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Comp insurers turn to mediation to treat opioid-addicted claimants


Mediation programs in two states are bringing together opioid-addicted workers and workers compensation insurers to create plans to get these workers off drugs.

In February, the New Hampshire Department of Labor launched the Opioid Pilot Mediation Program, which will provide an opportunity for insurers and opioid-dependent workers whose cases have been settled in the workers comp system to come together before a volunteer mediator to devise a treatment plan to eliminate or reduce the worker’s use of opioids for pain management.

New Hampshire’s pilot was inspired by the Massachusetts’s Opioid Alternative Treatment Pathway, which launched in June 2016, said Edward Sisson, the New Hampshire department’s director of workers compensation.

The idea for the program came to Omar Hernández, senior judge with the Massachusetts Department of Industrial Accidents in Boston, when he heard about an employee waiting for a hearing in the workers comp system who passed away due to opioids.

Rather than waiting a year for addiction help, “I thought there had to be a different way we could speed up the process and address these needs quicker,” he said.

Once an insurer and worker commit to going through the process, they are assigned an administrative law judge from the Department of Industrial Accidents who will meet with them within 30 days to allow each side to discuss their goals and concerns and to jointly develop a procedure to follow to reach those goals, according to Judge Hernández. At this time, an agreement is also reached outlining each party’s obligation with regard to payments, time frames, participation, costs and fees. A care coordinator is then assigned to oversee the worker’s care, with the costs incurred by the insurer, and the worker begins the process of moving away from medication-based treatment following the pre-agreed upon program. If the process is unsuccessful, either party can withdraw from the program and go through a traditional dispute resolution process.

Since the program began, 52 individuals have entered the program and have either gone through or are in active treatment or in the mediation process, which Judge Hernández sees as a big success.

“We’re getting more and more traction, and attracting more and more people to participate,” he said.

Portland, Maine-based insurer Maine Employers’ Mutual Insurance Co. utilized the Massachusetts Opioid Alternative Treatment Pathway program to help one of its claimants taper off the opioid Suboxone. The employee had experienced homelessness and is now working and in recovery, said Gus Gonnella, MEMIC’s vice president of claims.

Niko Pappas, director of workers compensation claims for the Massachusetts Interlocal Insurance Association Inc., recently referred one claimant to the program after it became aware of the volume of opioids the woman was taking. Although the woman, who is in her late 30s, has been hesitant to get on board, her attorney is supportive of the program, Mr. Pappas said.

Mr. Pappas, who was involved in the creation of the Massachusetts pilot, said that while an insurer may hesitate to pay up front for these types of treatment programs, he noted that the reduction in long-term medical management for the claimant is a cost saver, and that reinsurers especially are excited by the prospect of “less risk or exposure that they’re on the hook for.”

As a medical case manager for workers comp case management company Windham Injury Management Group, Mike Pringle has had first-hand experience working with about eight opioid-addicted claimants as they went through the Massachusetts program.

Typically, it takes between 12 and 24 months for someone who has a long-term opioid abuse situation to successfully complete treatment, he said.

“It takes a lot of coaching, but for people who do it, they win in the end,” Mr. Pringle said.

In one recent case, Mr. Pringle said a young man who hadn’t worked since 2012 was successfully weaned off opioids and last month returned to work.

While there can be roadblocks for paying for treatment, such as utilization review time restrictions, he said claims adjusters have been receptive to the program, and he now gets calls from adjusters who want help weaning someone from opioids.

Another limitation is that workers are not eligible for the program until their workers compensation cases are settled, said Mr. Pappas.

In January, New Hampshire’s labor department began training about a dozen attorneys who volunteered to provide mediation services for the pilot program, and department officials have begun meeting with the workers compensation section of the New Hampshire Bar Association to get the word out and generate interest, said Mr. Sisson.

Although New Hampshire’s pilot is only in the beginning stage, Marian Mitchell, director of claims at The Lawson Group, a workers comp third-party administrator based in Concord, said the company will be looking for potential candidates to refer to the program.

Pete Sheffer, director of the New Hampshire Automobile Dealers Association Workers Compensation Trust, said he also can see the value in the state’s new program.

“Having the opportunity to have some end in sight through a rehab program is certainly beneficial to a carrier if it results in being able to stop paying for opioids, and, as we know, it’s beneficial for injured employees as well,” he said.

Although Massachusetts has not yet studied the impact of the program, Judge Hernández said these programs can be a win-win for so-called “legacy” cases where a claimant has been on opioids for years. And access to addiction treatment and recovery resources is one of the three key interventions outlined by the Massachusetts Department of Health for reducing opioid use. The department will be looking into the impact of the Opioid Alternative Treatment Pathway in the future, according to Letitia Davis, senior scientist for the health department.

“(The insurers) are spending a lot of money on these opioids and it doesn’t really treat the long-term chronic pain,” said Judge Hernández. “From a cost standpoint, obviously there’s a short-term cost initially, but in the long run, insurers are going to save money, and they’re saving lives as well.”





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