New Workers’ Compensation Rules on Opioids: What Does it Mean for You?

New Workers’ Compensation Health Care Services Rules Limit Treatment for Injured Michigan Workers Suffering From Chronic Pain

Effective December 24, 2014, the Michigan Workers’ Compensation Agency implemented new rules governing injured workers’ use of pain medications containing opioid analgesics such as morphine, codeine, and methadone. Injured Michigan workers often use opioid or narcotic medications to control pain that results serious work injuries. These rules apply to all work injuries causing chronic pain except cancer-related pain.

Rule1008a(1) states that in order for an injured worker’s doctors to receive payment for opioid or narcotic pain treatment for chronic pain beyond 90 days, the doctor must submit a written report to the payer (insurance company or self-insured employer) every 90 days. The report required of the doctors is very detailed. Among other information, the doctors’ 90 day reports will need to include the following:

• A full summary of the care rendered to the injured worker that focuses on increased function and return to work.
• A statement as to why other alternative treatment of the injured worker was ineffective.
• A statement that the doctor considered the results of screening tools to detect factors that may increase the risk of abuse by the injured worker such as history of alcohol or drug abuse.
• A treatment plan including overall goals and functional progress.
• Periodic drug screens, and a conscientious effort to reduce the injured worker’s pain through non-opioid treatment.

The doctor and the injured worker will also be required to enter a drug treatment agreement signed by both the injured worker and the doctor. This agreement will outline the risks and benefits of opioid use, the conditions in which the doctor will prescribe opioids for the injured worker, and the responsibilities of the prescribing doctor and the injured worker. The agreement between the doctor and the injured worker must be reviewed and updated every 6 months.

Finally, R418.101008b allows the workers’ compensation insurance company or employer to deny reimbursement to doctors for prescribing and dispensing opioid or narcotic medications used to treat chronic pain related to serious work injuries. Denial of reimbursement may occur if the workers’ compensation carrier or employer determines that the doctor’s reporting and treatment plan are not adequate.

Why Should a Workers’ Compensation Insurance Adjuster Have the Power to Make These Medical Decisions?

Of course, the workers’ compensation attorneys at McCroskey Law truly understand the problems with injured workers becoming addicted to pain medications because of use to treat chronic pain related to work injuries. However, we believe that the new Workers’ Compensation Agency rules go much too far by making it difficult for doctors to treat injured workers.

First, the rules impede treating doctors’ decision-making power when treating injured workers with chronic pain. Most of us agree that our own doctor is in the best position to help us make decisions about the best form of medical treatment. Why take the decision-making power regarding medical care away from our doctors and give it to insurance companies and employers?

Secondly, the reporting requirements for the doctors and the patients is so time consuming and cumbersome that coverage for opioid treatment for chronic work-related pain will be shifted away from workers’ compensation system and onto other forms of insurance where reporting is not required, such as group employer health insurance, Medicaid and Medicare. The workers’ compensation insurance companies and employers are responsible to pay for medical treatment related to work injuries, not Medicaid, Medicare, or other health insurance.

Finally, and most importantly, many doctors will simply refuse to treat injured workers because of the time and cost associated with the reporting requirements of the new rules. These rules will take away an injured worker’s ability to treat with the doctor of his or her choice.

If you are an injured worker suffering chronic pain, these new rules may greatly impact how your doctor will be able to provide care to you by use of pain medications. If your medical treatment has been cut off, contact the lawyers at McCroskey Law right away for a free consultation. We may be able to help get your treatment reinstated.