A leading regional energy company won a significant decision from the Maryland Workers’ Compensation Commission involving a claimant with a complicated medical history suffering from the severe overprescription of opioid medications. As Maryland has no specific guidelines, statutes, or regulations governing opioid prescription limits for workers’ compensation claims, implementation of the Goldberg Segalla’s pioneering Opioid Impact Program (OIP), designed and overseen by partner Debra L. Doby, proved to be crucial in the case. Partner Joseph C. Tarpine III and associate Meredith L. Pendergrass of the firm’s Workers’ Compensation Practice Group in Baltimore successfully advocated for a weaning plan in line with the latest Centers for Disease Control (CDC) Guidelines. The decision will save the insurer significant costs associated with unnecessary medications — and it may serve as an important precedent as the state of Maryland’s policymakers and administrators come to grips with the nation’s ongoing opioid crisis.
The claim in this case had an extensive history, including three spine surgeries. The claimant’s treating physician continued to prescribe the claimant 120 morphine milligram equivalents (MME) per day since his most recent cervical fusion in January 2017. A Functional Capacity Evaluation indicated the claimant’s dependence on opioids would be a barrier to returning to employment. At the same time, the claimant, who was over 50 years old, indicated he was in too much pain to attempt to return to any job, participate in work hardening, or participate in vocational rehabilitation — and the claimant had not worked since the injury in December 2013. By the time of Goldberg Segalla’s involvement, Medicare Set-Aside (MSA) for the claim had ballooned to nearly $150,000.
Joe and Meredith initiated attempts to have the claimant ordered into a weaning program, as both the claimant and his treating position were unwaveringly opposed to any voluntary weaning. The claimant visited four doctors in the months leading up to the final hearing in an attempt to avoid weaning by resuming “active treatment.” At the hearing, Joe and Meredith argued for in-patient weaning to under 50 MME per day, based on the CDC Guidelines, the claimant’s lack of subjective and objective benefit from the opioids, and the likelihood that he was suffering from opioid-induced hyperalgesia.
After the final hearing, the Maryland Workers’ Compensation Commission issued its decision denying further active treatment and ordering weaning and ongoing palliative care as needed in conjunction with Joe and Meredith’s recommended weaning plan — a ruling that significantly reduced the claim’s MSA. The decision also demonstrates the effect that Goldberg Segalla’s OIP continues to have on the front lines of the opioid epidemic.