2017 NWCDC

Looking Back: Workers’ Comp in 2017

Injured workers and their employers search out ways to combat chronic pain, but they’re not always in agreement on the best solutions.
By: | December 6, 2017 • 3 min read

Prescription drugs and other methods of chronic pain relief have been at the center of workers’ comp conversations for years, whether it’s something as controversial as opioids and marijuana or it’s deciding where injured workers can fill their prescriptions.

Over the past year, these hot topics have led to decisions that could impact the workers’ comp industry moving forward.

The Marijuana Debate Continues

Twenty-nine states and the District of Columbia have legalized the use of medical marijuana. Legislation on this taboo drug is under rapid change, leaving many wondering where that leaves workers’ comp.

In Maine this year, the state legislative committee was urged to reconsider regulatory framework surrounding recreational marijuana.

Under the law, businesses wouldn’t be able to reject applicants for testing positive for marijuana because the applicant might use the drug for medicinal purposes. Employers wouldn’t be able to fire an employee for a positive drug test after an incident of injury. Instead, the employer would be tasked with proving the employee was impaired on the job.

In Massachusetts, for example, a woman was offered a position on the condition she passed a mandatory drug test, but she was using medical marijuana for Crohn’s disease. The employer said it wouldn’t be a problem but fired her regardless.

Twenty-nine states and the District of Columbia have legalized the use of medical marijuana. Legislation on this taboo drug is under rapid change, leaving many wondering where that leaves workers’ comp.

In July, the court ruled that under Massachusetts law her use of medical marijuana was “as lawful as the use and possession of any other prescribed medication.”

The employer had to prove she was impaired on the job to justify letting her go.

Additionally, workers’ comp carriers and insurance organizations have made a move toward accepting medical marijuana practices.

Liberty Mutual implemented a formalized claims-review process to evaluate workers’ comp requests for medical marijuana this year. Safety National teamed up with third-party vendors to distribute manufactured medical marijuana patches and gels.

Combatting the Opioid Epidemic

The opioid epidemic was declared a public health emergency in October, and to combat this growing crisis, some insurers and pharmacies are limiting coverage of opiate-based prescriptions.

Cigna announced it will not cover OxyContin prescriptions — the most common cause of opioid-related overdose and death — for customers on employer-based health plans. CVS limited opioid prescriptions to a seven-day supply.

The Workers’ Compensation Institute found that overuse and misuse of opioids resulted in mixed results depending on the state, showing that while some states are cutting the number of opioids prescribed to injured workers, other states are still prescribing more.

A study published by the Journal of the American Medical Association found a link between legalized medical marijuana and opioid-related deaths. States that legalized medical marijuana saw a 25 percent decrease in deaths from opioid overdoses.

Workers’ Choice in Pharmacy

At the end of the day, however, injured workers still need to fill their pain relief prescriptions. This year, a handful of states faced the question: Should employees get a choice in pharmacy?

In Kentucky, the law permits workers to choose their own medical provider, however one company faced a hiccup when their injured workers turned to Injured Workers Pharmacy (IWP), a mail-order business that sells medications on a lien basis. When the insurer refused to pay, the employees turned to the law.

The court ruled in favor of the workers, allowing them to choose their own pharmacy with impunity.

Yet, in Louisiana, a worker who turned to IWP to fill his prescriptions, was denied. The judge ruled in favor of the employer, stating that under state law, pharmacy choice in a workers’ comp case belongs to the employer.

And these states are not the only ones facing this growing issue. Workers and pharmacies continue to bring cases against employers in the hopes of bypassing the insurer’s pharmacy of choice. &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

Janet Sheiner, VP of risk management and real estate at AMN Healthcare Services Inc., sees innovation as an answer to fast-evolving and emerging risks.
By: | March 5, 2018 • 4 min read

R&I: What was your first job?

As a kid, bagging groceries. My first job out of school, part-time temp secretary.

R&I: How did you come to work in risk management?

Risk management picks you; you don’t necessarily pick it. I came into it from a regulatory compliance angle. There’s a natural evolution because a lot of your compliance activities also have the effect of managing your risk.

R&I: What is the risk management community doing right?


There’s much benefit to grounding strategic planning in an ERM framework. That’s a great innovation in the industry, to have more emphasis on ERM. I also think that risk management thought leaders are casting themselves more as enablers of business, not deterrents, a move in the right direction.

R&I: What could the risk management community be doing a better job of?

Justified or not, risk management functions are often viewed as the “Department of No.” We’ve worked hard to cultivate a reputation as the “Department of Maybe,” so partners across the organization see us as business enablers. That reputation has meant entertaining some pretty crazy ideas, but our willingness to try and find a way to “yes” tempered with good risk management has made all the difference.

Janet Sheiner, VP, Risk Management & Real Estate, AMN Healthcare Services Inc.

R&I: What was the best location and year for the RIMS conference and why?

San Diego, of course!  America’s Finest City has the infrastructure, Convention Center, hotels, airport and public transportation — plus you can’t beat our great weather! The restaurant scene is great, not to mention those beautiful coastal views.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

The emergence of risk management as a distinct profession, with four-year degree programs and specific academic curriculum. Now I have people on my team who say their goal is to be a risk manager. I said before that risk management picks you, but we’re getting to a point where people pick it.

R&I: What emerging commercial risk most concerns you?


The commercial insurance market’s ability to innovate to meet customer demand. Businesses need to innovate to stay relevant, and the commercial market needs to innovate with us.  Carriers have to be willing to take on more risk and potentially take a loss to meet the unique and evolving risks companies are facing.

R&I: Of which insurance carrier do you have the highest opinion?

Beazley. They have been an outstanding partner to AMN. They are responsive, flexible and reasonable.  They have evolved with us. They have an appreciation for risk management practices we’ve organically woven into our business, and by extension, this makes them more comfortable with taking on new risks with us.

R&I: Are you optimistic or pessimistic about the U.S. health care industry and why?

I am very optimistic about the health care industry. We have an aging population with burgeoning health care needs, coupled with a decreasing supply of health care providers — that means we have to get smarter about how we manage health care. There’s a lot of opportunity for thought leaders to fill that gap.

R&I: Who is your mentor and why?

Professionally, AMN Healthcare General Counsel, Denise Jackson, has enabled me to do the best work I’ve ever done, and better than I thought I could do.  Personally, my husband Andrew, a second-grade teacher, who has a way of putting things into a human perspective.

R&I: What have you accomplished that you are proudest of?

In my early 20s, I set a goal for the “corner office.” I achieved that when I became vice president.  I received a ‘Values in Practice’ award for trust at AMN. The nomination came from team members I work with every day, and I was incredibly humbled and honored.

R&I: What is your favorite book or movie?

The noir genre, so anything by Raymond Chandler in books. For movies,  “Double Indemnity,” the 1944 Billy Wilder classic, with insurance at the heart of it!

R&I: What is your favorite drink?


Clean water. Check out Water.org for how to help people enjoy clean, safe water.

R&I: What’s the best restaurant at which you’ve eaten?

Liqun Roast Duck Restaurant in Beijing.

R&I: What is the most unusual/interesting place you have ever visited?

China. See favorite restaurant above. This restaurant had been open for 100 years in that location. It didn’t exactly have an “A” rating, and it was probably not a place most risk managers would go to.

R&I: What is the riskiest activity you ever engaged in?

Eating that duck at Liqun!

R&I: If the world has a modern hero, who is it and why?

Dr. Seuss who, in response to a 1954 report in Life magazine, worked to reduce illiteracy among school children by making children’s books more interesting. His work continues to educate and entertain children worldwide.

R&I: What do your friends and family think you do?

They’re not really sure!

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]