A North Carolina YMCA and its insurer prevailed in a crucial request to change the treating pain management provider of an employee receiving ongoing temporary total disability benefits since an injury in 2000.
North Carolina is especially vulnerable to the nation’s epidemic of opiate overprescription as the state has not historically had any guidelines or statutes controlling the prescription of opioids in workers’ compensation claims. While the North Carolina Industrial Commission enacted new rules governing the utilization of opioids on May 1, 2018, the guidelines do not apply to legacy claims where the employee has been receiving prescription drugs for several years. Those are the types of claims that can cost insurers and self-insurers millions.
While at GS, Partner Leann A. Gerlach of the firm’s Greensboro office utilized medical motion procedure to expedite a full evidentiary hearing. With help from Debra L. Doby — architect of the Workers’ Compensation team’s Opioid Impact Program (OIP) — Leann deposed the claimant’s treating physician, a pain management specialist and a serial overprescriber of opiates, citing guidelines from the Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA). Evidently outmatched, the physician testified that the guidelines were controversial, and were “not necessarily” developed by pain experts — even though they have been extensively reviewed and commented on by dozens of stakeholders and pain medicine specialists and adopted by the North Carolina Medical Board.
Leann successfully called in to question the pain management specialist’s prescribing practices. She demonstrated that, despite taking increasingly larger doses of several prescription drugs for many years, the claimant’s objective levels of function had decreased dramatically, while his subjective levels of pain remained consistently high. In light of this evidence, the Industrial Commission agreed that the pain management provider’s treatment was not medically necessary and allowed the carrier to change the treating physician. This case highlights how proactive legal intervention can cut down the costs and risks associated with prescription opioids, even in states that do not have guidelines addressing chronic usage in legacy claims.