Orlando, FL  5/8/2017 3:30:40 PM— Fasten your seat belts and hold on tight to your seat. We are about to touch on a topic that is both sensitive and unpleasant.

The opioid crisis is not just a hot topic in mainstream media, the issue is real, and closer to you than you realize.

The insurance industry is beginning to understand its need to take an active part in finding a solution, taking proactive steps to monitor opioid prescriptions that may help injured workers.

Here’s a case you might relate to. 

Walt Disney Parks and Resorts U.S., right here in Lake Buena Vista, Florida.

During a Risk & Insurance Management Society Inc. conference in Philadelphia last month—  Barry Dillard, director of claims management of Walt Disney Parks and Resorts U.S., told attendees the key is to be proactive at the onset of an injury. He mentioned “compassion” and “triage” as important first steps.

Concerned of the well-being of its over 70,000+ employees, the company operates on-site clinics for injured workers and implemented a self-administered and self-insured workers compensation program. 

Disney’s management considered this a step in ensuring their company had a grasp on the worker’s care at the onset, said Mr. Dillard of the company’s self-administered and self-insured workers compensation program during his speech at the Philadelphia conference.

PROACTIVITY IS KEY

Disney decided to put in place a pharmacy program’s clinical oversight, which includes a pharmacy task force to look at trends and outliers among injured workers.

The company also has clinical roundtables and raises “red flag alerts” if a worker’s prescriptions are out of line with standard care. The first issue they detected by using this program was precisely the potential opioid crisis.

Thanks to the effectiveness of this preventive program they were able to identify those cases of injured workers who had been prescribed with opioids for pain management and established patterns.  Remarkably, today, opioids aren’t a problem with Disney.

 

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While this may not seem an issue you relate with, here’s a case recently viewed in the Tennessee Supreme Court. The widow of an injured worker who died of an overdose from opioids can’t receive workers compensation death benefits because his death was caused by conduct unrelated to his work accident.

A Tennessee chancery court determined that the victim’s death was compensable in a claim filed by his wife, saying she had met her burden of proof to show that his death was a direct and natural consequence of work injury. 

An appeal by his employer, which claimed his conduct created an intervening cause of death, was referred to a Special Workers’ Compensation Appeals Panel and later transferred to the high court for review.

A five-judge panel of the Tennessee Supreme Court reversed the decision of the chancery court, relying on a Tennessee case law that says a worker’s conduct can limit compensability of subsequent injuries that are a direct and natural result of a compensable primary injury.

They concluded that the employee failed to take his pain medicine in accordance with his physician’s instructions, which ultimately caused his demise, the ruling said. “His death was no longer causally related to his work-related injury, and his overdose was an independent intervening cause.”

This case is explicit in terms of what difference it makes to be proactive vs. facing the court ruling which involves a substantial amount of time, resources and money. However, we understand not all businesses are the size of a Disney enterprise, thus making the right choice of insurance can make all the difference.

It is important to learn the specifics of your current insurance policy to make sure your interests are well protected.  You can schedule an appointment with one of our business insurance experts at Garzor Insurance, who understand the needs of Florida insurers and will present you the right options customized to your business.