Column: Workers' Comp

An Unnecessary Death

By: | August 3, 2015

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

Brandon Clark’s demise and his family’s victory in a legal battle for death benefits makes one wonder whether remedies among the expanding list of workers’ compensation claims services might have saved his life.

It’s an important question because the carpenter left behind a grieving family, including children. It also offers a chance to weigh the potential value those services might provide disabled workers, their devastated families and claims payers.

In the case of South Coast Framing v. Workers’ Compensation Appeals Board, the California Supreme Court laid out the lessons to be gleaned from the case, finding in favor of providing death benefits.

The court addressed issues expected to arise across more states, mirroring the industry’s concerns that too many injured workers have been prescribed an abundance of harmful drugs, including opioids.

Clark was 36 when he fell from a height of 10 feet in 2008, suffering a concussion and neck and back injuries that caused progressive pain until he died 10 months later of an overdose of prescription medications.

His family presented arguments about causation and the degree to which drugs prescribed by workers’ comp doctors and his personal doctor played a role in Clark’s death.

The court said the family met a standard that only required proving industrial causation is reasonably probable. There was evidence that Ambien, prescribed for pain-induced sleep problems, was causally related to his work injury while drugs prescribed by a workers’ comp doctor for depression and pain played at least some role in the death.

When you hear about the magnitude of a family’s loss, it makes one think that the value of all those workers’ comp services must be considered in more than just financial terms.

California claims payers now face a lower causation standard than they perhaps expected when multiple factors contribute to a worker’s death, including prescription combinations.

Since Clark’s 2008 injury, workers’ comp has seen an expanding list of services increasingly applied to address a rise in challenging disabilities, prescription misuse and increased medical expenses. I’m thinking of the growth in pharmacy benefit reviews, nurse case management and predictive analytics, to name just a few.

It’s always prudent to question the value of those services and whether inefficient application or overuse might drive unnecessary expenses.

But Clark’s death, among numerous other cases, also raises the question of whether a pharmacy benefit manager’s review of his prescriptions might have raised a warning. Or whether a nurse case manager’s discussions with Clark might have provided life-saving pain-treatment alternatives.

The court records don’t show whether Clark received such services, and my attempt to reach his family through their attorney failed. But considering several factors, including the accident year and his employment as a carpenter, I suspect there is a possibility he didn’t.

The attorney did tell me, though, that Clark’s family was his life’s focus and that they struggled to understand his demise.

When you hear about the magnitude of a family’s loss, it makes one think that the value of all those workers’ comp services must be considered in more than just financial terms. It’s not just a question of whether they reduce claims costs, eliminate litigation or improve worker productivity.

There are also families needing someone to deliver the right care that will spare them the painful financial and emotional devastation that comes with prolonged disabilities and the loss of a loved one.

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