Regulators Report Decreasing Opioid Use

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – Nebraska changed its rules regarding compensable mental-mental injuries. Washington is trying to limit the use of independent medical exams. Tennessee is putting the brakes on misclassification of employees. While the pandemic has made for a light year in state legislatures, they have passed some non-COVID related legislation.

Workers’ compensation regulators throughout the nation shared their issues and challenges as part of the Southern Association of Workers’ Compensation Administrators’ All Committee Conference this week. They addressed a variety of issues including PTSD, return-to-work programs, and opioids.

Opioids

“I’m just not seeing cases any longer involving excessive uses of opioids,” said R. Ferrell Newman, Chairman of the Virginia Workers’ Compensation Commission. “I’ve had the same experience, I’m not seeing it much either,” echoed Melodie Belcher, Georgia Administrative Law Judge, past President of SAWCA and moderator of the session.

Several other regulators expressed the same sentiment — that they are seeing less abuse of opioids this year; at least, within the workers’ compensation systems. “We know a number of workers are on opioids, they’re just not getting them from us,” said Vickie Kennedy, assistant director for Insurance at the Washington State Department of Labor & Industries. That state has seen a 95 percent reduction in chronic opioids as measured by six- to 12-weeks post injury, following the implementation of opioid guidelines into state rule. “We’ve got about 4,500 workers on chronic opioids in the workers’ compensation system,” Kennedy said. “They have active open claims.”

Georgia has been monitoring opioid data from its own system as well as reports from various research organizations, such as the Workers Compensation Research Institute and NCCI. “We’re not seeing near the prescription level and duration we were seeing just a few years ago, although we still have some physicians who appear to be over prescribing. We’re handling those primarily on a case-by-case basis,” said Frank McKay, chairman and chief Appellate Judge for the Georgia State Board of Workers’ Compensation.

“We are pretty much on the same pattern,” said Scott Weiant, deputy secretary for the Pennsylvania Department of Labor & Industry. “One of the things that was interesting, when we started seeing a decline in prescription counts and costs, we also have seen at the same time that our compound drug prescription count and our costs went down drastically.”

“We’re seeing the opposite; a transference of opioids to some of the topical ointments and compound medications,” Georgia’s McKay said.

“We too have seen a trending downward on opioid scripts … We’re also looking to see what impact medical marijuana may have on that,” said Illinois Workers’ Compensation Commission Chairman Michael Brennan. “We don’t have any answer on that, probably not for a year or two.”

Legislation

First responders in Nebraska may be entitled to workers’ compensation benefits for mental-mental injuries — if they have undergone resilience training and an examination prior to a claim. That was one of three non-COVID pieces of legislation passed this year in that state. “It does represent a change in mental-mental rules, definitely expands the types of cases in which benefits may be available and it definitely contains a statement of policy as to why those changes are being made,” said Jill Schroeder, administrator of the Nebraska Workers’ Compensation Court.

Resilience training, she explained must meet guidelines established by the ‘Critical Incident Stress Management Program.’ It teaches the ability to adapt to, manage and recover from adversity, trauma, tragedy, threats or other significant sources of stress.

“It’s a very interesting statute and I think the reason behind it was to help first responders have resources that would prepare them well for the stress that they experience at work and to also recover following incidents that might expose them to extra stress,” Schroeder said.

In Washington, lawmakers passed a bill describing when a IME can be requested. The idea is to put controls around the use of them.

“The intent of those who testified is to reduce the opportunity for repeated IMEs in order to build a preponderance of evidence,” said Kennedy. “It’s interesting because having more IMEs doesn’t necessarily give you a preponderance if you’ve got some real expert medical opinion on the other side. But there’s this long-held belief that ‘if I have three opinions and you have one, I win.’ And that’s not necessarily the case.”

One of just two bills passed in Tennessee targets misclassifying employees and the failure of employers to provide workers’ compensation insurance. The aim is to correct a hole that’s been present.

“If you were from outside the state and come in, you have to carry workers’ compensation, where Tennessee is the primary coverage,” said Abbie Hudgens, administrator of the Tennessee Bureau of Workers’ Compensation. The legislation includes the ‘successor in interest division.’ “In the past, people could dodge their penalties by going out of business for a few months and coming back with a new name. Now that liability with penalties will follow the owners.”

Louisiana is also focused on the issue of misclassification of workers, though not necessarily through legislation. It’s being addressed through the Game On Program, a partnership among the state’s Workforce Commission, Unemployment Insurance, Office of Workers’ Compensation and Department of Revenue.

“Our Fraud department goes out, they do unannounced visits and request Unemployment wage information,” said Shannon Bishop, chief judge of the Louisiana OWCA. “Companies that have not secured workers’ compensation insurance can be fined $250 per employee, up to $10,000, and if they don’t pay they could have a Cease and Desist order.”

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