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In California, the Medical Treatment Utilization Schedule adopted by the DWC is presumed to be correct. It is the starting point for the UR and IMR decision making process. An applicant would have to overcome that presumption with high quality scientific evidence. The Chronic Pain chapter of the MTUS does not approve medical marijuana. Under the heading “Cannabinoids” the MTUS states “Not recommended. In total, 11 states have approved the use of medical marijuana for the treatment of chronic pain, but there are no quality controlled clinical data with cannabinoids.” Nonetheless, it is just a matter of time before the issue of “medical marijuana” becomes a problem for the comp industry.

According to an article in Business Insurance America, the issue of medical marijuana in the workers’ comp arena is approaching a crucial “tipping point,” and producers who haven’t taken action on behalf of their clients could be in for some nasty surprises. That’s the message from PRIUM Senior Vice President Mark Pew, a 30-year workers’ comp vet and opinion leader on the medical marijuana front. It’s also the message of an upcoming roundtable discussion at the 2014 CLM Annual Conference in Florida. Hosted by PRIUM’s Scott Yasko, the discussion will center on the clinical risks and benefits of medical marijuana, as well as potential legal liabilities and state-mandated payment. It’s all part of rampant industry-wide concern on medical marijuana and its future in workers’ compensation, Pew told Insurance Business. “It’s definitely a concern – especially given these stories that tug at the heartstrings about seizures that can only be controlled by marijuana,” Pew said. “The question is, should there be constraints around it, or should it just be locally legalized?”

Pew said that while no carrier has admitted to making payouts for medical marijuana treatment, “water cooler talk” suggests many workers are already using insurance dollars to pay for the substance. And that could be a problem if agents don’t discuss the issues with employers up front – especially given the dissonance between state and federal law. “Brokers may need to proactively bring up medical marijuana – whether the employer will accept it as a treatment option, how it will be controlled, and how the PBM will enforce formularies,” Pew said. “At the moment it’s not a strategic discussion, but it needs to be.” If producers don’t take this first step of establishing consistent standards when it comes to medical marijuana, the employer could be left open to both federal lawsuits and workplace liabilities in which an employee using marijuana paid for by the employer injures themselves or another worker. Pew believes the industry as a whole is on a “tipping point,” with at least 51% of workers’ comp professionals in favor of allowing medical marijuana as a treatment option. As such, employers and their insurance agents need to make strategic decisions ahead of time to protect both their workers and themselves. “Medical marijuana is a societal inevitability, and workers’ comp professionals need to figure out how they’ll deal with it,” he said. “In many cases, the train has left the station and you’ll either be riding the train or driving the train, or you’re going to get run over by the train.”

The roundtable discussion will be held April 10 at the Boca Raton Resort and Club in Boa, Raton, Fla.