Frequently Asked Questions for Workers’ Compensation Patients

Workers’ compensation is a type of employer insurance that pays lost wages to workers who have been injured or disabled due to a work-related injury or illness. Workers’ comp may also cover medical costs, disability, and rehabilitation.

Healthesystems is a privately owned company that provides pharmacy and ancillary medical benefits solutions to workers’ comp insurance carriers and employers. For over 20 years, Healthesystems has worked behind the scenes with workers’ comp insurance companies to process medications and medical services. While we’re not the insurer and don’t make decisions about claims, we help make sure you receive the services your claim allows.

According to the Occupational Safety and Health Administration, the top three work injuries reported in 2022 and 2023 were being caught in or compressed by equipment or objects, falls to a lower level, and being struck objects or equipment. However, the type and risk of work-related injuries varies widely depending on your job tasks and workplace. For instance, sprains and strains can also be common injuries.

When a workplace injury occurs, get medical attention as soon as possible. It’s okay to get medical treatment before reporting your injury to your employer. Report your injury to your employer as soon as you can.

When you report your injury to your employer, they will provide you with the appropriate workers’ compensation claim form. If your employer does not provide this form, contact your state’s workers’ compensation board.

Your employer’s workers’ compensation insurance provider will be your point of contact for your claim. They will assign you a claims examiner who will handle your case.

Depending on your injury, your benefits may include lost wages, medical care and/or devices, prescription drugs, physical therapy, temporary and/or permanent disability benefits, and ancillary medical services such as diagnostic testing, physical therapy, and temporary and/or permanent disability benefits. Supportive ancillary services, such as medical transportation or language translation services, may also be available.

Ancillary medical services are medically necessary services and products that support the diagnosis, treatment, recovery, and functional restoration of an injured worker, but are not part of the core physician office visit or hospital inpatient care. Examples include medical equipment, diagnostics, transportation, and home health.

No. Your regular health insurance likely excludes workplace injuries and will not cover them. Workers’ compensation insurance is specifically designed to cover medical expenses for workplace injuries or illnesses.

Some states may allow you to choose your doctor. Others may require you to see a doctor from a specific network or provider list. Ask your employer or claims examiner for approved doctors in your area.

Yes. It’s important to attend all scheduled appointments so your doctor can monitor your recovery and update your treatment plan as needed. Missing appointments can slow down your healing and may also delay or affect your workers’ compensation benefits. If you need to reschedule, contact your provider as soon as possible.

Once your workers’ comp claim is approved, any authorized medical care should be billed directly to the workers’ compensation insurance provider. You should not be paying out of pocket for authorized care.

Your prescription benefit information will be provided by Healthesystems, either through digital channels such as text or email, or through the mail, depending on how your employer’s insurance plan is set up. When filling a prescription for a work-related injury or illness, share this information with your pharmacist.

In workers’ compensation, some prescriptions are reviewed automatically when they’re processed because they don’t fall within standard guidelines or the approved drug list. When that happens, an extra step may be needed to make sure the medication is right for your work related injury. This review happens behind the scenes to help ensure your treatment stays on track.

In workers’ compensation, some prescriptions are reviewed automatically to make sure they meet treatment guidelines and are related to your work injury. This can sometimes cause a delay, and in some cases the medication may not be approved. If that happens, your pharmacist or claims team can explain why and help review next steps, such as trying a different medication or addressing what’s needed for approval.

Pharmacy rules can vary by state and employer, but many workers’ compensation plans encourage use of a pharmacy network so prescriptions are covered and billed directly, with no out of pocket costs to you. Using a network pharmacy can also help prevent delays.

Use the Healthesystems pharmacy search to find a pharmacy near you.

Yes. Healthesystems offers a Mail Order Home Delivery program that allows qualifying patients to receive prescription medications directly to their doorstep, saving time and avoiding the hassle of driving to a retail pharmacy. Ask your claims examiner for more information.

Ask your claims examiner for a claimant medical reimbursement form and submit it with the appropriate medical documentation.

First, ask for medical clearance from your doctor. Then, talk to your employer about your desire and readiness to return to work, and discuss any necessary accommodation or modifications to your work duties.