2017 RIMS

Reviewing Medical Marijuana Claims

Liberty Mutual appears to be the first carrier to create a workflow process for evaluating medical marijuana expense reimbursement requests.
By: | April 24, 2017 • 2 min read

Liberty Mutual established a formalized claims-review process to determine whether circumstances warrant paying for medical marijuana requested by a workers’ compensation claimant.

It appears that the Boston-based carrier is the first to take this approach.

Craig J. Ross, doctor of osteopathic medicine and regional medical director, Liberty Mutual

Developing the workflow process for evaluating medical marijuana expense reimbursement requests became necessary for several reasons, including the legalization of marijuana for medical use in 29 states, said Craig J. Ross, a doctor of osteopathic medicine and a Liberty Mutual regional medical director.

The internal claims-review guidelines direct adjusters to involve the insurer’s legal and medical experts when injured workers request reimbursement for medical marijuana.

The additional expert review is necessary because the doctors prescribing cannabis typically are not the same physicians treating injured workers for the medical cause of their workers’ comp claim, Ross said during an interview at the Risk and Insurance Management Society’s annual conference held April  23-26 in Philadelphia.

“You need a workflow to determine whether marijuana might be medically appropriate for that patient, how they came to it, whether the indication is really for the work-comp injury or some other condition, and whether there are jurisdictional drivers that will make us more likely to say yes,” Ross said.

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So far, while Liberty Mutual has received very few claims requesting payment for cannabis, a spokesman could not say how many requests for medical marijuana reimbursements it paid or rejected.

The claims it has seen, though, typically involve cases where doctors and their patients are searching for alternatives to ongoing opioid use.

Out of workplace safety concerns, insurers and employers overwhelmingly have taken measures to discourage employee marijuana use, said Kevin Glennon, a registered nurse and VP of clinical programs at One Call Care Management.

Glennon said has not heard of other insurers establishing claims-handling processes specifically for addressing whether medical marijuana reimbursement requests should be paid.

Glennon is scheduled to speak on medical marijuana in workers’ comp during the RIMS conference. He provides workers’ comp services for several injured workers who use medical marijuana, but they have not requested that their insurers pay for the drug, which remains illegal under federal law.

“The [insurance] carriers that I am working with, they know that these individuals are utilizing medical marijuana, but the injured worker has never broached the subject of reimbursing for it,” Glennon said.

Some states that have legalized medical marijuana require insurers to reimburse claimants for their spend on the drug while other jurisdictions prohibit doing so, said Glennon added.

Meanwhile, public support for legalizing marijuana, especially for medical use, continues to grow. More than 60 percent of Americans believe the drug should be legalized, according to a CBS News poll released earlier this month. That is up 5 points from a year earlier.

More than 70 percent of Americans oppose any federal government attempt to stop cannabis sales in states where it has been legalized for recreational use, the poll found. A Marist poll, also released earlier this month, found that 80 percent of Americans support marijuana use for medical purposes.

While Liberty Mutual has received few requests to pay for marijuana, the insurer is attempting to stay ahead of the trend, the spokesman said.

Additional stories from RIMS 2017:

Blockchain Pros and Cons

If barriers to implementation are brought down, blockchain offers potential for financial institutions.

Embrace the Internet of Things

Risk managers can use IoT for data analytics and other risk mitigation needs, but connected devices also offer a multitude of exposures.

Feeling Unprepared to Deal With Risks

Damage to brand and reputation ranked as the top risk concern of risk managers throughout the world.

 

Cyber Threat Will Get More Difficult

Companies should focus on response, resiliency and recovery when it comes to cyber risks.

RIMS Conference Held in Birthplace of Insurance in US

Carriers continue their vital role of helping insureds mitigate risks and promote safety.

Resilience in Face of Cyber

New cyber model platforms will help insurers better manage aggregation risk within their books of business.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

Wawa’s Director of Risk Management knows that harnessing data and analytics will be key to surviving the rapid pace of change that heralds new risk exposures.
By: | July 27, 2017 • 5 min read

R&I: What was your first job?

My first job was at the age of 15 as a cashier at a bakery. My first professional job was at Amtrak in the finance department. I worked there while I was in college.

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

A position opened up in risk management at Wawa and I saw it as an opportunity to broaden my skills and have the ability to work across many departments at Wawa to better learn about the business.

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

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The advancements in analytics are a success for the industry and offer opportunities for the future. I also find value in the industry focus on emerging and specialty risks. There is more alignment with experts in different industries related to emerging and specialty risks to provide support and services to the insurance industry. As a result, the insurance industry can now look at risk mitigation more holistically and not just related to traditional risk transfer.

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

Developing the talent to grow with the industry in specialization and analytics, but to also carry on the personal connections and relationship building that is a large part of this industry.

Nancy Wilson, director, quality assurance, risk management and safety, Wawa Inc.

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

I have had successes at all of the RIMS events I have attended. It is a great opportunity to spend time with our broker, carriers and other colleagues.

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

I think the biggest challenge facing most companies today is related to brand or reputational risk. With the ever-changing landscape of technology, globalization and social media, the risk exposure to an organization’s brand or reputation continues to grow.

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

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The changing consumer demands and new entrants into an industry are concerning. This is not necessarily something new but the frequency and speed to which it happens today does seem to be different. I think that is only going to continue. Companies need to be prepared to evolve with the times, and for me that means new risk exposures that we need to be prepared to mitigate.

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

I try to be optimistic about most things. I think the economy ebbs and flows for many reasons and it is important to always keep an eye out for signs of change.

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

I am fortunate to have opportunities professionally that make me proud, but I have to answer this one personally. I have two children ages 12 and 9 and I am so proud of the people that they are today. They both are hardworking, fun and kind. Nothing gives me a better feeling than seeing them be successful. I look forward to more of that.

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

This is really hard as there are too many favorites. I do prefer books to movies, especially if there is a movie based on a book. I find the movie is never as good. I have multiple books going at once and usually bounce back and forth between fiction and non-fiction.

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

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I have eaten at a lot of different restaurants in many major cities but I would have to pick Horn O’ Plenty in Bedford, PA. It is a farm to table restaurant in the middle of the state. The food is always fresh and tastes amazing and they make me feel like I am at home when I am there. My family and I eat there often during our trips out that way.

R&I: What is your favorite drink?

I do love a good cup of coffee (working at Wawa helps that). I also enjoy a good glass of wine (red preferably) on occasion.

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

Vacations aside, I do get an opportunity to travel for work and visit our food suppliers. The opportunities I have had to visit back to the farm level have been a very interesting learning experience. If it wasn’t for my role, I would have never been able to experience that.

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

My husband, kids and I recently did a boot-camp-type obstacle course up in the trees 24 feet in the air. Although I had a harness and helmet on, I really put my fear of heights to the test. At the end of the two hours, I did get the hang of it but am not sure I would do it again.

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

The first people that come to mind are those who are serving our country and willing to sacrifice their own lives for our freedom.

R&I: What about this work do you find the most fulfilling or rewarding?

Every day is different and I have the opportunity to be involved in a lot of different work across the company.

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

My husband and children have a pretty good sense of what I do, but the rest of my family has no idea. They just know I work for Wawa and sometimes travel.




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