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

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.

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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.

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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]