The Ohio Bureau of Workers Compensation recently decided to drop the manager of their drug formulary, Optum Rx , who in the words of a court administrator were “hosing” the State of Ohio.
“Told you so,” said me and many other critics of drug formularies.
Drug formularies are touted as a way to reduce opioid abuse and limit drug costs. But formularies are run by pharmacy benefit managers (PBMs) who have been widely criticized for pushing up drug costs. In 2017 The City of Omaha opposed a drug formulary bill in the Nebraska Legislature over similar fears of being hosed by PBMs.
The news out of Ohio came at about the same time as a viral (for the world of workers’ compensation) blog post penned by Judge and Professor David Torrey. Judge Torrey politely bench-slapped an “industry representative” who stated that injured workers needed to “get off their asses” during a panel discussion at a workers’ compensation conference about alternatives to opioids for pain managment.
I understand and share concerns about prescription drug abuse by injured workers. I’ve also encountered clients with serious bowel issues from opioid-induced constipation. Addiction seems to get more attention than digestive issues when it comes to opioids and workers compensation. I believe part of that stems from the fact that calling some an “addict” is away to dog whistle that an injured worker is a malingerer. Turning injured workers into “addicts” is a way of putting some medically-termed lipstick on a moral and ideological pig created by the insurance industry.
Perhaps true to the Trump age, the panelist in Pennsylvania dropped the conern trolling about addcition and voiced the id buried in the dark heart of the workers compensation medico-legal-industrial complex. Telling injured workers that they just need to get back to work is great for cutting expenses for workers compensation insurers. Drug formularies are good way to increase revenue for the insurance-side middleman in the workers’ compensation system. Drug formularies pre-date the opioid crisis, but they were adapted to “solve” the opioid crisis.
In response to the opioid crisis, the insurance industry has medicalized its age old criticisms of injured workers and the drug companies and PBMs have jacked up drug prices. Meanwhile injured employees aren’t getting any real help in how to deal with chronic pain. Doctors have long known that opioid dependence is a serious issue and that there are no easy solutions to chronic pain. Opioid prescriptions have been declining since 2012. If insurers and self-insureds were serious about chronic pain, they would approve alternative pain control methods and give doctors discretion to prescribe medication as needed.
The problem with that solution for insurers and self-insureds is that solution would cost them money. It’s easier to lecture injured workers’ about resilience, churn some money off of drug formularies and shift the cost of pain management back onto injured employees.
Getting hurt at work and getting fired are two of the most stressful occurrences for an employee. Oftentimes, these stressors are combined when an injured worker receives a severance agreement. This article provides five questions an injured worker who gets a severance agreement should ask:
Does signing a severance agreement settle your workers’ compensation claim? Connecticut courts recently ruled that a severance agreement does not release a workers compensation claim. However, Florida courts have held the opposite. My state of Nebraska generally does not allow workers’ comp claims to be released in severance agreements. Consult with a lawyer in your state to get a good answer. Most lawyers who do workers’ compensation work on a contingent fee basis are generally happy to spend a reasonable amount of time answering questions from injured workers faced with a severance agreement. Don’t let fear of cost deter you from contacting a lawyer.
What does your state’s workers’ compensation act cover? Some workers’ compensation statutes, like Ohio and Texas, also cover retaliatory discharge cases. My state of Nebraska makes wrongful discharge a separate civil claim. The consequence of that for injured workers in Nebraska and other states with so-called “common law” retaliatory discharge causes of action: a severance agreement would close out that case along with most other claims under fair employment statutes like the ADA, FMLA and Title VII. If you are in a state where retaliatory discharge is covered under your workers’ comp statute, then that case may not be released in a severance agreement in a comp claim if your state doesn’t allow comp claims to be settled in severance agreements.
What are your chances for receiving unemployment benefits? Finding out your chances of receiving unemployment is critical – again, especially if you are forced to choose between severance and workers’ compensation. The key questions to ask for eligibility for unemployment are 1) whether you earned enough wages to be covered 2) whether you quit without good cause or were fired for misconduct and 3) whether you are able and available for work. Of course, if you have an ongoing workers’ compensation claim, the fourth question is how receiving unemployment would affect your workers’ compensation claim. If you chose to negotiate your severance agreement, either by yourself or with a lawyer, try to include a provision where the employer chooses not to oppose your application for unemployment benefits.
Do you get benefits like vacation pay, even if you don’t sign a severance agreement? In some states, including my state of Nebraska, an employee should receive vacation pay or paid time off regardless of whether they sign a severance agreement or not. Again, if you live in a state where an employer can release a workers’ compensation claim through a severance agreement, your eligibility for vacation pay along with unemployment benefits should help you decide whether it make sense for you economically to pursue your workers’ compensation claim if you have to pick between severance and workers’ compensation. This also holds true for severance agreements in general if you an employer is asking to you to release a strong fair-employment claim for a low-ball severance amount.
Did you contact a lawyer who is knowledgeable about workers’ compensation? This is a critical period and critical especially if you live in a state where comp claims can be released by severance agreements. An experienced workers’ comp lawyer can value your comp claim. Some ways to evaluate whether a workers’ compensation lawyer is knowledge is to check whether they are a member of the Workers’ Injury Law & Advocacy Group (WILG). Another is to see if you can search them on your state’s workers’ compensation court website or through free legal research services like FindLaw and Google Scholar. A knowledgeable workers’ compensation lawyer in your state should also be able questions 1-4.