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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

As a professor of business, Jack Hampton knows firsthand the positive impact education has on risk managers as they tackle growing risks.
By: | April 9, 2018 • 4 min read

R&I: Who is your mentor and why?

Ellen Thrower, president (retired), The College of Insurance, introduced me to the importance of insurance as a component of risk management. Further, she encouraged me to explore strategic and operational risk as foundation topics shaping the role of the modern risk manager.

Chris Mandel, former president of RIMS and Risk Manager of the Year, introduced me to the emerging area of enterprise risk management. He helped me recognize the need to align hazard, strategic, operational and financial risk into a single framework. He gave me the perspective of ERM in a high-tech environment, using USAA as a model program that later won an excellence award for innovation.

Bob Morrell, founder and former CEO of Riskonnect, showed me how technology could be applied to solving serious risk management and governance problems. He created a platform that made some of my ideas practical and extended them into a highly-successful enterprise that served risk and governance management needs of major corporations.

R&I: How did you come to work in this industry?

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From a background in corporate finance and commercial banking, I accepted the position of provost of The College of Insurance. Recognizing my limited prior knowledge in the field, I became a student of insurance and risk management leading to authorship of books on hazard and financial risk. This led to industry consulting, as well as to the development of graduate-level courses and concentrations in MBA programs.

R&I: What was your first job?

The provost position was the first job I had in the industry, after serving as dean of the Seton Hall University School of Business and founding The Princeton Consulting Group. Earlier positions were in business development with Marine Transport Lines, consulting in commercial banking and college professorships.

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

Creating a risk management concentration in the MBA program at Saint Peter’s, co-founding the Russian Risk Management Society (RUSRISK), and writing “Fundamentals of Enterprise Risk Management” and the “AMA Handbook of Financial Risk Management.”

A few years ago, I expanded into risk management in higher education. From 2017 into 2018, Rowman and Littlefield published my four books that address risks facing colleges and universities, professors, students and parents.

Jack Hampton, Professor of Business, St. Peter’s University

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

The Godfather. I see it as a story of managing risk, even as the behavior of its leading characters create risk for others.

R&I: What is your favorite drink?

Jameson’s Irish whiskey. Mixed with a little ice, it is a serious rival for Johnny Walker Gold scotch and Jack Daniel’s Tennessee whiskey.

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

Mount Etna, Taormina, and Agrigento, Sicily. I actually supervised an MBA program in Siracusa and learned about risk from a new perspective.

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

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Army Airborne training and jumping out of an airplane. Fortunately, I never had to do it in combat even though I served in Vietnam.

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

George C. Marshall, one of the most decorated military leaders in American history, architect of the economic recovery program for Europe after World War II, and recipient of the 1953 Nobel Peace Prize. For Marshall, it was not just about winning the war. It was also about winning the peace.

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

Sharing lessons with colleagues and students by writing, publishing and teaching. A professor with a knowledge of risk management does not only share lessons. The professor is also a student when MBA candidates talk about the risks they manage every day.

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

Sensitizing for-profit, nonprofit and governmental agencies to the exposures and complexities facing their organizations. Sometimes we focus too much on strategies that sound good but do not withstand closer examination. Risk managers help organizations make better decisions.

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

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Developing executive training programs to help risk managers assume C-suite positions in organizations. Insurance may be a good place to start but so is an MBA degree. The Risk and Insurance Management Society recognizes the importance of a wide range of risk knowledge. Colleges and universities need to catch up with RIMS.

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

Cyber risk and its impact on hazard, operational and financial strategies. A terrorist can take down a building. A cyber-criminal can take down much more.

R&I: What does your family think you do?

My family members think I’m a professor. They do not seem to be too interested in my views on risk management.




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