It’s Not Our Problem – Or Is It?


All along we knew that there had to be other players in the crazy opioid mess that has befallen society in general and work comp carriers in particular.  Is it truly just the doctor and patient who should be held responsible, or are there others?  How about rogue plaintiff attorneys who may be the most obvious enablers?

Could be, but right now the newest party in the opioid crosshairs is the insuring entity (carrier, employer, fund, etc.) who finances abuse through its prescription drug “ignorance.” We’re not talking about lack of knowledge, but, rather, ignoring the problems they are helping to create by blindly paying for long-term opioids.

Reporting in the May 21, 2012 edition of Business Insurance, Roberto Ceniceros notes several state appellate court rulings holding employers and carriers financially liable in the overdose deaths of their opioid- using claimants. The courts in several states have recently ruled that comp payers will be held liable for harmful outcomes, such as addiction and death, when caused by the long-term, inappropriate use of prescription narcotics paid for by that payer.

Historically, payers have claimed that the claimants’ misconduct (addiction, abuse, etc.) was an intervening, superseding event which constituted noncompliance with physician orders and relieved them (the payer) of any responsibility in the ensuing harm.  Courts have now begun to rule in favor of the claimant (or decedents) using various rationale including the notion the claimant was deprived of clear thinking by the drugs provided by the carrier.

Jon Gelman, a comp expert and national spokesman on occupational safety and health, faults the medical-delivery system AND WORK COMP PAYERS for making pain medications easily available, rather than providing more extensive care which could be more costly. But, actually, what could be more costly than financing a lifetime of drug dependency and its ensuing and certain complications? Additional drugs, new drugs, failing organs, dialysis, transplants and other medical complications is enough, in and of itself, to make the financial investment in better treatment worthwhile.

Utilization review showed that a doctor’s treatment provided to the claimant – including prescriptions for docusate, fentanyl, oxycodone, Fentora, Lyrica and Sonata – was neither reasonable or necessary. And the payer knew, or should have known, the damage that would ensue.  Does this sound like your system? Are you in the cross hairs?


Call us, We can do better.

William Faris, JD
Chief Executive Officer

Posted in Medical Cost Containment, OMCA