What Do You Think: Was Employer Justified in Reviewing Worker's Opioid Treatment?

Dover, DE (WorkersCompensation.com) – A big question that comes up with pain treatment, particularly treatment involving opioids, is how long a worker needs to be treated.

That’s what Delaware’s top court had to decide in a recent case involving a worker’s narcotics treatment and her fibbing about marijuana.

A worker slipped and fell on her employer’s cafeteria floor. As a result, she experienced injuries to her neck, low back, left arm, and left leg. Following the accident, the worker sought medical treatment with various providers for continuing problems and received total disability benefits.

The worker was prescribed both opiate and non-opiate medications following the accident, but she reported that she still needed medication for “breakthrough pain.” Because of this, the worker filed a petition to determine additional compensation due.

The employer sought a utilization review to challenge the treatment and medications the worker’s doctor prescribed. The review determined that certain opioid medications prescribed to the worker were not compliant with state guidelines and the Industrial Accident Board affirmed that opinion.

In turn, the employer sought to terminate the compensability of the worker’s narcotic medications and injection treatment. The worker’s medications included a buprenorphine patch, oxycodone, and cyclobenzaprine. Additionally, the “vast majority” of the worker’s urine drug screen tests were positive for marijuana over an 8-year-period, despite the worker’s denials about marijuana use.

The employer’s doctor concluded that there was disproportionate description of pain, and he recommended a “complete detoxification from any abusable medications,” including marijuana.

The IAB found that the worker was not credible because she initially denied using marijuana before changing her argument to say she had a medical marijuana card. Additionally, the IAB determined that the use of narcotics had not led to an improvement in the worker’s condition.

The worker appealed to court, which agreed with the IAB that the worker’s medical services were not necessary and reasonable. The worker appealed to the Delaware Supreme Court, contending that the employer had no legitimate basis to contest causation.

Delaware law allows an employer to seek review of a claimant’s treatment to evaluate the quality, reasonableness, and necessity of health care services for acknowledged compensable claims.

Was the employer able to challenge the worker’s need for narcotic medication?

A. Yes. The employer was able to seek review of the worker’s need for ongoing treatment.

B. No. The employer continued to pay for the worker’s treatment, meaning that it acknowledged her injury remained compensable.

If you chose A, you agreed with the court in Sheppard v. Allen Family Foods, No. 346, 2021 (Del. 06/23/22), which explained that permanent impairment awards do not serve as a permanent bar to challenges on future treatment.

The court also explained that the employer had a good faith basis for the causation challenge, pointing out that the worker “lied about her illegal use of marijuana” and that she began receiving here treatment from a nurse practitioner and not a medical doctor.

As a result, the court concluded that the IAB was not “legally erroneous” in ruling in the employer’s favor.

This feature does not provide legal advice.

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