Author: WorkCompAcademy

The WCIRB has released its Study of Chronic Opioid Use and Weaning in California Workers’ Compensation. This Study uses data from the WCIRB databases of medical transaction records and unit statistical reports to help understand the cost implications of chronic opioid use and the process of weaning injured workers off of opioids in California workers’ compensation.

Until 2012, opioid use in California workers’ compensation, as in many other systems, was growing. Since 2012, claims with opioid prescriptions in the California workers’ compensation system have dropped sharply but opioid prescriptions still reflect a significant portion of all pharmaceutical costs.

About 22% of the claims with accidents in 2013 and 2014 with at least one paid medical service had an opioid prescription, with those claims accounting for about 60% of the total medical payments of all 2013 and 2014 claims within two years of the date of injury.

The recent decline in opioid use is attributable to both fewer newer claims for which opioids were prescribed and a reduction in opioid use on claims in which there was “chronic” opioid use. There is limited information available on workers’ compensation claimants who “weaned” off of opioids.

Approximately 60% of the chronic opioid claims involved permanent disability compared to 11% of all claims. Conversely, only 3% of the chronic opioid claims were medical only claims compared to 65% of all claims.

The median time from achieving chronic opioid status to wean off of opioids completely was 8 months. The median time from accident date to when the worker was weaned off completely was 19 months.

Claims involving chronic opioid use are considerably more expensive than the typical workers’ compensation claim. The average medical payments per claim for physician services over the 24-month period after the accident date for claims involving chronic opioid use was more than nine times the average of all claims.

During the first 6 months after weaning started, weaned claim opioid payments dropped 48% and total drug payments decreased by 42% compared to the payments during the 6 months before weaning. The percentage of payments per claim for non-opioid pain medications (i.e., NSAIDs) reduced significantly less than the decreases of both total drug payments and the opioid payments for the weaned claims during the 6 months after weaning began.

Injured workers who did not wean off of opioids were significantly more likely to have a major surgery than those who weaned off. However, injured workers who weaned off of opioids were more likely to have a major surgery within 30 days of the injury date.

Felony charges were filed against a retired LAPD officer in an alleged workers’ compensation fraud case. Former Officer Terry Johns, 56, was arrested Thursday morning by detectives with the Department’s internal affairs division, officials said. A criminal complaint accused Johns of eight counts, including workers compensations insurance fraud, insurance fraud, and attempted perjury under oath.

The arrest was made after an undercover surveillance investigation in which detectives were sent to see if the ex-officer was really injured, as he had claimed in official documents.

The Los Angeles Times reports that Johns was enrolled in a controversial program that pays veteran cops and firefighters their salary and pension simultaneously for up to five years. Johns joined the Deferred Retirement Option Plan, or DROP, in July 2014. The next month he filed a workers’ compensation claim for a bad back, public records show.

He then took a long injury leave, collecting nearly $250,000 in pension and salary for the time off, according to city payroll data. He retired in 2016.

At a news conference Thursday, Police Chief Charlie Beck said internal affairs investigators had observed Johns engaged in activity “inconsistent” with his claimed injuries but refused to offer further details.

The DROP program was approved by voters in 2001 with a promise that it would keep veteran officers on the job a few years longer with no additional cost to the city. A Times investigation published last month found more than 1,200 public safety officers had joined DROP and then gone out with injuries — typically bad backs, sore knees and other ailments of aging bodies — turning the program into an extended leave at nearly twice the pay. The program has paid out more than $1.6 billion in extra pension checks since its inception in 2002, The Times found.

Nearly half of participants who entered DROP from July 2008 to July 2017 subsequently took injury leaves. Their average absence was 10 months, but hundreds stayed out for more than a year.

Two married LAPD officers joined DROP, then went out with carpal tunnel syndrome and other cumulative injuries. They missed more than two years, and spent some of that time starting a family business and vacationing at their condo in Cabo, The Times found. They collected nearly $2 million in salary and pension while in the program.

A firefighter in DROP who filed a claim for a bad back and a sore knee worked part time as a longshoreman at L.A. Harbor while on injury leave from the department, according to one of the doctors who examined him in the course of his workers’ compensation case.

Mayor Eric Garcetti and key members of the City Council called for a thorough review of the program last month following The Times’ investigation. But Garcetti and the council ignored a report from the city administrative officer in 2016 warning the program was not, and never had been, “cost neutral” as promised to voters and was no longer necessary to retain veteran officers.

Johns, 56, spent 32 years on the LAPD, according to a department news release. He was arrested and booked into the Riverside County jail where he was being held on $160,000 bond, Beck said. Johns is the first DROP participant arrested on suspicion of workers’ compensation fraud, Beck said, adding that he isn’t aware of any other ongoing investigations of program participants.

Diane Minish sustained serious personal injuries after she fell off a forklift on premises owned by Hanuman Fellowship. Minish initially reported that her injuries occurred while she was working as a volunteer, doing construction work for the Fellowship. Both Minish and the Fellowship reported the injury to the Fellowship’s workers’ compensation carrier and Minish received more than $270,000 in workers’ compensation benefits.

Minish also filed a civil action seeking damages for personal injuries. Minish alleged that she volunteered to assist at the Center and that the defendants acted negligently in requesting her to stand on a raised forklift while it was moving. The Fellowship answered and asserted that workers’ compensation was Minish’s exclusive remedy.

Minish argued the exclusive remedy rule did not apply because the Fellowship failed to comply with the requirements of Labor Code section 3363.6 for extending employment status to its volunteers. She also argued that her injuries did not arise out of and in the course of her employment because she was visiting a friend and was not volunteering at the time of the accident.

The trial court granted the Fellowship summary judgment on its exclusive remedy defense, reasoning that Minish was judicially estopped from denying she was subject to the workers’ compensation remedy.

The court of appeal reversed the summary judgment in a prior appeal in Minish v. Hanuman Fellowship (2013) 214 Cal.App.4th 437, 443 (Minish I). The court held judicial estoppel did not apply because the Fellowship had not shown that the WCAB made any findings in favor of Minish. The court rejected the Fellowship’s arguments based on equitable estoppel, since the Fellowship had not pleaded equitable estoppel as a defense and there were triable issues concerning the elements of the defense.

On remand, the trial court construed Labor Code section 3363.6 and found the Fellowship had complied with its requirements. The court found that based on her prior representations that she was injured while doing volunteer construction work and her acceptance of workers’ compensation benefits, Minish was equitably estopped from asserting in the civil action that her injuries did not arise out of and in the course of her employment. In light of its findings, the trial court found it unnecessary to adjudicate the question of Minish’s volunteer status.

On this her second appeal, Minish challenges the court’s ruling on the equitable estoppel defense, arguing that the evidence was insufficient to satisfy three elements of the defense.

The court of appeal again reversed the trial court in the unpublished case of Minish v. Hanuman Fellowship.

Equitable estoppel provides that Minish may not deny the existence of a state of facts (her injuries arose out of and in the course of her employment) if she intentionally led the Fellowship to believe those facts to be true and to rely upon such belief to its detriment.

For estoppel to apply, the trial court was required to find that Minish was apprised of the facts (that she knew her injuries did not arise out of and in the course of her employment) and that the Fellowship was ignorant of the true state of those facts. Since the knowledge element is missing, there can be no estoppel.

A new study published in the Journal of the American Medical Association and summarized by Reuters Health, claims that acetaminophen, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are better than opioids at easing the intensity of chronic pain in the back, knees or hips.

And opioids are no better than these other drugs at reducing how much pain interferes with daily activities like walking, working, sleeping or enjoying life, researchers report in JAMA, online March 6.

“We already knew opioids were more dangerous than other treatment options, because they put people at risk for accidental death and addiction,” said lead study author Dr. Erin Krebs of the Minneapolis VA Health Care System and the University of Minnesota. “This study shows that extra risk doesn’t come with any extra benefit,” Krebs said by email.

NSAIDs carry their own risks, especially at high doses, including the potential for internal bleeding, kidney damage and heart attacks. But they aren’t addictive.

For the current study, researchers randomly assigned 240 patients seeking pain treatment at VA primary care clinics to receive either opioids or alternative medicines like acetaminophen or ibuprofen for one year.

Participants were 58 years old on average and most were men. Back pain was their most common complaint, affecting 156 patients, or 65 percent, and the rest had either hip or knee osteoarthritis pain.

People in the opioid group started therapy with fast-acting morphine, a combination of hydrocodone and acetaminophen, or immediate release oxycodone. If that wasn’t successful, patients next got long-acting morphine or oxycodone, and then doctors tried fentanyl patches.

In the non-opioid group, patients first got acetaminophen and NSAIDs. If those options didn’t help enough, doctors tried options like the nerve pain drug gabapentin (Neurontin) and topical painkillers like lidocaine, followed by the nerve pain drug pregabalin (Lyrica) and tramadol, an opiate painkiller.

Researchers asked participants to rate how much pain interfered with their lives at the start of the study, and again 12 months later. By this measure, both groups improved equally over the course of the year, based on a 10-point scale with higher scores indicating worse impairment.

With opioids, scores declined from an average of 5.4 at the start of the study to 3.4 a year later. With other drugs, scores dropped from 5.5 to 3.3.

Patients also rated pain intensity on a 10-point scale with higher scores indicating more severe symptoms, and non-opioid drugs worked slightly better on this measure.

In both groups, patients initially rated their pain intensity at 5.4, but scores dropped to just 4.0 with opioids and fell to 3.5 on the other drugs.

One limitation of the study is that people knew which medications they were prescribed, which might affect how patients reported their own pain severity and daily functioning, the authors note.

Even so, the results offer fresh evidence that opioids may not be worth the addiction risk when treating chronic pain, said Marissa Seamans, a researcher at Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn’t involved in the study. ‘There is increasing evidence that non-opioid pain relievers are just as (if not more) effective than opioids for chronic non-cancer pain,’ Seamans said by email.

Kyle Pike was employed by the County of San Diego as a Deputy Sheriff Detention.  On July 31, 2010 he injured his right shoulder and received a combination of Labor Code section 4850 salary continuation benefits and permanent disability benefits between October 27, 2010 and November 15, 2011 and April 30, 2015 through June 19, 2015.

Pike received a Stipulated Award of 12% permanent disability, and filed a timely Petition to Reopen on May 26, 2015 as he claimed an entitlement to Labor Code section 4850 benefits for the period September 15, 12 2015 through March 28, 2016, and temporary total disability benefits from March 29, 2016 through August 18,2016 which was beyond the five year time limit from the date of his injury.

The issue to be determined was whether applicant could receive additional benefits for periods of temporary disability that extended more than five years from his July 31, 2010 date of injury.

The WCJ concluded that when acting upon a timely petition to reopen, the Appeals Board may award temporary disability benefits more than five years from the date of injury, provided that applicant is limited to an aggregate of 104 weeks of benefits. A split panel decision denied reconsideration. However the court of appeal reversed in the published case of County of San Diego v WCAB, and Kyle Pike.

The court of appeal concluded that the plain language of the statute indicates that the T.D. benefit is limited to five years from the date of injury.

Section 4656, subdivision (c)(2) provides, “Aggregate disability payments for a single injury occurring on or after January 1, 2008,[ ] causing temporary disability shall not extend for more than 104 compensable weeks within a period of five years from the date of injury..” (Italics added.)

“The legislative history of section 4656, subdivision (c)(2) is entirely consistent with the statutory text in supporting the conclusion that the Legislature intended to limit temporary disability benefits to five years from the date of a worker’s injury for injuries occurring on or after January 1, 2008.”

“None of the arguments presented by Pike or the CAAA in support of Pike’s claim for benefits is persuasive.”

“Accordingly, we annul a Board order affirming a workers’ compensation administrative law judge’s order that awarded temporary disability benefits for periods of disability occurring more than five years after Pike’s injury.”