Board Bulletins and Subject Numbers

October 31, 2016

Opioid addiction is a major public health crisis in the state that deeply affects many of New York’s injured workers. The New York Non-Acute Pain Medical Treatment Guidelines (NAP MTG) adopted by the Chair in 2014 present a comprehensive approach to the management of chronic pain, and include best practice recommendations for the appropriate use of narcotics.

As the NAP MTG makes clear, long-term opioid use is only recommended in limited circumstances, and must involve constant clinical monitoring and re-evaluation. The NAP MTG also includes best practices for safely weaning injured workers from opioids and other narcotics.

A workers’ compensation hearing can now be scheduled to determine whether continuing opioid usage is necessary or whether weaning from opioids is recommended.

Hearing Process

Request for Further Action by Carrier/Employer (Form RFA-2): An insurer may request a hearing specifically to consider whether the claimant should be weaned from opioids. Form RFA-2 has been changed to include a new hearing purpose under the Medical Issues section of the form. To request a hearing to consider opioid weaning, check the box on Form RFA-2 labeled “Opioid Weaning under Non-Acute Pain Guidelines.”

IMPORTANT: An Independent Medical Examination (IME) or Records Review, which indicates weaning goals and recommended weaning program or resource, is required and must be submitted with Form RFA-2.

Form RFA-2 is available on the Board’s website. To print a paper form, see: Request for Further Action by Carrier/Employer (Form RFA-2). To submit this form online, see Web Submission of Claim Forms.

Claimant’s Medical Report: In response to the insurer’s Form RFA-2, the claimant will have the opportunity to submit a medical report from his or her prescribing physician. The report must contain the provider's review of the use of opioid medications, a list of the claimant’s current medications and a review of whether the opioid medication is in compliance with the Non-Acute Pain Medical Treatment Guidelines. The provider may comment on weaning resources identified in the IME and/or provide alternative resources. The medical report is due by the date of the hearing, which will be held approximately 45 days after the Board notifies the claimant of the insurer’s request for a hearing. Depositions: The Independent Medical Examiner may be deposed by the claimant and/or the claimant’s representative; such transcripts must be submitted to the Board prior to the hearing on opioid weaning. If contrary medical evidence is submitted, the insurer may request cross-examination of the claimant’s provider at the hearing.

Hearing Process: After all the evidence is submitted and the parties are heard, the Workers’ Compensation Law Judge (WCLJ) will issue a ruling finding either:

• Insufficient proof that there is a need for continuing long-term opioid use and the claimant must be weaned from the narcotic medication(s); or
• Insufficient proof that there is a need for continuing long-term opioid use and the claimant must be weaned from the narcotic medication(s), and enrolled in an addiction treatment program; or
• Claimant demonstrated the opioid use was effective in terms of improved function and reduction of pain, and that weaning will be unnecessary at this time.

When the WCLJ rules that the claimant must be weaned from the opioid medication, the insurer will be required to cover the cost of the claimant’s addiction treatment program or weaning protocol, as directed. If the claimant is to be weaned without addiction services, the insurer will remain liable for the claimant’s medications for the duration of the weaning process. If an addiction treatment program has been directed, then after 30 days, the insurer will only be liable for payment of narcotic prescriptions written by an addiction treatment program physician.

Contact Information

If you have any questions concerning opioid weaning issues, or where to find resources related to weaning from opioids, please see the Board’s brochure: Is My Pain Medication Making Me Worse? If you have any questions about a workers’ compensation hearing pertaining to opioid weaning, please contact the Board at (877) 632-4996.