Addiction to Prescribed Medicine (South Dakota) (California)

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Addiction to Prescribed Medicine (South Dakota) (California)

Postby Bethv on Wed Nov 01, 2017 11:07 am

In 2007 we had an employee who was disgruntled and quit. He write a letter and left. Shortly after that he claimed he hurt himself on the job (knee). I was not here at the time but it seems we did file a claim with our Insurance carrier for WC and that was that.
I started working here January 2016 and saw this case still active. Long story short, it seems the employee claims he hurt his knee while working and saw the Dr who treated him with Pain Medicine, now recall this is back in 2007.
Long story short, the Dr recommended surgery (Laparoscopic or similar) and the employee did not want to do it so the Dr kept him on pain meds until I came around and started asking about this case. It seems once I started asking why he was still on pain meds the answer was the obvious one, he became addicted and now cant stop taking them. This is apparently our problem due to the injury we don't have any confirmation of any injury by management etc.
According to Insurance our company or Insurance company is liable to keep him on the plan because it is the fault of the injury he became addicted.
I have gotten some activity but not enough to satisfy my questions.
FIRST: When does the employee have to take responsibility for their actions and decisions. He choose not to do surgery.
SECOND: When does the DR take responsibility and say NO MORE PAIN PILLS BECAUSE YOU ARE GOING TO BE ADDICTED
THIRD: I final got the insurance to talk to the DR and now he is weaned off pain meds but needs at least a year of very expensive medicine to beat his addiction. WE WILL HAVE TO PAY THAT NOW TOO??

So basically, the ex-employee choose to remain on the pain meds and not take the option to repair his knee. The DR Let him get hooked on these over 10 years.
Isn't there some law that releases our corporation due to the choices made by the ex- employee and the DR.

Please help.
I know we are not Paying this, Insurance is but it will and has hurt our renewals. The ex-employee may also be abusing the drug since he was telling the DR his pain was not better. They gave him a patch of some kind (Im looking into that) and I told them it is hard to put a patch on wrong since there is no specific place it has to go, just on for 24 hours.
He may very well be abusing this drug now and I would like to have him drug tested weekly if possible but not sure if it is ethical to ask. I do not want to make assumptions but I have my suspicions and 10 years is a long time.
Reserve is now up to a total payout of all $573,000.00. A month ago it was $245,000. That was for 10 years so in one year they need $300,000.00. Something is very wrong with this picture

They increased the Medical by almost $300,000.00 for the next year but I know the medicine and Dr visits are not that much.

Help Please
Everyone protects the employee but who is protecting the company.

Any advice or facts are appreciated.
Bethv
 
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Joined: Wed Nov 01, 2017 10:49 am

Re: Addiction to Prescribed Medicine (South Dakota) (California)

Postby LawAdvocate on Wed Nov 01, 2017 12:51 pm

So in order to answer your question - are you in South Dakota or California - Your post comes up as both - the laws are different in each state, so don't want to waste time answering for both. The injured worker is never on a "plan" the injured worker is covered under the workers' compensation policy and is entitled to those rights or benefits for life, absent caps for a benefit . However in general:

FIRST: When does the employee have to take responsibility for their actions and decisions. He choose not to do surgery.
Never, it is called bodily autonomy/integrity a basic civic right and Federal law, so the answer is the same in SD or CA. He never has to have surgery if he does not want to do so, he can choose medication or other types of pain management. Bodily Autonomy is why you "consent" to any medical procedures meaning you get to decide what is best for you given the risks and advantages. You don't have the right to drug test anyone not in your employ, that is ridiculous. There is no reason to drug test him, he is an addict and now will go through rehab, which includes slips, he will never be the same- what are you going to do if he tests positive? Put him in Work Comp jail? He gets medical care for the rest of his life in either SD or CA for as long as he can prove it is related to the initial injury.

SECOND: When does the DR take responsibility and say NO MORE PAIN PILLS BECAUSE YOU ARE GOING TO BE ADDICTED
Never, until the Feds knock down his doors and say you are over prescribing narcotics.
If the carrier sues the physician for medical malpractice, called subrogation it may be able to recover under SD law, this area of law is undecided in SD. There are no payments to the carrier from the injured worker's medical malpractice suit in CA. No responsible physician says no more pain pills, if you are on certain medications, especially opiates - you need to be weaned off or your brain and central nervous system can fry resulting in strokes, heart attacks and death.

THIRD: I final got the insurance to talk to the DR and now he is weaned off pain meds but needs at least a year of very expensive medicine to beat his addiction. WE WILL HAVE TO PAY THAT NOW TOO??
You aren't paying for it, your carrier is. I bet that all of the premium that was already paid toward that worker has already been spent given the case has been open for nine years. It is no longer your money. But yes the carrier has to pay for any required drug rehabilitation, the basic theory in law is they pay for everything related to the injury, including bad medical treatment - drug rehab, surgery do overs, etc.

The total cost of a claim is not charged against you in either state. You getting an "experience modification rating" or an ex- mod, where the amount paid in claims through a certain time period is calculated - this claim fell off of your ex-mod in both states a long time ago. It should not be hurting your renewals any more. Your broker should be explaining this to you. If he is not explaining it, there are companies in both states that conduct an Audit to assure your ex-mod and premium are correct. Further why has there never been a push to settle the case? Now is the wrong time with a drug rehab plan because it is expensive, but it may be possible to settle the claim.

Everyone does not protect the employee - case-in-point, your carrier did not assure the minimum standards of medical care and I can name dozens of other instances where employees are not protected.

You have to protect your company by working closely with the broker and if you are allowed to choose the attorney with the carrier,than working with the attorney.
LawAdvocate
 
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