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Physicians, Not Insurance Companies, Should Make Medical Decisions


As it appeared in the Citizens’ Voice. As a practicing attorney for 19 years in our region, I have helped hundreds of our fellow citizens who become injured or sick on the job navigate our state’s workers’ compensation system to make sure they receive the care they deserve. For many years, I have watched and fought for people who were forced to suffer because of insurance companies’ greed and their failure to handle injured workers’ claims properly.

The current system is confusing and complicated for workers and their families and, far too often, it can seem insurmountable when insurance companies drag workers through a lengthy appeals process with challenges to legitimate claims.

As if this were not problematic enough, legislation that could literally erode all workers’ rights is currently being fast-tracked in Harrisburg. This proposal would deal a blow to all injured workers by putting a claims adjustor between the patient and his or her doctor.

Senate Bill 936 would establish a pre-approved list of prescription drugs — a “drug formulary” for injured workers. This means that the insurance companies can overrule doctors and deny a worker the medicine that was prescribed by his or her physician.

Medical decisions should be made by a patient’s doctor — not a national panel or organization dominated by the insurance industry.

Senate Bill 936 is beyond problematic because it puts insurance companies’ profits before workers’ compensation patient care. SB 936 would restrict treating doctors from prescribing the necessary medications to their patients unless the medications appear on a statewide formulary that is controlled by the insurance company.

Some business groups might tell you that this bill is an attempt to cut costs – but what they are not telling you is that workers’ compensation rates have been steadily declining in Pennsylvania since 2012.

Interestingly, there is no provision in the bill to ensure that any savings the insurers see from a drug formulary would be passed on to the businesses they insure.

This bill was approved by the state Senate without benefit of a public hearing where workers or experts in this field could offer testimony. It is now pending in the state House and the insurance industry has launched an aggressive campaign in support of the bill.

As everyone knows, Pennsylvania’s workers’ compensation system is based on a handshake between workers and employers. Under current law, injured workers have surrendered their right to sue their employer in exchange for a system that provides for wage loss and medical benefits for workplace injuries and illnesses.

The workers’ compensation system has served employers and workers well for many years. Obviously, the system could always be made better and I would support more transparency and accountability in the prescription of opioids, however, SB 936 is not the answer, Instead, it is a complete disservice to Pennsylvania workers and a license for insurance companies to play doctor. The only people who should make medical decisions regarding your health is your treating physician and you.

GREGORY E. FELLERMAN is a founding partner of Fellerman & Ciarimboli and President of the Northeast Pennsylvania Trial Lawyers Association.

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