Opioid Risks

Latest NFL Suit Reflects Broader Opioid Issues

Former players accuse the league of misuse of prescription painkillers.
By: | August 18, 2014 • 4 min read

The problem of over-dependence on opioids in workers’ compensation is well-documented and well-publicized, but it’s being brought to attention in a different light in a recent lawsuit against the NFL.

Nine ex-players are arguing that the league put their health in jeopardy by prescribing powerful painkillers to treat injuries and combining medications into dangerous “drug cocktails” without informing of them of their addictive properties and negative side effects. The plaintiffs allege that “in contravention of Federal criminal laws, the NFL has intentionally, recklessly and negligently created and maintained a culture of drug misuse, putting profit in place of players’ health.”

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Lots of questions will need to be answered before it can be determined whether the suit holds any water. Are players considered employees of the NFL? Were the prescribing practices of their treating physicians actually illegal? Should the players have taken a more active role in determining their treatment and ability to play? Can they prove that any ongoing health issues are the result of treatment they received as players?

The league will likely use exclusive remedy as their defense, an approach challenged by the concussion lawsuit settled last year, which the league ultimately settled by establishing a fund for the treatment of former players. The strength of the exclusive remedy defense will hinge upon whether team physicians broke the law by distributing addictive painkillers and not fully educating players about their side effects.

“In the NFL and other sports, if you’re a starting player and hurt your hamstring, there are three other guys that will take your place if you don’t get back on the field.” — Mark Pew, senior vice president, PRIUM

That defense may also be weakened by an Aug. 13 ruling out of a Miami-Dade circuit court that declares Florida’s exclusive remedy provision unconstitutional on the grounds that the state’s benefits to injured workers have gradually eroded. Judge Jorge E. Cueto’s ruling states that “the benefits in the act have been so decimated, since its implementation 40 years ago, “that it no longer provides a reasonable alternative” to civil court.

Opioid Problem Persists

The lawsuit highlights the unique environment that professional sports players work in.

“Players are hyper motivated to get back on the field,” said Mark Pew, senior vice president at PRIUM. “The average worker doesn’t necessarily lose their job if they get injured. Those that don’t have the discipline to get back to work, they get comfortable staying at home. In the NFL and other sports, if you’re a starting player and hurt your hamstring, there are three other guys that will take your place if you don’t get back on the field.”

With their own trainers, physical therapists and physicians on staff, pro sports teams are also insulated from the general healthcare system. The plaintiffs allege that teams kept poor records of treatment history and “directly and indirectly” supplied players with un-prescribed narcotics to manage pain, a violation of federal drug laws. The “constant diet” of pain pills led some of the players into full-blown addiction.

Though players’ circumstances differ dramatically from the average worker’s, the suit reflects conversations taking place across the country about misuse of opioids in workers’ compensation.

“A 2013 NCCI study found that prescription drugs were 18% of all medical costs in workers’ comp, which is very high when you take into account all the expensive medical procedures and treatments that workers’ comp pays for, including catastrophic claims all the way down to sprained ankles,” Pew said.

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Payers tend to avoid more conservative treatment options because they have a history of over utilization, and they don’t want to get stuck paying for lifestyle management for the rest of a claimant’s life. Paying for yoga and gym memberships – things that increase functionality and flexibility and can help manage chronic pain – are seen as too alternative.

But, as Pew said, “the pendulum is beginning to swing in the other direction.” Just as exclusive remedy comes under fire, more workers’ comp payers and healthcare providers are seeking ways to reduce dependence on opioids and pursue more conservative treatments like physical therapy to deal with chronic pain.

Even the pro sports leagues.

“Sports teams have everything at their disposal to go with more conservative options,” Pew said.

“Everyone owns their own healthcare. You should question the treatment that’s been provided. Though there’s still a concept that doctors are never wrong, patients need to understand treatment options.”

Katie Siegel is a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2017 RIMS

RIMS Conference Opens in Birthplace of Insurance in US

Carriers continue their vital role of helping insureds mitigate risks and promote safety.
By: | April 21, 2017 • 4 min read

As RIMS begins its annual conference in Philadelphia, it’s worth remembering that the City of Brotherly Love is not just the birthplace of liberty, but it is the birthplace of insurance in the United States as well.

In 1751, Benjamin Franklin and members of Philadelphia’s first volunteer fire brigade conceived of an insurance company, eventually named The Philadelphia Contributionship for the Insurance of Houses from Loss by Fire.

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For the first time in America — but certainly not for the last time – insurers became instrumental in protecting businesses by requiring safety inspections before agreeing to issue policies.

“That included fire brigades and the knowledge that a brick house was less susceptible to fire than a wood house,” said Martin Frappolli, director of knowledge resources at The Institutes.

It also included good hygiene habits, such as not placing oily rags next to a furnace and having a trap door to the roof to help the fire brigade fight roof and chimney blazes.

Businesses with high risk of fire, such as apothecary shops and brewers, were either denied policies or insured at significantly higher rates, according to the Independence Hall Association.

Robert Hartwig, co-director, Center of Risk and Uncertainty Management at the Darla Moore School of Business, University of South Carolina

Before that, fire was generally “not considered an insurable risk because it was so common and so destructive,” Frappolli said.

“Over the years, we have developed a lot of really good hygiene habits regarding the risk of fire and a lot of those were prompted by the insurance considerations,” he said. “There are parallels in a lot of other areas.”

Insurance companies were instrumental in the creation of Underwriters Laboratories (UL), which helps create standards for electrical devices, and the Insurance Institute for Highway Safety, which works to improve the safety of vehicles and highways, said Robert Hartwig, co-director, Center of Risk and Uncertainty Management at the Darla Moore School of Business at the University of South Carolina and former president of the Insurance Information Institute.

Insurers have also been active through the years in strengthening building codes and promoting wiser land use and zoning rules, he said.

When shipping was the predominant mode of commercial transport, insurers were active in ports, making sure vessels were seaworthy, captains were experienced and cargoes were stored safety, particularly since it was the common, but hazardous, practice to transport oil in barrels, Hartwig said.

Some underwriters refused to insure ships that carried oil, he said.

When commercial enterprises engaged in hazardous activities and were charged more for insurance, “insurers were sending a message about risk,” he said.

In the industrial area, the common risk of boiler and machinery explosions led insurers to insist on inspections. “The idea was to prevent an accident from occurring,” Hartwig said. Insurers of the day – and some like FM Global and Hartford Steam Boiler continue to exist today — “took a very active and early role in prevention and risk management.”

Whenever insurance gets involved in business, the emphasis on safety, loss control and risk mitigation takes on a higher priority, Frappolli said.

“It’s a really good example of how consideration for insurance has driven the nature of what needs to be insured and leads to better and safer habits,” he said.

Workers’ compensation insurance prompted the same response, he said. When workers’ compensation laws were passed in the early 1900s, employee injuries were frequent and costly, especially in factories and for other physical types of work.

Because insurers wanted to reduce losses and employers wanted reduced insurance premiums, safety procedures were introduced.

“Employers knew insurance would cost a lot more if they didn’t do the things necessary to reduce employee injury,” Frappolli said.

Martin J. Frappolli, senior director of knowledge resources, The Institutes

Cyber risk, he said, is another example where insurance companies are helping employers reduce their risk of loss by increasing cyber hygiene.

Cyber risk is immature now, Frappolli said, but it’s similar in some ways to boiler and machinery explosions. “That was once horribly damaging, unpredictable and expensive,” he said. “With prompting from risk management and insurance, people were educated about it and learned how to mitigate that risk.

“Insurance is just one tool in the toolbox. A true risk manager appreciates and cares about mitigating the risk and not just securing a lower insurance rate.

“Someone looking at managing risk for the long term will take a longer view, and as a byproduct, that will lead to lower insurance rates.”

Whenever technology has evolved, Hartwig said, insurance has been instrumental in increasing safety, whether it was when railroads eclipsed sailing ships for commerce, or when trucking and aviation took precedence.

The risks of terrorism and cyber attacks have led insurance companies and brokers to partner with outside companies with expertise in prevention and reduction of potential losses, he said. That knowledge is transmitted to insureds, who are provided insurance coverage that results in financial resources even when the risk management methods fail to prevent a cyber attack.

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This year’s RIMS Conference in Philadelphia shares with risk managers much of the knowledge that has been developed on so many critical exposures. Interestingly enough, the opening reception is at The Franklin Institute, which celebrates some of Ben Franklin’s innovations.

But in-depth sessions on a variety of industry sectors as well as presentations on emerging risks, cyber risk management, risk finance, technology and claims management, as well as other issues of concern help risk managers prepare their organizations to face continuing disruption, and take advantage of successful mitigation techniques.

“This is just the next iteration of the insurance world,” Hartwig said. “The insurance industry constantly reinvents itself. It is always on the cutting edge of insuring new and different risks and that will never change.” &

Anne Freedman is managing editor of Risk & Insurance. She can be reached at [email protected]