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Treating Injuries without Employer Pain: Managing the Challenges of Opioids and Marijuana

Liberty Mutual's claims management framework can help businesses tackle challenges as they come, including medical marijuana.
By: | July 27, 2017 • 5 min read

Most employees have peace of mind that while a workplace injury may cause pain or disrupt their lives, they’ll be treated as quickly and effectively as possible through their employers’ workers’ compensation programs. Employees also know that they’ll have treatment options that best fit their conditions and medical needs. Two potential treatments, however, present unique challenges for employers: opioids and medical marijuana.

Updated medical guidelines, new laws, and cultural shifts have driven the rise of these two classes of drugs as potential forms of treatment in workers’ compensation cases. While opioids and medical marijuana are in very different stages as treatment methods, complications exist that could put employees and businesses at risk if not managed effectively. Their potential impacts mean employers need to have a forward-thinking claims framework in place to help keep employees safe and minimize risk.

The Rise of Opioids in Workers’ Comp

Doctors and nurses must ask patients to rate their pain on a scale of one to 10, and treat it accordingly. That subjectivity, in part, has given rise to the over-prescription of opioids. “Historically, opioids were used appropriately to alleviate pain associated with cancer and similar severe pain conditions. Over time, physicians prescribed opioids for far less severe pain conditions. The resulting rise in availability has also contributed to the current epidemic in the United States,” said Maureen McCarthy, SVP and Manager, Workers’ Comp Field Claims, Liberty Mutual Insurance.

The Centers for Disease Control and Prevention (CDC) estimate that nearly half of all U.S. opioid overdose deaths involve prescription opioids – in 2015, there were 15,000 prescription-related opioid deaths1.

Its impact is also being felt in the workers’ comp space. Seventy percent of injured workers take some form of an opioid painkiller – and workers’ comp claims involving opioids cost, on average, $20,000 more than claims without2.

A Flexible Framework for Evolving Claims

Opioids aren’t the only change impacting workers’ comp; emerging treatments like medical marijuana are also on the rise. Liberty Mutual Insurance built a flexible claims management framework to address evolving treatment methods.

The framework’s foundation is in Liberty Mutual’s deep industry knowledge and engagement with experts and institutions. For example, when the CDC was drafting national guidelines to help doctors prescribe opioids appropriately, Liberty Mutual’s regional medical directors provided feedback during the comment period.

“There were two things in the initial draft that were concerning to us. One was the lack of emphasis on functionality. If opioids are not helping patients achieve functional improvement in their day -to-day lives, the risk of continuing or increasing dosages might outweigh the benefits,” said Dr. Craig Ross, Regional Medical Director, Liberty Mutual. “We were also concerned about the combination of opioids with benzodiazepines, which significantly increases the risk of overdose.”

“Both of these issues were addressed in the final guidelines, and we were able to quickly incorporate these guidelines into our claims framework to help mitigate opioid misuse and abuse,” stated Dr. Ross.

A Data-Driven Approach to Flagging Risk

Liberty Mutual also focuses on early intervention and communication. Identifying high-risk claims early on is key to protecting employees from opioid dependence. The company’s analytics team uses a data-driven approach to flag these cases. Often, the psychosocial factors of a claim provide good indicators of whether an injured worker is at increased risk for drug dependence.

In addition, the company’s pharmacy benefit management partner helps provide a complete view of an employee’s opioid use by monitoring overall dosage. Liberty Mutual can also track physician prescription patterns and identify those who may be prescribing too early or frequently.

Conversations from the Start

“If an injured worker is prescribed an opioid, the claims handler receives a system alert to review the prescription,” McCarthy said. “The next step is to reach out to the treating physician and to connect with one of our nurses or regional medical directors for a strategy consult.”

“We train our claims handlers to ask questions,” Dr. Ross said. “If the prescription doesn’t adhere to the CDC guidelines, why not? Is it improving functionality? If not, can we explore some alternative treatment options?”

Relaying that information and guidance to an injured worker is delicate and nuanced. Every patient’s case, personality, and disposition is different. It’s important to make complex medical information simple. Because Liberty Mutual equips its claims handlers with strong client relations skills, they are able to explain to patients why their prescriptions may not be appropriate for them.

Applying the Claims Framework to Medical Marijuana

The Liberty Mutual claims management framework – evidence-based treatment, proactively identifying high-risk cases, engaging providers and patients early and often– can be applied to any emerging risk, including medical marijuana.

While not yet common in workers’ comp cases, medical marijuana is likely to gain popularity as more states pass laws that legalize use.

“There is little evidence that medical marijuana is an effective treatment for workplace injuries,” Dr. Ross said.

Liberty Mutual’s claims team carefully monitors the legal and regulatory environment in each state. “As part of our approach, if an injured worker asks to be reimbursed, we hold a roundtable discussion with the claims team, legal team, and a regional medical director to determine if it’s the most appropriate path,” Dr. Ross said.

The top concern for employers is that medical marijuana will impede a worker’s ability to do his or her job, potentially resulting in injury to themselves or to coworkers, or property damage.

“We work with employers on a case-by-case basis to determine the exposure and work within the confines of their workplace safety programs and policies,” McCarthy said.

While the use of medical marijuana is still in its infancy in workers’ comp, Liberty Mutual’s problem-solving framework helps businesses tackle changes as they come, always pursuing the best outcomes for injured workers.

To learn more, visit libertymutualgroup.com/workerscomp.

1 https://www.cdc.gov/drugoverdose/data/overdose.html
2 http://helioscomp.com/insights/influence/opioids

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.

 

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Liberty Mutual Insurance offers a wide range of insurance products and services, including general liability, property, commercial automobile, excess casualty and workers compensation.

More from Risk & Insurance

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2018 Risk All Stars

Masters of Risk

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]