MO: Commission Cuts Percocet From Future Medical Award

The Commission may limit the scope of some future medical awards not only to what body parts are compensable but what specific drugs are reasonable.  A recent Commission case prohibits certain narcotics to manage pain from an automobile accident.  Claimant failed to show entitlement to percocet, Meyer v Pyramid Construction, DOLIR 6-24-10. The parties stipulated to future medical for admitted injuries.  Like Ward v Ameren Services, DOLIR 11-17-09, which proscribed use of oxycontin, claimant failed to show the specific drug was necessary or reasonable. 

 Comment:  These decisions absolve the employer’s liability for past medical bills when a specific drug is found not necessary or reasonable.  An employee may create disputes regarding future medical bills when a claimant attempts to substitute one specific proscribed narcotic for another.

Some claimant’s symptoms never get better from treatment, for various reasons.  The challenge remains how to best manage intractable pain. The long-term use of narcotics is a huge cost in Missouri worker’s compensation.  When an administrative law judge awards such medications, the financial impact can fester for the life of the claim.  Even a Medicare set aside with future narcotic use can put many seasoned adjustors into shock. An ideal defense to such claims of future narcotic use may establish that claimant engages in drug-seeking behavior or engages in fraud by misrepresenting his or her level of function.   From a medical standpoint, an expert can comment whether off-label use of certain narcotics is appropriate or not, or whether claimant’s objective pathology reasonably correlates with reported pain levels. An expert can also examine reasons or attempts to wean claimant from long-term narcotic use, as in Meyer v Pyramid Construction, or explain why long-term use of a drug or class of drugs is not reasonable.  In Ward v Ameren Services, an expert testified that long-term use of oxycontin would “ruin” the claimant.     Any case involving future prescription care should address whether narcotic or non-narcotic use is appropriate.  Hempel v Lincoln County Electric, DOLIR 2-4-10 limited a future medical award to only “non-narcotic” drugs when a neurologist recommended against use of narcotics. 

Source: Martin Klug, Huck, Howe & Tobin. Read Martin Klug’s Mo. Workers’ Comp Alerts