In Workers’ Compensation Case, First Circuit Reaffirms Choice of Pharmacy Remains with Employer

In Corona v. Louisiana Correctional Institute for Women, 2020 WL 6536945 (La. App. 1 Cir. 11/6/20), the First Circuit reversed the finding of the workers’ compensation court and reaffirmed that the choice of pharmacy rests with the Employer.

Corona v. Louisiana Correctional Institute for Women – Background

Therein, the claimant sustained injuries arising out of the scope and course of her employment with the defendant, the State of Louisiana. On April 24, 2017, the claimant filed a Disputed Claim for Compensation, alleging that the State had denied her medications and choice of physician. On July 3, 2017, she amended her claim and sought payment for unpaid invoices for prescription medications obtained through the Injured Workers’ Pharmacy (IWP).

Following a trial on the matter, the Office of Workers’ Compensation (OWC) ruled in favor of the claimant and found that the State was responsible for the payment of her prescription medication. In its reasoning, the court found that the State had no authority to mandate that IWP use the billing process of Sedgwick Claims Management Services. As such, the State was obligated to pay the disputed invoices.

The State of Louisiana’s Appeal

In its appeal, the State argued that there was no liability for payment because the claimant and IWP were both notified in a letter by Sedgwick that it would no longer authorize payment for any medications filed directly by IWP, as the plaintiff had previously been provided a pharmacy card by Sedgwick for her prescriptions. In support of its argument, the State cited to the recent Louisiana Supreme Court case of Burgess v. Sewerage & Water Board of New Orleans, 16-2267 (La. 6/29/17), 225 So.3d 1020, wherein the court held that there is no right of the injured employee to select a specific prescription provider. In light of this holding, the State maintained that it was obligated to pay no more than $750 for non-emergency care.

The First Circuit’s Ruling

The First Circuit Court of Appeal was persuaded by this argument and reversed the judgment of the OWC. The court looked to the fact that both the claimant and IWP were notified on several occasions that Sedgwick would no longer authorize payment for any dispensed medications following their initial letter, and further found it significant that Sedgwick’s litigation consultant testified at trial that she had directly called IWP and advised of same. Given the fact that IWP was well aware of this lack of consent on the part of the State, there was no responsibility on the part of the State to pay any invoices in excess of the $750 previously paid. The court accordingly reversed the OWC and further solidified the Louisiana Supreme Court’s holding that the choice of pharmacy ultimately rests with the employer. ​