As any employer knows there are several legal, reporting remedies for ostensible or factually verified, injured employees who make financial demands. Workers compensation is the most well-known remedy, but in an era of
… employees working at various locations, especially home
… the inability of an employer to physically see and watch employees
the situation turns more complex for verification of an illness or injury that is work-related.
The examination, search and discovery of factual data has become a new science. OSHA, while handicapped by budget restraints, also plays a major role in determination of an employee’s damages and employer’s faults. And, as we have previously discussed, cannabis businesses have a unique set of issues because of its availability, utilization and potential mind altering effects.(see our sixth issue on this).
So what is an employer to do for verification and potential long term payouts?
The word “holistic” has been bantered about but might apply on this issue. The first thing an employer must do is be compassionate until the claim of injury is substantiated or not. This means taking the proper route and showing concern for the ostensible injureds’ illness claims.
Employers should also innovate the investigative process by using telemedicine and pharma maintenance: watching what meds are prescribed, staying in close contact with your carrier to be certain that they are aware of your efforts, helping employees find an appropriate patient-care worker comp provider, and monitoring those costs and claim payments when made. Most states have regulations that must be met, which makes a false claim a crime.
There is also a way to “score” your medical provider’s practice using clinical treatment data, physician utilization data, practice patterns, information from managed care metrics like utilization review, case management adherence, electronic payments and reviews of your providers’ current and past denials/appeals. While this seems complicated and excessive, a worker comp carrier should understand and perform these tasks with some gratitude (we’ll have more on this in our next issue.)
Lastly of note, a recent case in Massachusetts barred a workers compensation claim for medicinal cannabis costs: an important topic for the industry. The plaintiff paid $24,268 for medicinal cannabis, but the top state court ruled that it is not covered by insurance. Central Mutual Insurance, the carrier, believed that because cannabis is federally illegal no payment was provided for despite the state legalizing it’s use.
So, please, please ask and be mindful of what your injured employee is buying and using for their illness and whether your carrier will reimburse. There is substantial clinical evidence that non-THC cannabis helps with pain. The problem is that it is still very expensive.
That’s it for now: more next issue on the subject as COVID-19 rages; more people are ill and cannot or will not work for all sorts of reasons including mental ones. Be safe and well.
P.S. We have also learned that reinsurers, which are mostly European, have denied paying for cannabis-use claims — which is too bad. Except for The Netherlands, Europe is way behind in legalization.