July 14, 2014
Ed Templeton of Lebanon, PA recently prevailed on a penalty petition for unpaid prescription drugs. Mr. Templeton had, many years ago, signed a Compromise and Release Workers’ Comp Settlement Agreement, releasing Kleinfelter Chevrolet (his employer) and Federated Mutual Insurance Company (the Workers’ Compensation insurer) from all future wage loss. As part of the C&R agreement, both sides agreed to keep medical coverage open so that Mr. Templeton could continue to get the treatment he required following his work –related injury by having the workers’ comp carrier pay for lifetime medicals relating to the work injury.
Mr. Templeton was prescribed Qualaquin by Dr. Stanley Grabias. The Qualaquin was effective in helping with Mr. Templeton ongoing issues with muscle spasms in his back and leg. Mr. Templeton was acquiring his medicine through the Injured Workers’ Pharmacy, or IWP, a company which specializes in providing hassle free mail order prescription medicine to injured workers.
After paying for the medication for years, the workers’ comp insurance company decided to stop payment of the prescription expenses and bills, arguing that the prescription was not causally related to the work injury. Mr. Templeton, through Calhoon and Kaminsky P.C., filed a petition for payment of the medical bills and for penalties for non-payment of medical bills. The case first assigned to Workers’ Compensation Judge James P. Deeley and following his retirement was transferred to the Honorable Paul Baker in Harrisburg. The insurance company presented the opinion of Dr. Michael Wolk, the IME doctor hired by the comp carrier, who stated that the prescription for Qualaquin was not causally related to the work injury to Mr. Templeton back. The Claimant testified that the Qualaquin had helped him greatly throughout the years following his initial spinal surgery. Dr. Stanley Grabias, who had treated Mr. Templeton since his work-related injury, opined that the Qualaquin had been beneficial to Mr. Templeton, that the Qualaquin was used to treat the muscle spasm associated with the work injury, and that the Qualaquin would continue to help Mr. Templeton. Believe it or not, it was the comp carrier’s position that the medicine is only to treatment of malaria and since Ed does not have malaria they should not have to pay for it. This is what happens when a workers’ comp adjuster plays doctor.
WC Judge Baker found the testimony of Dr. Grabias and the testimony of Mr. Templeton to be credible and persuasive. Judge Baker entered an order, stating that the treatment of Qualaquin was causally related to the work injury. Judge Baker ordered that the insurance company must pay the unpaid medical bills, must pay statutory interest to the IWP, and must pay penalty fees of 50% of the unpaid medical bills to Mr. Templeton.
