Hank is a material handler who sustains a compensable work-related injury. As part of his treatment, his physician prescribes prescription pain medication, particularly a narcotic pain medication, such as Oxycontin. Hank's treating physician also releases him to return to modified duty, with restrictions of no lifting greater than 10 lbs., can drive a vehicle, but no heavy equipment or tow motor. Fortunately for Hank, his employer has a modified duty program and is interested in bring him back to work --- but there's one problem. His employer has concerns about Hank's ability to perform the modified duty job they have for him. They were hoping to have Hank perform light courier work between plants, but they don't want him "all drugged up while operating a company vehicle."
These are legitimate concerns. Many employers find themselves in this same predicament: there is a release to return to work, but the injured worker is on heavy pain medications which may create additional liabilities for the employer. What's an employer to do?
Communication is key
If there is a nurse or medical case manager assisting with this claim, send him or her a list of the modified duties, or a modified duty job analysis form, to discuss with the physician. Often times having something to demonstrate the availability of modified duty will help facilitate a RTW, but can also encourage the physician to prescribe medication that will not impeded an injured worker's ability to operate a vehicle, etc. Perhaps they can provide some alternative medication for the injured worker to take during working hours. If it is an injured worker who has been on heavy pain medications beyond the recommended time frames, it may also give the physician another basis to adjust the patient's pain regimen.
Understand the risks
Not all medications will prevent an injured worker from driving, just not all dosages will have the same impact on each individual. Unfortunately there is no magic screening to determine how each individual will react to a particular dosage.
You, as the employer, should pay attention to, and address any changes in the injured worker's performance or ability to perform the work assigned to them. If there is an issue, address it with the employee, document it, and talk with their physician.
Consider your options
If the treating physician won't budge on the prescription regimen, check with your claim representative to determine if the injured worker can be seen by another physician, or have their treatment reviewed for reasonableness and necessity if it seems wonton. If the injured worker cannot drive, can someone pick him or her up? Consider adjusting modified duty to address your concerns. We've all heard stories of injured workers who were over-prescribed narcotic pain medications, but the important thing to remember is that we all play a part in the injured worker's recovery: the injured worker, the employer, the doctors, and the insurance carrier. The sooner we can return an injured worker to modified duty, the sooner we can get them back to full duty and return them to a state of wellness.
In a more recent Pennsylvania case, (JD LANDSCAPING v. WCAB (HEFFERNAN), an injured worker's accidental overdose, attributable to the overuse of pain patches, was deemed causally related to the work injury. As a result, a fatal claim petition was granted. Most of us have heard the stories on the news about how narcotic pain medications are ruining the lives of injured workers, family members and even communities. Anything we can do to address this problem, including an early RTW intervention, may help to prevent such horrible outcomes.
While the majority of injuries do not require the use of narcotic or other "heavy" pain medications, it is not unlikely that employers will be faced with the challenge of returning someone to work who has been prescribed pain medications. Communicating with the treating physician through a case manager or claim representative can help facilitate a return to work, or a reduction or change in dosing, and demonstrates to the injured worker that you are working with them, acknowledging their situation, and trying to find an appropriate solution. What we don't want to do is allow an injured worker to become even more detached from the daily work habit, become more isolated, and experience a reduced likelihood of ever returning to work.
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