Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.
Doctor choice. And choice of treatment. The Wisconsin way.
Unlike systems in other states, an injured worker in Wisconsin has access to their own doctor and what that doctor recommends for medical care. Wisconsin does not have specific directed care or a panel of worker’s compensation doctors. The choice of medical care and experienced practitioners produces some of the fastest return to work rates in the country, along with low costs per claim.
The only “limit” is the “two doctor rule,” where a Wisconsin injured worker has the right to see their own doctor or to get a second opinion from another doctor. While any doctor beyond the “two doctor” limit would be excluded from coverage (unless mutually agreed to by the work comp carrier), a worker has the right to see any doctor that is part of the referral chain from the two doctors–making doctor choice virtually unlimited if the worker obtains an appropriate referral!
The recommended medical care should be covered by the work comp carrier is reasonable and necessary to cure from the effects of an injury. Unless the insurance company has a contrary medical opinion (through an adverse, or “independent” medical evaluator), they generally are responsible for the medical treatment recommended, whether that is therapy, office visits, prescriptions, injections, surgery, etc.
Other states place limits on the type of treatment a worker can receive. A recent article revealed that Ohio legislators are limiting when injured workers can have certain prescription medications or surgery (Ohio Imposes Strict Rule on Workers’ Back Surgery, Opioids). Ohio is required a worker undergo 60 days of “alternative care”, potentially without opiate use, before having a work-related back surgery.
To date, Wisconsin’s legislature preferred the medical expertise of its physicians and their treatment recommendations. Relying on experienced, quality medical practitioners allows workers swift access to the necessary medical care and recommendations–and puts them back in the workplace fast!
Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.
Workers who report an on-the-job injury may not be subject to mandatory drug testing if a new rule from the Occupational Safety and Health Administration that prohibits blanket post-injury drug tests withstands a court challenge from employers.
In May, OSHA published a rule prohibiting employers from having policies that force employees hurt on the job to take drug tests because of concerns about retaliation. This blog has long recognized the potential for retaliation that mandatory drug tests pose and supports the proposed rule by OSHA. OSHA’s new rule was drafted at roughly the same time as the release of the U.S. Department of Labor report that was critical of the shortcomings in state workers’ compensation systems.
Though OSHA implemented the limits on drug testing to limit retaliation, the rules limiting drug testing also help preserve employee doctor choice, which is an integral part of workers’ compensation law in Nebraska and other states. Many employers will inform employees that they must get drug tested at an occupational medicine clinic if they have a work injury even if workers have a right to see their own doctor. This can lead to employees being forced back to work too soon and or not receiving sufficient treatment for their work injuries. Both the fear of retaliation and the circumvention of doctor choice rules lead the costs of work injuries to be borne by employees, which is a major concern of the Department of Labor.
Due to push back from employers, the rule’s enforcement will be postponed until Nov. 1 and will likely be delayed longer due to a court challenge to the rule. A challenge to a Labor Department rule deeming that home health aides were employees for the purposes of the Fair Labor Standards Act took over a year to work its way through the federal courts, until it was upheld by a federal circuit court in June.
Even if the rule is implemented, post-injury drug testing will not disappear from the workplace. Employers can still test if they have a reasonable suspicion of intoxication or drug use. Most federal and defense contractors will be exempt from the OSHA rule, as well as truckers and railroad employees. Furthermore, in states with drug-free workplace laws, mandatory post-injury testing may still be permitted, depending on the language of the statute. Nebraska allows employers to fire an employee who refuses a lawful request for a drug test. If the new OSHA rule is ultimately upheld by the federal courts, I would expect a push by employers to amend drug-free workplace laws.
Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.
Chicago Mayor Rahm Emmanuel said in 2008 that “You never let a serious crisis go to waste.” In the context of opioids and workers compensation this could mean reforms to workers compensation systems beyond drug formularies If solving the opioid crisis means limiting the number of doctors who can prescribe opioids, then there will be fewer doctors who will treat workers compensation cases.
Additional licensure and certifications aren’t unheard of in the world of occupational health. In 2016, the Federal Motor Carrier Safety Administration implemented a new rule that only doctors on their registry can perform DOT Physical Examinations for truckers and other professional drivers. This reduced the number of doctors who can perform those examinations.
When I testified on LB 408, a bill that would have implemented drug formularies for opioids under the Nebraska Workers’ Compensation Act, some doctors were testifying that there was little training in regards to prescribing opioids. Though an opioid prescription registry like the DOT examination registry wasn’t proposed, you could certainly see it proposed as a solution to the opioid problem.
By limiting the numbers of doctor who handle workers’ compensation claims through additional licensing requirements, injured employees will have fewer choices for medical treatment and are more likely to have their employer control their care.
Evidence shows that the workers compensation system has made some contribution to the opioid crisis. According to a 2015 report by the Bureau of Labor Statistics over 3.5 million employees were injured at work. Half of those injuries required the employee to miss sometime from work. A study of employees in 25 states done by the Workers Compensation Research Institute revealed that 55 to 85 percent of employees who missed at least one week of work were prescribed at least one opioid prescription.
When I testified on LB 408 the consensus among the doctors testifying on the legislation was that injured workers were more vulnerable to narcotic addiction than other patients who are prescribed narcotic pain medication. Scientific studies give some credence to these conclusions. Workers compensation claims can cause economic insecurity. According to an article in Scientific America, Addiction rates for opioids are 3.4 times higher for those with incomes under $20,000 per year than they are for employees making more than 50,000 per year.
But that article also shared studies that state that pain pill prescriptions are not driving the opioid epidemic. Patients with pre-existing addiction issues are more likely to become addicted to opioids and 75 percent of those who develop opioids start taking opioids in a non-prescribed manner. Furthermore, only 12 to 13 percent of ER patients who are treated for opioid overdoses are chronic pain patients.
Workers’ Compensation is traditionally an area of the law that is controlled by the states. Regulation of drugs is generally an area reserved for the federal government. Any laws imposing additional hurdles or requirements upon doctors who prescribe opioid drugs may have to come from the federal government.
Today’s post comes from guest author Roger Moore from Rehm, Bennett & Moore.
It used to be that the most to fear from an examination scheduled by an insurance company would be an unfair or incomplete assessment of the work injury. Now it seems insurance companies are using doctors to essentially cross-examine injured workers and delve deeply into irrelevant issues in an attempt to embarrass, harass and probe where they do not belong.
- Do you have painful, frequent, or difficulty urinating?
- Do you have painful breasts, periods or intercourse?
- Have you suffered physical, sexual or emotional abuse?
- Do you have erectile difficulty?
- Do you get along with supervisors and other employees?
- Do physical or mental problems run in your family?
- Is anyone in your family disabled?
- Did you smoke, drink or use illegal drugs in the past?
These are some of the more disturbing questions asked by a doctor of a patient in a pre-exam questionnaire sent directly from the doctor’s office to the injured worker. You might surmise that this was a case of some sort of reproductive injury associated with mental duress of some type by looking at the questions. In fact, this worker only alleged carpal tunnel syndrome! Most assuredly, embarrassing facts about this worker would just happen to show up in the defense doctor’s final report for the Court’s review at trial.
Any time anyone other than your lawyer sends you something to complete, you should be very careful about filling it out. It’s probably unethical for doctors to send these reports to injured workers who are represented, but we’re seeing more and more of these go out. They are becoming more and more intrusive; in fact, this questionnaire was 11 pages long. It’s my practice not to have clients complete any of these pre-exam questionnaires from doctors.