In 2006, the claimant was injured while working for Federal Marine Terminals. He subsequently underwent three back surgeries—two were unsuccessful. In 2009, the claimant began seeing a pain management physician who prescribed narcotics pain medication.
The parties reached a partial settlement in 2010. By “partial,” I mean that the parties settled the indemnity portion of the claim but left the medical benefits open. By leaving medical benefits open, the employer and carrier remained liable for medical benefits—like the pain medicine.
Subsequently, an issue arose regarding the payment of additional pain medicine. The employer and carrier didn’t want to pay for the narcotics. In part, the employer and carrier argued that the claimant’s use of marijuana rendered the continued narcotic therapy unreasonable. The case proceeded to a formal hearing, after which the administrative law judge determined that the employer and carrier were obligated to pay for the medicine because the narcotics were medically reasonable and necessary. The Benefits Review Board—and now the Eleventh Circuit—affirmed:
Here, substantial evidence supports the ALJ’s determination that continuing use of narcotic pain treatment is reasonable and necessary. The ALJ extensively reviewed the evidence presented at the hearing and issued a thorough order explaining the decision. Specifically, the ALJ found Schofield credibly testified that he experienced pain on a daily basis as a result of his work-related injury and that he would not be able to function without the use of his narcotic medicine. In support of the decision, the ALJ reasonably relied on the opinions of Schofield’s treating pain-management physicians, Dr. John Barsa and Dr. Miguel Attias, who both testified that narcotic medication were, and continue to be, medically necessary to treat Schofield’s chronic pain.
[The employer and carrier] contend that Schofield’s positive drug tests for illicit or non-prescribed drugs, such as marijuana, render continued use of narcotic therapy unreasonable, citing guidelines from the American Pain Society. Petitioners also rely on evidence that several other physicians advised against continuing treatment with narcotics due to Schofield’s positive drug tests and the long-term consequences associated with using opioid medications to treat chronic pain.
While the record does contain evidence that is favorable to their position, [the employer and carrier] have not shown that it was unreasonable for the ALJ to conclude that the treatment prescribed by Dr. Barsa and Dr. Attias was reasonable and necessary. Dr. Barsa and Dr. Attias both stated that, despite the drug tests and the long-term adverse consequences of using narcotics, the narcotic prescriptions were medically reasonable and necessary. Dr. Attias also testified that he was working with Schofield to reduce and ultimately eliminate his use of narcotics. In addition, Dr. Barsa’s and Dr. Attias’s opinions were supported by Dr. David Herson, who evaluated Schofield and reviewed his medical records. Dr. Herson, who was board-certified in anesthesiology and pain management, testified that Schofield’s narcotics prescriptions were medically reasonable and necessary and that he found no indications that Schofield abused the drugs prescribed to him. Based on the evidence, a reasonable ALJ could conclude that Schofield’s narcotic medications were medically reasonable necessary, despite their risks and despite the contrary views of other physicians.
Federal Marine Terminals, Inc. v. Dir., OWCP, No. 15-14115 (11th Cir. Jun. 7, 2016).
Attribution: Photo courtesy of Flickr user .v1ctor Casale.