Implementing Medical Marijuana Into Workers Compensation

By Sherri Hickey, Assistant Vice President of Medical Management, Safety National

Sherri HickeyMedical marijuana has already been legalized in 29 states and D.C., with 12 states pending legislation. It is time for the workers’ compensation industry to embrace this new reality and learn how to incorporate the use of medicinal marijuana into claims handling where appropriate. It might surprise many to hear that there are actually advantages and improved outcomes related to its use.

Understanding Recreational Versus Medical Marijuana
There are many misconceptions regarding differences between recreational and medical marijuana. A cannabis plant is made up of over 80 cannabinoids. With recreational marijuana, the primary cannabinoid is tetrahydrocannabinol (THC). It is traditionally smoked and the THC is what provides the high or the impairment. Recreational marijuana is metabolized through the liver. Drug tests are designed to detect THC, which can stay in the system for weeks or months.

In the case of medical marijuana, the primary cannabinoid is cannabidiol (CBD). It is not smoked, but rather is delivered in forms like oil and liquid. In addition, medical marijuana contains 0% THC, so use provides no high or psychotropic effect. It is metabolized through the blood stream, therefore it will exit the body within 24 hours. Because of these elements, standard drug tests looking for THC will not detect its use.

Medical marijuana can be used for many symptoms, however, in the workers’ compensation arena it will primarily be used to manage pain, anxiety, muscle spasms, post-traumatic stress disorder and to control seizures. It can be vaporized, added to food or liquid, developed into a topical that is rubbed into skin or a transdermal that can be applied as a patch. Unlike recreational marijuana, medical marijuana can be delivered in managed doses. It is currently regulated individually by state and each state is actively managing quality and consistency in items produced.

It is important to mention that THC-based marijuana can have some medicinal capabilities and individuals could benefit from using both forms. However, for treatment of injured workers that are likely to re-enter the workforce, it is not recommended for use – especially when there are so many benefits associated with the THC-free version.

Where to Begin
Let’s face it, this country is in the midst of an opioid crisis due to opioid overprescribing in general.

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Uber and Alternative Workers’ Comp Insurance


With the growing popularity of the “gig economy”, especially companies like Uber, a Transportation Network Company (TNC), questions about protecting workers have come front and center.  Most drivers for Uber are considered independent contractors which exempts them from some needed protections including workers’ comp.  But recently TNCs and insurance companies have been exploring ways to provide better protections for TNC drivers.

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Workers’ Comp Rates to go Down in FL, According to NCCI

The Supreme Court of Louisiana Gives Choice of Pharmacy to Employers


In Burgess v. Sewerage, the Supreme Court of Louisiana handed down an opinion that UR Nation believes is a big win for system participants. In the case, Darvel Burgess sustained a work-related neck and back injury in 2008 while working for Sewerage & Water Board of New Orleans (S&WB) as a maintenance technician. In 2011, S&WB notified Burgess that it was now using Corvel Caremark Pharmacy and that all future medications would need to be obtained through the Corvel Caremark Pharmacy.On October 18, 2011, Burgess signed the letter of acknowledgement that he would adhere to the S&WB pharmacy policy. S&WB also sent a letter to IWP, Burgess’ choice of pharmacy. The letter said IWP was not an approved pharmacy that that payment for future prescriptions would be denied. Burgess continued to obtain prescription medication from IWP and on September 21, 2012 filed a disputed claim for compensation against S&WB and sought reimbursement and penalties against S&WB for pharmacy bills owed to IWP.

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Out Front Ideas webinar: Workers’ Compensation 2.0

Out Front Ideas webinar: Workers’ Compensation 2.0


Mark Walls
VP Communications & Strategic Analysis-Safety National; Founder Work Comp Analysis Group; Co-Host Out Front Ideas


We would like to invite you to join us for our next Out Front Ideas with Kimberly George and Mark Walls broadcast.

September 12, 2017 • 11:00 AM – 12:00 PM CST
Our panel will debate the following scenario:
The year is 2019. The Supreme Court of the United States has just declared state workers’ compensation systems to be “unconstitutional” because they no longer provide a “grand bargain” to injured workers. Recognizing the chaos this will cause, the Court gives states six months to enact new workers’ compensation legislation before implementing its order. What would you do?

Join us for this thought-provoking “Out Front Ideas with Kimberly and Mark” webcast taped live from WCI’s 2017 Workers’ Compensation Educational Conference. This wildly-popular opening industry keynote panel session features a high-profile panel debate on the construction of workers’ compensation 2.0.

What will it include? What will change? Everything is on the table!
Expert panelists include:
• David Stills, Vice President, Global Risk Management, Walmart Stores, Inc.
• David North, President and CEO, Sedgwick
• Mark Wilhelm, CEO, Safety National
• Matthew Peterson, CEO, Ancillary and Individual Chief Administrative Officer, Employer and Individual, UnitedHealth Group

To register click below. Once registered you can watch during the broadcast, or watch the archived recording after the broadcast at your convenience.

Finally, please check out our Archives for all the previous Out Front Ideas content you may have missed.

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Employer must face discrimination claim in medical marijuana case

Employer must face discrimination claim in medical marijuana case

A company that fired a worker who tested positive for marijuana even though she was authorized to use it by her physician must face a claim of handicap discrimination, the Massachusetts Supreme Court ruled Monday.

Cristina Barbuto accepted an entry level position at Advantage Sales and Marketing in the summer of 2014. Ms. Barbuto, who was authorized by her physician to use marijuana to stimulate her appetite and help with symptoms of Crohn’s disease, told Advantage she would test positive for marijuana on drug screens. A supervisor told Ms. Barbuto her medicinal use of marijuana “should not be a problem,” which he later confirmed after consulting with others at the company, according to court documents in Cristina Barbuto vs. Advantage Sales and Marketing L.L.C.


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Opioids are Just One Pharmaceutical Issue Facing Workers Comp Programs

Opioids are Just One Pharmaceutical Issue Facing Workers’ Comp Programs

By Jim Thompson

Sarasota, FL ( – Opioids, the class of powerful pain-relieving drugs including oxycodone, hydrocodone, codeine and morphine, have dominated headlines in recent years as the United States has seen a rapid increase in problems associated with both their prescription and non-prescription use.

There are, however, other significant pharmaceutical issues in workers’ compensation that have been getting far less attention than opioids.

First, a look at how the opioid issue developed:

It was within the workers’ compensation arena that the problem of opioid addiction began to surface, according to Joe Paduda, president of CompPharma. CompPharma works with pharmacy benefit managers (PBMs) within workers’ compensation programs to find cost-effective solutions to pharmaceutical issues.

Paduda told that problems with opioid use — specifically, that the drugs had become at least as much of a medical issue as the underlying injury — were first noticed within workers’ compensation programs more than a decade ago.

In the years since, Paduda said, workers’ compensation programs have come to rely on PBMs to alert claims handlers to opioid issues. In addition, Paduda said, PBMs have set up formularies — lists of approved medications — that provide alternatives to opioids. Read more

Workers’ Compensation: 10 more issues to watch for 2017

Workers’ Compensation: 10 more issues to watch for 2017

The first Out Front Ideas with Kimberly and Mark webinar of 2017 provided our thoughts on the 20 Workers’ Compensation Issues to Watch in 2017.

In early January we discussed what we consider as the first 10 issues that workers’ comp professionals need to be aware of in the coming year. What follows is a summary of the remaining 10 issues we talked about:

11. Impaired workforce

After the November elections, eight states and the District of Columbia allow for recreational use of marijuana. This means around one in five people live in a state where recreational marijuana is now legal.

For employers, this means the reality that a percentage of your workforce is likely impaired. Years ago many employers stopped doing pre-employment drug testing because they couldn’t get enough applicants to pass to fill their jobs. New OSHA regulations from 2016 seek to significantly limit the use of post-injury drug testing, which further inhibits employers looking to maintain a drug-free workplace policy.

Related: Seeing marijuana through the haze of myths

The answers to this issue are challenging. Drug testing for marijuana always focused on whether the drug was present in the system because it was illegal. It can be detected in the system 30 days after use, but showing presence of the drug doesn’t show impairment. This is an area in which the science needs to catch up with social reality. We need an established standard for what constitutes impairment when it comes to marijuana.

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Colorado’s largest workers-comp insurer is paying $50 million dividend

Pinnacol Assurance, Colorado’s largest workers compensation insurer, will pay a dividend of $50 million this year, returning an average of $941 per company to the roughly 53,000 businesses that earned it.

This will be the second straight year that Pinnacol, which writes policies for nearly 60 percent of the state’s businesses, is issuing a dividend, and the amount is about $30 million higher than what it gave back to clients in 2016.

Dividend checks are calculated based on the policy holders’ size and performance, and about 6 percent of Pinnacol clients did not meet the minimum qualifications to earn a payout. Read more

Court Calls Workers’ Comp Penalties Against Nonemployers ‘Absurd’

A company cannot be penalized for failing to comply with the Workers’ Compensation Act if it is not later defined as the claimant’s employer, a split Commonwealth Court panel has ruled in an issue of first impression.

A three-judge panel of the court held in Ayerplace Enterprises v. Workers’ Compensation Appeal Board (Royal) that, although Ayerplace Enterprises failed to make certain workers’ compensation payments after the company was initially determined to be an employer, Ayerplace could not be penalized under the Workers’ Compensation Act for the delay, since it was later determined on appeal not to be the claimant’s employer.

The decision reversed a ruling from a workers’ compensation judge and appeal board, which held that success on the merits of the employment issue did not excuse the company’s initial violation of the act.

According to Commonwealth Court Judge Robert Simpson, the only way for penalties to be assessed is for the company to be an employer, and therefore subject to the act.

“It is axiomatic that penalties for noncompliance with the act may only be imposed on litigants that are subject to the act, and more specifically, subject to the penalty provision,” Simpson said. “To construe the act otherwise would lead to an absurd result, like that here, where a litigant that is neither an insurer nor employer under the act, and has no liability for benefits, is required to pay penalties.”

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