Boone v. SYAB Services, Delaware. Supr. No. 525, 2012 (July 16, 2013) (Order)

Delaware Supreme Court affirms Employer's right to compel a Claimant to utilize preferred prescription providers

Claimant, Patricia Boone, suffered a work-related low back injury. Thereafter, she came under the medical care of Dr. Ganesh Balu. Claimant routinely utilized Dr. Balu's in-house pharmaceutical dispensary. Employer, SYAB Services, requested that Claimant utilize its preferred pharmacy contractor, Express Scripts. Employer requested, and the Industrial Accident Board granted, an Order compelling the Claimant to utilize Express Scripts. Employer argued that its vendor could provide the exact same prescriptions to the Claimant, but at a fraction of the cost.

Claimant appealed the Board's Order to the Superior Court, arguing that she had an absolute right to direct medical care and utilize a pharmacy of her choosing. Employer contended that under the workers' compensation statute the Claimant had no such express and unqualified right. The Superior Court agreed with Employer and affirmed the Board's Order. Claimant next appealed the Supreme Court.

At the Supreme Court, similar arguments were asserted. The Court concluded that the statute does not provide the Claimant with an unqualified right to choose a pharmacy - based upon a plain reading of the statute delineating Employer's obligations. The Court contrasted that language against the statutory language providing the Claimant a right to choose a medical provider and noted that the latter provision omitted a "pharmacist" or "pharmacy". The Court went on to conclude that although Dr. Balu's prescription costs were within the Fee Schedule, it was within the Board's discretion for it to determine that the Employer's less costly alternative (Express Scripts) was reasonable and the Board was empowered to compel the Claimant to utilize Express Scripts.