Opioid Costs and The Aftermath

Carriers, Third Party Administrators and employers are all facing the same dilemma. How to address the opioid crisis as waiting for government oversight is not the answer to the workers’ compensation systems opioid problem today. A few days ago I met with a claimants daughter, her mother has been in the system for over twenty years. Twenty Years folks!  The daughter shared that her mother has gone through multiple surgeries over the years and by taking so long obtaining treatment authorizations, her mother is now addicted to opioids prescribed and created by the treating comp physicians. Now the carrier continues to pursue for the total reduction in opioids which is great in one aspect but just a little too late. Deciding to reduce opioids totally out of her treatment and leaving the claimant now without any protocol for even a detox program is truly unacceptable to say the least.

Carriers, TPA’s or employers and everyone involved in the claims process all have a responsibility here to the claimants within this system. Whether it be fiduciary, legal or just plain moral obligation as a society in general, we owe a duty to these claimants. When seeking a reduction in opioid use, we all must strive to at least give a claimant some sort of aftercare treatment plan for detox to say the least. We can all do better when working in sync together resulting in effective claim management, administrative cost reductions, and most of all providing the services originally promised by helping the claimant to return to work as fast and healthy as possible.

There is a great financial benefit for the carrier, employer and third party administrator in stepping up to do what is right. We all are aware from various studies already performed that claims with opioid use carry a 19% higher cost for the life of the claim. There is so much data creating awareness, yet no implementation for solving the problem overall. Too much data is sometimes not a good thing, as discussed in a previous post by a study performed by Lockton examining 273k claims over a five year span from 150 various companies which were initially denied only to be overturned a year later carried a 55% higher cost per claim. Now, if a carrier’s physician’s requests a diagnostic study to be performed with the onset of the injury involved early on, instead of not providing the authorization promptly, we should as carriers, TPA’s and employers allow this small initial cost incurred today as it far outweighs the future total costs over the life of the claim.

To my belief, there’s not going to be government protocol of intervention in place anytime soon if at all, we all must help to do our part no matter how big or small with our roles involved to stop this systemic problem that is plaguing the industry.Remember, we are not trading commodity’s here, each claim is an individual and unique to its own merits. It’s time to wake up people, who says doing what’s right has to come at a higher cost, the answer may just be the simplest solution right in front of you the whole time.


Written By:

Paul Gold

Founder & CEO

PG Resolutions Group