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High court finds worker’s narcotic pain medication no longer compensable

pain medication

The Delaware Supreme Court on Thursday upheld a determination that an injured worker’s prescribed narcotic pain medications were no longer compensable. 

Zelda Sheppard was working for Allen Family Foods in 2011 when she slipped and fell. She received total disability benefits and was prescribed opiate and non-opiate medications, according to Sheppard v. Allen Family Foods

In August 2012, Ms. Sheppard filed a petition for additional benefits, alleging that she had suffered a permanent impairment. The Industrial Accident Board determined she was entitled to permanent benefits for a 10% impairment to the cervical spine and a 7% impairment to the right upper extremity. 

In 2016, Allen requested utilization review of the treatment/service for medications prescribed to Ms. Sheppard. After two unsuccessful attempts at contacting her doctor, the utilization reviewer determined that certain opioid medications prescribed were not compliant with the state’s medical guidelines 

The IAB affirmed the decision of the utilization reviewer. 

In December 2019, Allen filed a petition to terminate the compensability of Ms. Sheppard's narcotic medications and injection treatment. 

The petition was supported by a doctor’s opinion recommending complete detoxification from any abusable medications, including opiates, benzodiazepines, muscle relaxers and marijuana. He recommended reducing Ms. Sheppard's medications over the course of three months and continuing treatment with “non-opioid medication management and occasional rounds of physical therapy.” 

The IAB found the doctor’s opinion persuasive and agreed with his conclusion that Ms. Sheppard should be weaned off the narcotics. 

Ms. Sheppard appealed to the Superior Court, which affirmed the IAB’s decision stating that substantial evidence supported the decision. 

In affirming, the state’s highest court found that Allen had a good faith basis for its challenge to Ms. Sheppard’s ongoing treatment, given the opinion of a doctor, the AIB’s finding as to Ms. Sheppard’s lack of credibility, and the evidence that she had lied to her doctors about her use of marijuana. 

WorkCompCentral is a sister publication of Business Insurance. More stories here.