Painkillers Play a Major Role in Workers’ Compensation Claims

Insurance companies spend $1.4 billion annually on narcotic pain killers in workers' compensation claims, The New York Times recently reported. In addition, a California Workers Compensation Institute study revealed that if painkillers, which are opioids, are used too early, frequently or for too long, their use delays a worker's return to the job.

According to the U.S. Department of Labor's Bureau of Labor Statistics, the most common on-the-job injuries are sprains and strains, often located in the back. These injuries, those especially involving back pain, are often treated with painkillers, rest and some physical therapy. Sprains and strains account for nearly 43 percent of worker injuries in the U.S., and in New York neck, back and shoulder injuries account for 60 percent of the system's overall costs.

Other medical conditions can lead to painkiller use, however. In fact, from 2001 through 2008, prescription painkiller use increased by 63 percent, insurance company data shows.

Besides its high cost, it is unclear if the use of painkillers is even effective in fighting back and neck injuries. Often, a worker takes longer to return than if he or she went through physical therapy. Opioids also can lead to addiction and fatal overdose. These medications also have side effects such as drowsiness and lethargy.

New York Pain Treatment Guidelines

In reaction to the high costs associated with chronic pain medication use, New York has created certain guidelines for prescription painkillers. Insurers can now direct claimants to certain pharmacies where they must pick up their prescription. Workers' compensation law does not allow insurers to decline prescriptions out-of-hand, but can only direct where claimants receive them. The idea behind the law is to monitor prescription painkiller use and exclude doctors who, in the insurance companies' minds, over-prescribe painkillers.

Under the law, insurance companies are able to contest a claim if they feel an injury is not covered by workers' compensation, regardless of whether prescription painkillers or other treatment is required.

Workers' Compensation Claims

The prevalence of back pain in the workplace naturally means that they will make up a large portion of workers' compensation claims. In addition, pain medication can help a worker return to work more quickly, especially for minor injuries. Still, insurance companies are seeking to reduce what they deem are too-high costs associated with pain medication for work injuries, which in reality insurance companies partially brought upon themselves. For years, because pain medication is initially cheaper than physical therapy, insurance companies steered doctors towards pain medication instead of physical therapy or chiropractic care to treat back pain. Now, insurance companies are realizing that the long-term consequences of these practices have led to soaring costs. The good news for some injured workers is that the new Medical Treatment Guidelines, enacted in 2010, make it easier, initially, to obtain physical therapy and chiropractic care for back, neck and shoulder injuries in lieu of simply managing the pain with prescription medication. The bad news, however, is that these same guidelines place significant restrictions and burdens on the injured worker and his doctor after the initial period of treatment.

It is becoming increasingly difficult to navigate these new Medical Treatment Guidelines and changes to the law. Moreover, dealing with a workers' compensation claim is a complex process, especially if the claim is denied or contested. Workers who are injured and in pain should contact an experienced workers' compensation attorney to discuss how best to move forward with their claim processes.