Oftentimes, workers’ compensation cases involve treatment with opioids. In some scenarios, the use of opioid medication continues well after cases are settled. The continued provision of opioid medication is always very costly and can extend the life of a claim indefinitely.
For employers, the question is always when will paying for opioid medication come to an end, particularly in scenarios where the claimant is no longer in active treatment. This question was affirmatively answered by the appellate division in Martin v Newark Public Schools, A-0338-18T4 (App. Div. October 4, 2019).
Employers can cut off opioid treatment when there is objective medical proof that the treatment is no longer improving the claimant’s symptoms, because this means there is also no improvement in the claimant’s ability to function.
In Martin, the claimant, who was involved in a 2011 work accident and received a settlement award for the injury in November 2014, continued to receive Percocet through 2017. When the treating physician recommended surgery because the opioids were not improving the claimant’s symptoms, and would never improve his symptoms, the claimant refused surgery. Subsequently, the employer stopped paying for the claimant’s Percocet and a motion for medical treatment and temporary disability benefits was filed.
The trial judge ruled in favor of the employer, finding more credible the testimony of the treating physician who treated the claimant for six years than that of the one-time evaluator who testified in support of the claimant’s motion. The appellate division upheld the trial court’s decision, finding that the trial court rooted its decision in sufficient, credible evidence that further opioid medication would not cure or relieve the claimant’s symptoms.
This decision is a strong one for employers. It sets out the standard that must be met for continued opioid use and establishes that employers can challenge and successfully litigate cases involving long-term opioid use. Moreover, this decision can be extended beyond opioid medication and be equally applicable to any pain medication or pain management treatment.
Therefore, in cases where the treating physician has opined that continued medication or pain management treatment will not improve symptoms, employers should immediately move to stop paying for the treatment. The Martin decision is proof that courts will side with employers if the decision to cut off pain medications or pain management treatment is supported by requisite medical evidence.
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