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The Opioid Epidemic’s Impact on Workers’ Compensation

January 31, 2020

By Naeisha Rose

“Prolonging the treatment that is needed it is not going to help the injured party or the carrier from saving resources.” — John C. Merlino, attorney and labor activist.

New York, NY – In combatting the nation’s opioid epidemic the federal government may have unintentionally increased the amount of workers’ compensation denials across the country, resulting in victims not receiving immediate treatment after an accident in the workplace. 

In 2018, a report revealed that nearly 70-percent of workers’ compensation claims were denied, according to Risk & Insurance, a digital magazine that focuses on risk management and commercial insurance. 

The report was based on research conducted by Lockton companies, a global risk management firm. The data was based on denials that were conducted from 2013 to 2017. 

The research concluded that of the 67-percent of claims that were denied by claim adjusters and employers within a year in the United States, that the amount of converted money that was awarded on average was 55-percent higher than the original claim, however, the tactic still remains. 

Denied litigated claims resulted in the average net claim compensation ballooning to $36,991 for claims that would have paid out around $10,153, according to the research. 

In 2019, the Labor Department issued a statement that it would set limitations on prescriptions for those hurt on the job with a seven-day supply of opioid painkillers, with only the option for three refills within the first 28 days, as reported by the Associated Press. Anything beyond that would require a medical certification. 

With more and more workers denied workers’ compensation, as well as treatment, they have been turning to pharmacies, like Franklin Rx in L.I. to meet their needs, according to COO Jonathan Mordechaev. 

“We are a full-service specialty pharmacy handling individual needs after vehicle accidents or workplace injuries,” Mordechaev said. “The first step is to reach out to an attorney, followed by seeking medical attention.”

After a workplace injury, many workers are often in need of some type of medication to aid in the healing process, according to Mordechaev. 

“We assist in getting their medication approved through the proper insurance,” said Mordechaev. “We do the legwork and all the background for them in order for them to obtain their medication without paying out of pocket, because often times they tend to use their private insurance, which they are not supposed to be doing.”

The problem that those who are denied workers’ compensation face is that insurance carriers want to know if the medication is medically necessary. 

Franklin Rx will reach out to the victim’s attorneys and physicians to help them in the process and make sure it is delivered for them. 

“The last thing you want to do is to be thinking about that,” said Mordachaev. “This is done from the comfort of their home and everything is delivered to them.”

Injured victims don’t have to wait online to only learn that a medication is not covered or out of stock at a time that is not convenient, according to the COO. To help those who are injured representatives of Franklin Rx need a claim number, the date of injury and their carrier. They also try to make sure that patients are getting diagnosed correctly. 

John C. Merlino, Esq., a partner at William Schwitzer & Associates and a labor activist, sees both sides to the dilemma when it comes to injured workers obtaining the medical treatment.

“The reason the majority of injured workers’ requests for medication get denied is, in part, due to the narcotic epidemic that is currently occurring in the United States,” said Merlino. “The carriers will deny injured workers because the doctors have to express what is the medical necessity to continue with a certain narcotic medication, and need to balance the long term affect which can be detrimental to the person.”

Doctors are becoming more aware and conscious of what they are prescribing to patients, especially when it comes to narcotics, according to Merlino.

“I’m noticing doctors being more cautious because they do not want to be in violation of any regulatory laws and they see what is occurring, they don’t want [addiction] to happen to their patients,” said Merlino. “I’ve seen a decline in dependency and an increase in awareness.”

Merlino has noticed physicians are taking a more holistic approach in treating patients who are on workers’ compensation.

“I’m seeing more dietary treatment, aqua-therapy and other modalities of treatment post-operative where medication is not the main modality,” said Merlino. “Doctors tend to cut patients off the medication sooner [from narcotics] so patients do not run the risk addiction in the future.”

Merlino has noticed an increased trend of patients getting acupuncture as well, along with topical creams versus narcotics for pain management, but acknowledges that this approach doesn’t necessarily work for everyone.

“Every person is obviously different,” said Merlino. “Carriers need to understand this and the quicker a claimant gets the needed treatment the faster they can get back to work, especially when it comes to surgeries.”

Merlino has had several clients who had injuries where surgery is indicated, but the carriers will fight tooth-and-nail and push unnecessary litigation, to either prolong the inevitable or seek to get the necessary surgery denied by a law judge. Litigation with carriers can end up going on for several months or even up to a year, added the partner.

“It’s a waste of the board’s time and resources, and it’s prolonging an injured worker from healing and getting better in an effort to go back to work,” said Merlino. “Prolonging the treatment that is needed it is not going to help the injured party or the carrier from saving resources.”  

“Carriers,” said Merlino “Must stop playing with their lives and understand injured workers’ want to get back to work to support their families.”

Adjusters are getting their marching orders from the big insurance companies that are only looking at the dollars-and-cents in a foolish manner, according to Merlino.

“Unfortunately, it’s a game big insurance companies are playing and who’s paying for it are the hardworking men and women who get injured at work.” said Merlino. “You can have somebody that fell 20 feet off a scaffold and then you can have somebody that fell six feet, both are injured. The mechanism of injury or the severity thereof should not be the sole factor in determining which injured worker gets authorization for treatment.”

Merlino fears that some of these victims might self-medicate while waiting for authorization from the carriers [surgery, physical therapy, injections] to be sorted out through lengthy litigation and/or ridiculous “red tape.”

“There has to be a happy medium, carriers must understand it’s a case-by-case situation when it comes to treatment and medications, it’s not a cookie-cutter guideline,” said Merlino. “Some of the carrier’s medical consultants do an exam in 15 minutes and then they offer an opinion on whether or not someone needs surgery, injections, physical therapy, which is ridiculous and the carriers get away with this.”

These long litigation processes tend to result in the injured parties turning to unemployment compensation for wage replacement and their private insurance for medical treatment all to avoid delays in getting the benefits needed.

“It’s cost-shifting,” said Merlino. “They are preventing injured people from saying that they got injured at work so that they can get the treatment they need to go back to work. That’s wrong!”

January 31, 2020

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