As most claimants in New York State are now aware, a conscious and concerted effort has been made over the last two years to tackle the perceived problems of long term opiate and narcotic use. As part of this policy, the Workers’ Compensation Board has issued Guidelines on the use of long term medications or “Non-Acute Pain Management”. While these are only classified as “guidelines” the NYS Workers Comp Board has strictly applied these rules to limit or curb the abuse that Albany feels applies to workers’ compensation claimants with chronic pain.
If you have been taking opiate pain killers for two to three years, we can almost guarantee that you will have to address this with your physician at some point in the future.
The Board has modified the RFA-2 form used by insurance companies to request a hearing to specifically include the request for a weaning program. However, this request must be accompanied by an IME (Medical doctor’s report) which provides for weaning goals or a weaning program. In response to the RFA-2, the injured worker will have the opportunity to submit a medical report from his or her prescribing physician. The report must contain the provider’s review of the use of opioid medications, a list of the claimant’s current medications and a review of whether the opioid medication is in compliance with the Non-Acute Pain Medical Treatment Guidelines. The provider may comment on weaning resources identified in the IME and/or provide alternative resources. The Board will issue a notice to the treating medical provider giving them opportunity to submit additional information if they desire.
Most importantly, the medical report is due by the date of the hearing, which will be held approximately 45 days after the Workers’ Compensation Board notifies the claimant of the insurer’s request for a hearing.
Hearing Process: After all the evidence is submitted and the parties are heard, the Workers’ Compensation Law Judge (WCLJ) will issue a ruling finding either:
- Insufficient proof that there is a need for continuing long-term opioid use and the claimant must be weaned from the narcotic medication(s); or
- Insufficient proof that there is a need for continuing long-term opioid use and the claimant must be weaned from the narcotic medication(s), and enrolled in an addiction treatment program; or
- Claimant demonstrated the opioid use was effective in terms of improved function and reduction of pain, and that weaning will be unnecessary at this time.
Thus, it is vital that the process of reviewing medications begin immediately after an IME report dealing with medications is received, so that we can work together with your physicians to ensure that you receive the proper pain management that you require.