Tag Archives: Workers’ Compensation

FDA requests removal of Opana ER for risks related to abuse

by Karl Voigt

Patients who are taking the pain medication Opana are now facing its manufacturer’s withdrawal of the medication from the market.

Earler this year, the US Food and Drug Administration (FDA) concluded that Opana ER “exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death”. The drug has been available since 2006.

The manufacturer, Endo Pharmaceuticals based in Malvern PA, has been withdrawing the medication from pharmacies since June. Supplies are nearly gone and patients should consult with their physicians for a suitable alternative.

The FDA has made no secret that they intend to review other opioid painkillers.

 

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New Hope to Replace Opioid Painkillers with Safer Alternative

by Karl Voigt

Researcher led by scientists from The University of Texas have revealed the results of their extensive research into a new pain medication that may provide an alternative to addictive opioids.

You may have read on this blog how researchers have focused on the sigma-1 nerve receptor protein in developing opioid pain alternatives. However, new research more than suggests that new medicine can be made from a group of molecules that bind with a sister receptor called sigma-1, little of which until recently  has been known.

Historically, and into the present, opioid medications like oxycodone and OxyContin can combat pain effectively. Unfortunately, to maintain efficacy, doctors have to increase the dosage. Further, these medications are physically addicting and can lead to reliance on non-prescription opioids.

All of us know very well of our country’s opioid crisis. The President’s Commission on Combating Drug Addiction and the Opioid Crisis has even urged President Trump to declare a federal state of emergency. Every day 142 Americans die of a drug overdose, most from heroin.

This is an entirely new class of medication that will hopefully not be addictive, and perhaps even more effective than opioids.

The downside is, of course, the drug must go through the laborious process of testing and approval. For more, read here.

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House Bill 18 Postponed

by Karl Voigt

“Formulary.”

If House Bill 18 passes and you’re a workers’ compensation recipient, that’s a word you’re going to have to get used to.

And likely another word:

NO“.

This new legislation is intended to reduce costs for insurance companies by limiting the types of drugs that doctors can prescribe for you. Which means that a panel of people who have no idea who you are is going to decide what medications you can and can’t take. House Bill 18 would enlist a private company to create a list – or “formulary” – of medications that are “allowed” to treat Pennsylvania injured workers. Non-formulary drugs would need a doctor’s special authorization that they are “medically necessary”.

While opponents of the Bill have procedurally postponed a vote, it may make its way back out of the House Labor & Industry Committee.

In short, it made its way back to committee pending legislators meeting with municipal and state police unions as well as health care providers. If their concerns are addressed, the bill can be amended and sent to the floor for another vote.

The Pennsylvania Bar Association remains opposed to the Bill.

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When Do You Need an Attorney for Workers’ Compensation?

by Karl Voigt

When do you need an attorney for Workers’ Compensation? For those of you who read my posts on Avvo.com, you know that I am by no means a salesman for lawyers. I often encourage Workers’ Compensation claimants to stick it out, and not enter into a fee agreement with a Workers’ Compensation lawyer until they actually need one. I usually say, “you’ll know when you need one.” Lawyers costs money. The general rule is that, once you go to Worker’s Compensation court with a lawyer, 20% of your checks are going to be paid to that lawyer as a fee.

Some recent experiences have really started to change my opinion. And I’ve been practicing Worker’s Compensation law for 26 years now. I have recently seen some very poor behavior from employers and adjusters right at the beginning of the case that makes me think injured workers should have lawyers working for them from day one.

Usually, right at the inception of a claim, the insurance company doesn’t have a lawyer working on its side. There’s an insurance adjuster who makes the initial decisions. Often bad decisions – for the injured worker.

I had someone contact me recently who had just hurt his low back at work. Okay, it happens; people get hurt and that’s what Worker’s Compensation is designed to address. What supposed to happen after that is the employer reports the injury to its Workers’ Compensation insurer and the injured worker gets medical treatment. If the employee can’t work because of the injury, he gets paid wage loss benefits.

So this gentleman hurt his back, immediately told his employer, who essentially disregarded him. His employer wouldn’t even let him know who his Worker’s Compensation insurance company is.

So, after I spoke with him, I used my own resources to track down the identity of this employer’s insurer. Then I contacted that insurance company, trying to hunt down the identity of the person responsible for handling this work injury claim. “No such claim,” they said. Okay, so the employer pay no heed to the law that says that all work injuries must be reported to the carrier within 24 hours.

My efforts now forced the employer into reporting the claim and a file was opened, a claim number generated, and an adjuster assigned. Under ordinary circumstances, the claimant might have simply gone on working in pain, allowing his employer to string him along.

The worker then discussed his case with the adjuster, who actually told him he was compelled to treat with a doctor chosen essentially by her! This would allow her to “twist the arm” of a doctor who was contracted with the carrier. This doctor, knowing who buttered his bread, would be more inclined to make medical decisions favoring the employer, rather than

Before this conversation with the adjuster, we had a discussion about his medical care. Anyone who’s well-read here or on Avvo.com know about the captive period, where a carrier tries to control the initial medical care given an injured worker. Based on the facts, we had decided that he could treat with his choice of doctor. The employer posted no list of physicians from which to choose, nor had the worker signed the “rights and responsibilities” form requisite for the captive period to be enforceable. Therefore, he could not be forced to treat with a company doctor.

But for our conversation, he could have been railroaded into substandard medical care.

All this in the space of just a few days.

Well, not every case goes like this at its inception. Some go smoothly, as it should. However, I suspect more cases like go this one would have when the worker doesn’t have counsel from the start. So, it certainly can’t hurt to get counsel involved from the very beginning. It can only set you in the right direction.

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Maine Allows for Marijuana Use in Workers’ Compensation

by Karl Voigt

If marijuana law is a particularly dynamic field of practice, then marijuana law as it pertains to Workers’ Compensation law is even moreso mutable. We have all seen news coverage of individual states trying to get a handle on changing legal standards with respect to marijuana growing, sales, and use. Only now are we beginning to see coverage of new stories that involve using marijuana to treat work injuries.

Two very new cases come to us from Maine, where medical marijuana is legal. Both come from the state’s Workers’ Compensation Board Appellate Division and both serve to advance the use of marijuana to treat injured workers’ chronic pain. In Bourgoin v. Twin Rivers Paper Company, WCB App. Div. No. 16-26 (August 23, 2016) and Noll v. Lepage Bakeries, Inc., WCB App. Div. No. 16-25 (August 23, 2016), the appellate reviewers essentially determined that federal law does not prohibit requiring the workers’ compensation employer and insurer to pay for medical marijuana.

While Maine does prohibit private health insurers from paying for medical marijuana, there is no such prohibition against workers’ compensation insurers paying for that treatment. Therefore, in Maine, so long as it is found “reasonable and proper”, a workers’ compensation insurer can be compelled to pay for medical marijuana.

Pennsylvania’s law is not quite this liberal; the Pennsylvania Worker’s Compensation Act requires that workers’ compensation insurance carriers pay for work-related medical treatment. Because the US Food and Drug Administration (FDA) has never categorized medical marijuana as medical treatment, insurers in Pennsylvania likely cannot be compelled to pay for medical marijuana

Regardless, the Maine employers challenged the judges’ rulings, arguing that federal law prohibits use of marijuana as a controlled substance. Paying for medical marijuana, they insisted, would put them at risk for federal prosecution, as the federal government’s authority to prosecute drug crimes supersedes Maine’s. The appellate Board, referring to the federal Justice Department’s own public statements that interfering with state medical marijuana laws is not one of its enforcement priorities, ruled that there was virtually no such risk of such prosecution.

Both cases ultimately allowed not just for the injured worker to use medical marijuana for treatment of chronic pain, but also compelled the workers’ compensation carrier to pay for that treatment. This is just the most recent ruling in this fledgling area of law. Stay tuned here for updates.

 

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Workers’ Compensation and Medical Marijuana

by Karl Voigt

This April, the Pennsylvania legislature enacted Act 16 of 2016 (the Medical Marijuana Program),which will enable patients with serious medical conditions to purchase marijuana to treat their symptoms. This is viewed as a conservative approach to the legalization of marijuana in certain circumstances, not a wholesale and liberal distribution of medical marijuana cards. The goal of the legislature was to assist patients suffering from very serious medical conditions in alleviating pain and improving the quality of their life.

This is still a fledgling Act and the Commonwealth is reporting that the process will not be 100% ready until as late as April of 2018. The legislature is still working on implementing regulations and procedures for patients, doctors, growers and dispensaries. Once in effect, patients will be able to purchase medical marijuana only in some forms, not including dried leaves. It will be legally available as a pill, oil, topical, vapor, tincture, or liquid.

Marijuana will be available to treat only serious medical conditions, as defined in the Medical Marijuana Act:

  • Cancer
  • HIV
  • Amyotrophic lateral sclerosis (ALS)
  • Parkinson’s disease
  • Multiple sclerosis
  • Damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity
  • Epilepsy
  • Inflammatory bowel disease
  • Neuropathies
  • Huntington’s disease
  • Crohn’s disease
  • Post-traumatic stress disorder
  • Intractable seizures
  • Glaucoma
  • Sickle cell anemia
  • Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain in which conventional therapeutic intervention or opiate therapy is contraindicated or ineffective
  • Autism
  • Terminally ill, where a medical prognosis of life expectancy of approximately one year or less if the illness runs its normal course
  • Ulcerative colitis

Most of our injured clients who qualify are going to have 1) damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity; or 2) severe chronic or intractable pain of neuropathic origin.

Because the Act conflicts with federal legislation that makes marijuana illegal, doctors can’t actually prescribe marijuana. Further, the US Food and Drug Administration (FDA) has never categorized medical marijuana as medical treatment. As a result, physicians in Pennsylvania can only recommend medical marijuana; it is merely a recommendation. Because the Pennsylvania Worker’s Compensation Act requires that workers’ compensation insurance carriers pay for work-related medical treatment, very likely carriers will not be responsible for the cost of medical marijuana.

Because doctors will be able to apply for certification to recommend marijuana in October, any of our clients who are interested in pursuing medical marijuana will have to ask their treating physicians if they intend to go through the process. If so, that doctor will guide them through the process. Otherwise, they will have to find a doctor who has chosen to obtain certification. If this is the case, our clients are urged to secure their medical records from their treating physicians for subsequent review by a certified doctor.

For more reading, check out the Department of Health’s website. The full text of the Act can be found here.

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CDC Guidelines for Prescribing Opioids for Chronic Pain

by Karl Voigt

You may have seen in the news, or perhaps even here, that the Center for Disease Control has published new Guidelines for Prescribing Opioids for Chronic Pain. This is seemingly in response to not just the addictive nature of opioids, but also the quadrupling of deaths from prescription opioid overdose over the past 15 years. Since so many of our clients have been offered or prescribed opioid medications to manage their pain, it is worth a review.

OxyContin

The Guidelines are targeted to primary care physicians and not so much to pain management doctors. Most of these Guidelines focus on the criteria for initiating opioids and, frankly, they suggest avoiding it.

Interestingly, however, primary care physicians write nearly 10 times more opioid prescriptions per year than pain management doctors combined. Based on my own experience, I wonder if this is because pain management physicians often write the initial opioid prescriptions, then later pass along care to the patient’s primary care doctor.

The new Guidelines can be found here: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.

The CDC also published a checklist for primary care doctors to use in initiating opioid prescriptions for their patients. It can be found at https://stacks.cdc.gov/view/cdc/38025.

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by | March 31, 2016 · 8:49 am