Column: Workers' Comp

Drug and Death Connection

By: | May 1, 2014 • 3 min read
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.

California’s Supreme Court is set to hear a case highlighting the dangers of prescribing multiple drugs to an injured worker, as similar claim narratives are repeated across the nation.


In South Coast Framing vs. Workers’ Compensation Appeals Board, the court will determine whether a commercial insurer should be financially responsible for the death of a worker who died from an accidental overdose a year after being injured on the job.

After Brandon Clark fell from a roof in 2008, and suffered head, neck, back and chest injuries, his workers’ comp doctor prescribed gabapentin, amitriptyline and hydrocodone, while his personal physician prescribed Xanax for anxiety and Ambien for sleeping difficulties.

A year later, he died from consuming a deadly combination of these legally prescribed drugs, several of which are commonly given to injured workers nationwide. Clark’s wife and three minor children are seeking death benefits, alleging his death followed from his fall and the “industrially prescribed medications.”

Now, California’s Supreme Court will decide whether a workers’ comp death benefit claim has a “causation standard and burden of proof requiring that an industrial injury constitutes a ‘material factor’ contributing to the employee’s death,” according to the court’s case summary.

South Coast Framing and its insurer, Redwood Fire and Casualty Co., a unit of Berkshire Hathaway Inc., argued during appeals court proceedings that Clark’s wife and children did not prove a causal connection existed between his death and the medication he took as a result of his work injury.

Thus far, the court proceedings reveal the medical and legal complexities of a case involving a worker’s comp claimant’s overdose death when multiple pharmaceuticals are involved and toxicology science has limited ability to parcel the role of each drug in a death.

Judges hearing the case have considered whether Clark’s consumption of each drug was related to his workplace injury and the probability that each of the drugs contributed to his death.

They also heard that he suffered from difficulty sleeping even before the accident, and had taken over-the-counter medication for the problem, according to his wife’s testimony.  A doctor testified, however, that Clark’s sleeping difficulties after his accident could have been caused by back pain or “stress at home.”

But when pharmaceuticals can potentially do as much harm as good and the supply of drug treatments isn’t slowing, workers’ comp payers have an important role to play, including continuing to drive down the long-term reduction in worker injuries.


Along with medical providers, lawmakers, claimants and others, payers can help mitigate potential pharmaceutical dangers by:

• Encouraging treating physicians to consult treatment guidelines.

• Offering cognitive therapies as alternatives to pain medications.

• Paying for pharmaceutical benefit managers to track prescriptions.

• Supporting legislation to address the prescribing and dispensing of drugs.

These measures add to payer expense and they won’t cure all the risks that accompany drug prescribing. But they can mitigate the potential of being held accountable for lost worker lives, drug addiction, and other dangers.

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]