, you should call our law firm at 1-800-999-0750 to speak with an attorney for free. We’ll help protect both your privacy and your claim.
What should you do?
Regardless of what’s going on, if you’ve been injured and are dealing with an insurance adjuster who is pressuring you to sign an authorization for the insurance company to gather your personal medical records, you need a lawyer now. Call our personal injury law firm at 1-800-999-0750 for a free consultation with one of our experienced lawyers.
With the 2019 Roar on the Shore event being moved from downtown Erie, PA to North East, PA at the Lake Erie Speedway, our Pennsylvania motorcycle accident attorneys anticipate an increase in the number of motorcycle accidents and injuries during this year’s event. Although we hope this projection proves to be untrue, it is an inescapable concern.
Although the Lake Erie Speedway appears to host a number of vendors to keep guests occupied, a large number of bikers will be traveling from North East to downtown Erie, PA to visit Erie’s many attractions, bars, and hotels. Given the nature of the event, we similarly expect a number of people to be traveling between the two locations after drinking, which always creates an increased risk of accident, injury, and wrongful death.
Regardless of the move, with 160,000 bikers and motorcycles brought to one location, there are bound to be accidents. If you’ve been hurt in a motorcycle accident, be sure to do the following:
- Save your receipts and medical bills;
- Take pictures of your bike and your injuries;
- Document your lost wages;
- Contact an experienced motorcycle accident attorney immediately;
- Do not talk to any insurance companies first.
Additionally, be aware that, in Pennsylvania, injured bikers (and their passengers) aren’t bound by “limited tort” and can always pursue a claim for pain and suffering. If you have been injured in a motorcycle accident in Erie, PA, call our experienced motorcycle accident lawyers for a free consultation.
Super Lawyers Rising Star
We at Bernard Stuczynski Barnett & Lager are proud to announce that Attorney Matthew J. Lager has again been named as a 2019 Super Lawyers Rising Star, making this the second year in a row he has received this honor! Attorney Lager was first selected as a Rising Star in 2018, and continues to make the yearly list. Each year, no more than 2.5 percent of the lawyers in the state are selected by the research team at Super Lawyers to receive this honor.
Super Lawyers, a Thomson Reuters business, is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high degree of peer recognition and professional achievement. The annual selections are made using a patented multiphase process that includes a statewide survey of lawyers, an independent research evaluation of candidates and peer reviews by practice area. The result is a credible, comprehensive and diverse listing of exceptional attorneys. The Super Lawyers lists are published nationwide in Super Lawyers Magazines and in leading city and regional magazines and newspapers across the country. Super Lawyers Magazines also feature editorial profiles of attorneys who embody excellence in the practice of law.
Attorney Lager’s practice focuses on Personal Injury, Car Accidents, Workers’ Compensation, and Social Security Disability. If you would like to schedule a free consultation with Attorney Lager, call 814-452-6232 today!
We at Bernard Stuczynski Barnett & Lager are proud to announce that Attorney Matthew Lager has been invited to speak about Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits at Walnut Creek Healthcare and Rehabilitation Center on Thursday, May 16, 2019, from 6:15 p.m. to 7:15 p.m., as part of the Erie County Bar Association’s Speaker’s Bureau, which provides speakers for local groups and organizations at no cost.
Attorney Lager’s speech will include a crash-course in the basics of Social Security Disability and Supplemental Security Income. This will include the difference between the two programs, how they overlap, who is eligible for benefits under the programs, and how to apply! If you or a loved one is unable to work because of a health condition, you should consider attending and learning the basics.
Attorney Lager has been with our firm since 2012 and has been a partner since 2017. He focuses his practice on Car Accidents, Workers’ Compensation, and Social Security Disability / SSI, and has previously been named one of Erie’s Top 40 Under 40.