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Does Workers’ Comp Cover Opioid Addiction Recovery?

As awareness has grown about the opioid addiction epidemic in the United States, many patients are seeking alternatives to opioids to treat their pain. But opioids are still considered by many physicians to be a worthwhile and effective method, and they continue to prescribe them. Like other types of medication, opioid pain medications can be covered by workers’ compensation benefits for someone who was injured on the job. When an employee receiving opioids as part of a workers’ compensation program becomes addicted to the drug, the employee can face a difficult road to recovery. Patients who develop dependencies can end up resorting to illegal methods to obtain pills, or slide into using other forms of opioids, like heroin. Many addicts end up struggling to hold on to their jobs and find their addictions interfering with their personal lives as well. When an employee receiving workers’ compensation benefits becomes addicted to the treatment medication, questions can arise as to whether the benefits should also cover services to help the patient recover from the addiction. The same question could be asked about injuries resulting from the addiction, including death or other complications from an overdose. This is a relatively new area of workers’ compensation law. Employers and insurers will undoubtedly try to distance themselves from providing coverage for complications which they will argue are beyond the scope of the employee’s workplace injury. But in some circumstances the employee may have a good argument that benefits should apply. A 2011 case in Pennsylvania looked at this issue in the context of a patient’s death by overdose. In that case, the patient’s prescription refills for an opioid patch to treat pain related to back injury had been denied further coverage by the insurer, but the patient’s sister, a physician, had provided a prescription anyway. Shortly after filling the prescription he received from his sister, the patient died of an overdose. In the case, the court held that the employer was responsible for paying the patient’s death benefits, despite the insurer’s decision to deny continued coverage for the medication J.D. Landscaping v. Workers’ Compensation Appeal Board (Heffernan), No. 1866 C.D. 2010 (Penn. 2011). Of course, Pennsylvania cases are not precedent in Nevada. But the Heffernan case shows that employees can in some circumstances may be able to establish a claim for benefits related to opioid addiction. One may assume that an employer’s responsibility may cease if the patient has violated the law—for example, by obtaining drugs through fraud or on the black market. But if an injury and its treatment also causes addiction, and the patient’s physician works with the patient to develop an addiction recovery program, it is worth pursuing coverage for that program even in the face of an initial denial of coverage. For over 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area pursue workers’ compensation claims. We strive to help every client achieve a complete recovery from their injuries. To schedule a free, confidential attorney consultation about your case call us today at 702-388-4476 or send us a request through our site.