American Association of State Compensation insurance Fund
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CopperPoint Mutual Insurance Company
Phone: (602) 631-2000
Address: 3030 North Third Street
Phoenix, AZ   85012
Website: www.copperpoint.com

State Compensation Insurance Fund
Phone: 888-STATEFUNDCA
Address: 333 Bush Street
Suite 800
San Francisco, CA   94104
Website: www.statefundca.com

Pinnacol Assurance
Phone: (303) 361-4000
Address: 7501 East Lowry Boulevard
Suite 800
Denver, CO   80230-7006
Website: www.pinnacol.com

Hawaii Employers' Mutual Insurance Co. Inc.
Phone: (808) 524-3642
Address: 1100 Alakea Street
Suite 1400
Honolulu, HI   96813
Website: www.hemic.com

Idaho State Insurance Fund
Phone: (208) 332-2100
Address: 1215 West State Street
P.O. Box 83720
Boise, ID   83720-0044
Website: www.idahosif.org

Kentucky Employers Mutual Insurance
Phone: (859) 425-7800
Address: 250 West Main Street Suite 900
P.O. Box 83720
Lexington, KY   40507-1724
Website: www.kemi.com

Louisiana Workers' Compensation Corporation
Phone: (225) 924-7788
Address: 2237 South Acadian Thruway
P.O. Box 83720
Baton Rouge, LA   70808
Website: www.lwcc.com

Maine Employers Mutual Insurance Company (MEMIC)
Phone: (207) 791-3300
Address: 261 Commercial Street
P.O. Box 11409
Portland, ME   04104
Website: www.memic.com

Chesapeake Employers’ Insurance Company
Phone: (410) 494-2000
Address: 8722 Loch Raven Boulevard
P.O. Box 11409
Towson, MD   21286-2235
Website: www.ceiwc.com

SFM Mutual Insurance Company
Phone: (952) 838-4200
Address: 3500 American Boulevard West Suite 700
P.O. Box 11409
Bloomington, MN   55431-4434
Website: www.sfmic.com

Missouri Employers Mutual Insurance
Phone: (800) 442-0590
Address: 101 N Keene St
P.O. Box 11409
Columbia, MO   65201
Website: www.mem-ins.com

Montana State Fund
Phone: (406) 495-5015
Address: 855 Front Street
P.O. Box 4759
Helena, MT   59604-4759
Website: www.montanastatefund.com

New Mexico Mutual Group
Phone: (505) 345-7260
Address: 3900 Singer Boulevard NE
P.O. Box 4759
Albuquerque, NM   87109
Website: www.newmexicomutual.com

New York State Insurance Fund
Phone: (212) 312-7001
Address: 199 Church Street
P.O. Box 4759
New York, NY   10007
Website: www.nysif.com

Workforce Safety and Insurance
Phone: (701) 328-3800
Address: 1600 East Century Avenue Suite 1
P.O. Box 4759
Bismarck, ND   58506-5585
Website: www.WorkforceSafety.com

Ohio Bureau of Workers Compensation
Phone: (800) 644-6292
Address: 30 West Spring Street
P.O. Box 4759
Columbus, OH   43215-2256
Website: www.bwc.ohio.gov

CompSource Mutual Insurance Company
Phone: (405) 232-7663
Address: 1901 North Walnut Ave.
P.O. Box 53505
Oklahoma City, OK   73152-3505
Website: www.compsourcemutual.com

State Accident Insurance Fund (SAIF)
Phone: (503) 373-8000
Address: 400 High Street SE
P.O. Box 53505
Salem, OR   97312-1000
Website: www.saif.com

Pennsylvania State Workers Insurance Fund
Phone: (570) 963-4635
Address: 100 Lackawanna Avenue
P.O. Box 5100
Scranton, PA   18505-5100
Website: www.dli.state.pa.us/swif

Beacon Mutual Insurance Company
Phone: (401) 825-2667
Address: One Beacon Centre
P.O. Box 5100
Warwick, RI   02886-1378
Website: www.beaconmutual.com

South Carolina State Accident Fund
Phone: (803) 896-5800
Address: P.O. Box 102100
P.O. Box 5100
Columbia, SC   29221-5000
Website: www.saf.sc.gov

Texas Mutual Insurance Company
Phone: (800) 859-5995
Address: 6210 East Highway 290
P.O. Box 5100
Austin, TX   78723-1098
Website: www.texasmutual.com

Workers Compensation Fund
Phone: (800) 446-2667
Address: 100 West Towne Ridge Parkway
P.O. Box 2227
Sandy, UT   84070
Website: www.wcfgroup.com

Washington Department of Labor and Industries
Phone: (360) 902-5800
Address: P.O. Box 44001
P.O. Box 2227
Olympia, WA   98504-4001
Website: www.lni.wa.gov

Wyoming Division of Workers Safety & Compensation
Phone: (307) 777-7159
Address: Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, WY   82002
Website: wydoe.state.wy.us

Workers Compensation Board - Alberta
Phone: (780) 498-3999
Address: 9925-107 Street
P.O. Box 2415
Edmonton, AB   T5J 2S5
Website: www.wcb.ab.ca

Workers Compensation Board of British Columbia (WORKSAFEBC)
Phone: (604) 273-2266
Address: P.O. Box 5350 Station Terminal
P.O. Box 2415
Vancouver, BC   V6B 5L5
Website: www.worksafebc.com

Manitoba Workers Compensation Board
Phone: (204) 954-4321
Address: 333 Broadway
P.O. Box 2415
Winnipeg, MB   R3C 4W3
Website: www.wcb.mb.ca

WorkSafeNB
Phone: (506) 632-2200
Address: 1 Portland Street
P.O. Box 160
Saint John, NB   E2L 3X9
Website: www.worksafenb.ca

Workers Compensation Board of Nova Scotia
Phone: (902) 491-8999
Address: 5668 South Street
P.O. Box 1150
Halifax, NS   B3J 2Y2
Website: www.wcb.ns.ca

Prince Edward Island Workers Compensation Board
Phone: (902) 368-5680
Address: 14 Weymouth Street
P.O. Box 1150
Charlottetown, PE   C1A 7L7
Website: www.wcb.pe.ca

Saskatchewan Workers Compensation Board
Phone: (306) 787-4370
Address: 200 - 1881 Scarth Street
P.O. Box 1150
Regina, SK   S4P 4L1
Website: www.wcbsask.com

Puerto Rico State Insurance Fund Corporation
Phone: (787) 793-5959
Address: G.P.O. Box 365028
P.O. Box 1150
San Juan, PR   00936-5028
Website: www.cfse.gov.pr
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AASCIF Newsletter

Arizona’s Legislative Efforts to Fight Rising Narcotics Usage In Workers’ Compensation Claims

Jim Stabler, Vice President & Chief Counsel, SCF Arizona
Law Committee

As workers’ compensation insurance professionals, we are acutely aware and constantly reminded of the problems posed by increasing narcotics usage by injured workers.  The disturbing trend of some physicians to willingly prescribe increasing dosages of multiple narcotics and other controlled substances to manage chronic pain has resulted in increasing incidence of addicted patients and deaths from overdoses.  According to the Centers for Disease Control and Prevention, more than 27,600 deaths from unintentional drug poisoning occurred in the United States in 2007. Opioid pain medications (such as oxycodone and methadone) were involved in more than half of these deaths. In 2007, opioid (prescription) overdose drug deaths were involved in more overdose deaths than heroin and cocaine combined. [1]

Addiction, diversion and overdose problems due to inappropriate narcotic drug prescriptions are present in workers’ compensation systems across the United States.  According to the National Council of Compensation Insurance, narcotics account for nearly one quarter of all workers’ compensation prescription costs.  Further, heavy narcotics use for workers’ compensation injuries has resulted in the necessity for increased substance-abuse treatment in workers’ compensation claims. [2]

What we typically see in workers’ compensation cases with high narcotics use:

  • No improvement in function and pain
  • Opioid therapy produces significant adverse effects
  • Patient exhibits drug-seeking behaviors or diversion such as “losing” medications, concurrent use of illicit drugs, getting opioids from multiple prescribers, recurring ER visits for pain complaints, selling prescription drugs.

In Arizona, SCF Arizona has been a leader in the fight to contain these alarming trends through legislation.  In 2010, SCF Arizona and the business community promoted and won passage of a law that brought greater scrutiny and imposed heightened accountability on physicians that prescribed controlled substances in an “off-label” manner.[3] The inappropriate prescription of the powerful narcotic Fentanyl, in its various forms, was the main driver for this legislation.  Approved by the FDA for use by cancer patients with intractable pain, the drug was freely prescribed by many physicians for back pain and other musculoskeletal pain complaints.  One year after passage of this law, SCF Arizona was successful in dramatically decreasing the incidence of prescription of such drugs.

However, as is often seen in the area of medical cost containment efforts, physicians that were determined to continue their practice of freely prescribing narcotics to willing patients simply changed their tactics.  Instead of prescribing the Fentanyl drugs in an off-label manner, some physicians switched their patients to other drugs approved by the FDA for treatment of chronic pain.  The most commonly prescribed drug in this category is, of course, the notorious Oxycodone (Oxycontin).  Again, as is all too commonly seen in workers’ compensation claims, the prescription of such drugs inevitably lead to increased dosages, often far exceeding the contemplated dosage as set forth in the package insert information provided by the pharmaceutical manufacturer and approved by the FDA.

As a result, if soon became apparent that the statute (ARS §23-1062.01) enacted in 2010 required amendment to impose the same scrutiny on physicians prescribing multiple narcotics in ever increasing dosages.  Again, SCF Arizona and the Arizona business community united in promoting and winning passage of an amendment to the law in 2011.  The new law imposed the following additional requirements on physicians:

  • Expanded the duty of the prescribing physician to justify the continued use of narcotics when any combination of narcotic drugs prescribed reached or exceeded a daily 120 morphine equivalent dosage threshold or where long acting (time release) narcotics were prescribed for acute rather than chronic pain.
  • Required the prescribing physician to submit an inquiry to the Arizona Controlled Substances Prescription Monitoring Program (CSPMP) to determine whether the worker was obtaining narcotics from multiple providers.

In addition, the new law allows the employer or carrier to move for a change of treating physician if the physician fails to comply with the statutory requirements and allows ongoing evaluation of the appropriateness of the narcotic usage notwithstanding any prior award of drug benefits.

Despite these legislative successes against inappropriate prescription of narcotics, the struggle is far from over.  Now, some claimants’ attorneys are inexplicably mounting legal challenges against the practice of independent medical examiners routinely checking the CSPMP database to learn whether the claimant is obtaining narcotics from multiple medical providers.  These attorneys claim that the CSPMP statutes only allow treating physicians to access the database and that by doing so, the IME physicians are breaching the patient’s confidentiality and even committing a felony by disclosing the findings to the carrier.  Although these legal arguments lack merit and border on the frivolous, it has caused some physicians to avoid the controversy and simply refuse to perform IMEs in cases in which the use of narcotics is an issue, no doubt one of the goals of the claimant’s attorneys.

In response to these deplorable tactics, we will be returning to the legislature in 2012 to amend the applicable statutes to make clear that an independent medical examiner may submit queries to the controlled substances prescription monitoring database and report those findings to all interested parties to the claim.  Given the strong public policy arguments in favor of controlling excessive, illicit and dangerous usage of narcotics in workers’ compensation claims, it is anticipated that this proposal will be quickly enacted into law.


 

[1] Centers for Disease Control and Prevention Issue Brief:  Unintentional Drug Poisoning in the United States, July 2010.  http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/brief.htm.

[2] NCCI Research Brief, Lipton, Laws & Li, “Narcotics in Workers’ Compensation” Dec. 2009

[3] ARS §23-1062.02

 

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