Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Category: LNI News (Page 21 of 22)

Sometimes I Get to Help Change People’s Lives…

I don’t normally post quick thoughts and comments on my blog. However, today I helped change an individual’s life after our office delivered him a big win, following years of fighting for his rights as an injured worker under the Industrial Insurance Act in Washington State.

What I do

For the record, I get questions about my job all the time. People ask me whether I see a lot of folks faking it or taking advantage of the system. And my answer is: Yes, sometimes I do come across those people, and I do my best to avoid representing them. However, as a Washington State Workers’ Compensation attorney, the vast majority of my clients are people who are fighting for benefits they should be provided under our Industrial Insurance Act based on premiums that have already been paid into the system.

Today’s story

To share today’s personal experience, note that I am not saying anything here that is not part of the public record at this point. Right now my associate is meeting with a client that was abruptly terminated from benefits a number of years ago. While we’ve been fighting through the slow moving legal process, the client became homeless and turned to street drugs to self medicate. Despite some serious preexisting problems, he was a successful union laborer before losing his only career to a significant injury.

A jury recently found that he should be provided with ALL of the years of back benefits and a pension going forward. Before he could accept these benefits, we had to help him get an ID (not necessarily easy for someone who has been homeless for over 4 years). Now that he has the ID, my associate will be taking him to the bank to open a new account so that he can apply for stable housing and get access to the medical treatment he needs. Today he walked into our office soaking wet, filthy and tired. His life is about to change. Now you know, this is why I do what I do. (Most, if not all of the credit goes to my new associate who took this case to a jury just a month after starting with us. However, we are all proud of what we collectively accomplished for this man over our years of representing him.)

We are here for injured workers in Washington State, and we do our best to help…

Washington State Workers Compensation System Struggles with Opioid Over-Prescription – Doctors’ Licenses Revoked

The opioid epidemic isn’t a new one. It is a predicament faced by many communities around the United States and in the Pacific Northwest, and significantly impacts injured workers in Washington State.

 

The Opioid Problem

Recently Everett, WA has been making headlines because it has been associated with a devastating black market OxyContin drug ring with ties to Purdue Pharma, the maker of OxyContin.  This black market and related allegations have been covered in recent articles by both the LA Times (see Article I and Article II on this matter) and the Wall Street Journal.

 

This isn’t the start of Purdue Pharma’s problems related to its manufacture and sale of OxyContin.  In 2007 the maker and three executives pled guilty in federal court to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused, and agreed to pay over $600M in fines. However, by 2010, it was too late.  Across the country, doctors had already been prescribing the powerful and highly addictive painkiller (related to Heroin) and many patients were already hooked.  OxyContin is just one, name brand variety of opioids prescribed primarily for pain.  Other common opioids include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), and codeine to name a few.  The fentanyl patch is another popular form of opioid medication that many patients aren’t even aware is an opioid.

 

Opioids in Washington State

As you can imagine, Washington State’s industrial insurance system, a system designed to provide treatment and other benefits to injured workers has been dramatically impacted by this epidemic. In 2006, when I first started practicing as a workers compensation attorney in Washington State, it was very common to see injured workers being prescribed protracted courses of opioids to treat pain.  This isn’t surprising, since Purdue Pharma had launched an aggressive campaign to convince providers that OxyContin was specially formulated to pose a lower threat of abuse and addiction to patients than other opioid formulations.

 

To its credit, the Department of Labor and Industries detected a surge in death rates for injured workers being prescribed these opioids and it began taking action to research and address the problem. In fact the Department received a grant from the Centers for Disease Control and Prevention to assess the effects and impacts of the Agency Medical Directors’ Opioid Dosing Guidelines.  Medical Director, Dr. Gary Franklin led this effort.  The team has published a number of peer reviewed articles on point and has used its research to develop guidelines for the prescription of opioids under the Industrial Insurance Act. According to Dr. Franklin, the 2007 publication of their “Agency Medical Directors’ Opioid Dosing Guidelines” was the first of its kind published in the entire country and established a 120 milligram daily cap for the medication.  Since then, the guidelines were updated in 2010 and 2013, but the 120 milligram cap remained.

 

Oversight and Prevention

In January 2013, the Department of Labor and Industries launched a statewide network for providers who treat injured workers, referred to as the Medical Provider Network (MPN). The MPN is part of legislation passed in 2011.  In order for providers to treat injured workers and be compensated by the Department for that treatment, the provider must be a member of the MPN.  Members of the MPN are required to follow “best practices” including opioid prescription guidelines.  Providers found to be non-compliant may be denied MPN membership or have their MPN status revoked.  Additionally the Washington State Medical Commission oversees medical care to ensure that the required standard of care is not violated.  In July 2016, Dr. Frank Li, a well-known pain management doctor and director of Seattle Pain Centers, who treated many injured workers under the Industrial Insurance Act had his license revoked by the Washington State Medical Commission for failing to properly monitor prescription use of powerful opiates. This crack-down story was extensively covered by the Seattle Times. Furthermore, according to a follow-up coverage by the Seattle Times:

“As many as 20 health-care providers who worked for Seattle Pain Centers have been suspended from the state Labor & Industries department network, which authorizes treatment for workers’ compensation claims.”

 

The Challenge

As a workers compensation attorney representing clients that suffer from the opioid problem, this recent development has left a large number of injured workers without an active attending physician on their claim.  Unfortunately, this puts the injured worker in a very difficult position.  Many of these individuals are actively being prescribed opioid pain medications, making them unattractive patients to other providers because of the likelihood of opioid addiction.  Fortunately, in addition to the dosage guidelines, the Department of Labor and Industries’ treatment guidelines provide guidance for Department approved opioid detoxification.

In simple terms, there are three options:  (1) a gradual tapering under the direction of the attending physician, (2) a short (3-5 day) in-patient detoxification followed by complete weaning over the course of an out-patient pain management program, or (3) if the addiction rises to the level of a mental health diagnosis, up to six months of treatment in a licensed chemical dependency treatment center may be authorized.

 

Personal Experience and Reality

Unfortunately, detoxification for individuals with a chronic addiction is not as simple as these three options make it appear.  These injured workers are truly and deeply addicted to these prescription medications.  In just the last year I have encountered clients on as high as an 800 milligram morphine-equivalent daily dosage of opioid pain medication, clients who have had complete psychotic breakdowns during the course of the in-patient detoxification program, clients who have been cut-off opioid pain medications without warning or weaning who have turned to black market or street drugs to avoid the unpleasant withdrawal symptoms, clients who have relapsed after completing the in-patient detoxification program, at least one client who unexpectedly died in his sleep while taking high dosages of opioid medications, and countless clients who refuse to acknowledge the addicting effects of the medication they are taking.  Make no mistake about it, these clients are often difficult to work with and, I suspect, equally difficult patients to treat.

 

Future Outlook

There are no easy solutions here.  Most injured workers are doing their best to follow medical advice and heal from their injuries and conditions, most medical providers are doing their best to treat patients while following best practices and medical guidelines, and the Department of Labor and Industries is doing its best to develop policies and regulations to limit the negative effects of opioid pain management.  Still the epidemic rages on.  From blue collar towns like Everett to big cities; our country continues to grapple with the mess opioid addiction leaves in its wake.

If you or someone you know is a Washington State injured worker addicted to opioid pain medications, obtaining authorization for treatment to help overcome the addiction is possible under the Industrial Insurance Act.  Talk to the doctor, claims manger or consult with an experienced attorney and obtain the help needed.  There are no easy solutions, but one person and one step at a time; we can overcome this opioid epidemic.

 

Additional resources: L&I Medical Provider Network website

Workers Compensation Lawyers and the Access to Justice Problem for Injured Workers

As a workers comp lawyer representing injured workers, one thing I find extremely disconcerting is the fact that individuals that suffer an injury at work often face major difficulties when deciding whether to retain representation to fight for benefits they are entitled to under the Industrial Insurance Act.

 

Introduction

The work that attorneys perform while representing injured workers is often complicated and time-consuming. Therefore, it is not surprising that the attorney’s fees associated with this representation reflect the challenges of work being performed. However, the result is that injured workers often find themselves fighting an uphill battle frequently compromised by access to justice issues linked to financial constraints. These financial constraints are not solely due to attorney’s fees. Other constraints include, but aren’t limited to, costs of litigation and reduced earning capacity while injured.

 

Background

First, if it comes to retaining legal representation, the Department of Labor and Industries is guaranteed representation by the Attorney General’s office and self-insured employers hire private counsel paid on an hourly fee basis. For workers compensation attorneys representing injured workers, the fee structure is contingent upon securing monetary benefits, meaning attorneys don’t get paid for the hours spent fighting for things like treatment authorizations or causal relationship of conditions. While important to injured workers, those benefits are not issued in monetary warrants or checks like time-loss compensation, permanent partial disability awards, and pensions are. Therefore, no contingent fee percentage can be charged for the time spent securing these kinds of benefits. What this means is that if an injured worker needs to retain representation to fight an issue like treatment or causal relationship of a medical condition, that injured worker must find a workers comp attorney willing to take the case and litigate it without any assurance of ever being compensated for the work performed. Attorneys that represent people injured at work have long argued that this represents a significant access to justice issue, but this argument has largely been ignored by the legislature.

 

Another difficulty faced by injured workers is the expense of litigation. Claims managers for the Department of Labor and Industries and self-insured employers cannot authorize treatment or casually relate a condition without medical support. However, often the claims managers want more specific information or completely overlook supportive medical opinions from treating providers. If an injured worker pushes the issue beyond the administrative level to the Board of Industrial Insurance Appeals to resolve a dispute that arises, the injured worker has the burden of presenting medical testimony to prove the need for treatment or causal relationship of the condition. For an injured worker earning only a small percentage of his or her pre-injury wages in time-loss compensation, securing supportive medical opinions are often cost prohibitive.

 

For example, a local orthopedic group, OPA Ortho charges $1,000 per hour for one of their medical providers to give testimony, even if the attorney travels to the doctor’s office. That hourly rate does not include the time the doctor spends reviewing their own chart notes to prepare for the deposition testimony. Imagine being injured, unable to work, and being told that in order to secure the treatment you need, your attorney will have to take testimony from your treating doctor and it will cost you a minimum of $1,000! On the flip-side, the Department and Self-Insured Employers seem very willing to pay out significant costs in order to obtain medical opinions that support their opinions.

 

Independent Medical Examiners

When the Department or a Self-Insurer wants medical evidence to support their opinion, they request an Independent Medical Examination or IME. IMEs are one-time evaluations performed by an evaluator that is not a treating physician. Despite clear case law to the contrary, the Department and Self-Insurers often take the opinions of the IMEs over the opinions of treating providers.

IMEs are a big business in the State of Washington. A public records request revealed that in a single year, 2014, the Department of Labor and Industries (L&I) paid out $18,272,904.94 in IME fees alone. That’s over $18M in fees paid by L&I, and this number does not include the fees paid out by Self-Insured employers. The sheer magnitude of costs associated with obtaining and presenting required medical testimony often prices injured workers out of the ability to push for the benefits they are otherwise entitled to under the Industrial Insurance Act.

 

Additional Considerations

For litigation before the Board, there is no fee shifting statute. That means each party is responsible for their own attorney’s fees and costs associated with litigation. A successful outcome before the Board of Industrial Insurance Appeals does not result in reimbursement of the costs and fees associated with obtaining the favorable outcome. However, if the matter goes up on appeal to the superior or appellate court from the decision and order of the Board, and the injured worker secures additional benefits or retains the right to benefits then costs and a reasonable fee for the services of the worker’s or beneficiary’s attorney shall be fixed by the court pursuant to RCW 51.52.130:

In the case of self-insured employers, the attorney fees fixed by the court, for services before the court only, and the fees of medical and other witnesses and the costs shall be payable directly by the self-insured employer.

Often, this simple fee shifting statute is viewed as an equalizer in workers compensation, giving incentive to attorneys representing injured workers to pursue difficult or challenging cases with no fee generating issues and acting as a deterrent from potentially meritless appeals as the Department or self-insured employer would ultimately be saddled with their own attorney fees plus the often costly hourly rates of the injured workers’ attorney in the event of a successful outcome for the injured worker. I assumed it was because of this statute that we rarely saw appeals from self-insured employers. However, this no longer seems to be the case. All four of the appeals I litigated at the Superior Court level in the past year have involved self-insured employer appeals.

 

Personal Experience

For example, I recently represented an injured worker who developed a complicated kidney condition secondary to his original industrial injury. This condition destroyed his kidneys and necessitated a lifesaving kidney transplant. At the administrative level, this kidney condition was accepted so that treatment would be provided under the claim. The self-insured employer disagreed with the determination and appealed it to the Board. Litigation before the Board required the presentation of lay witnesses, as well as competing testimony from two expert nephrologists, a specialty not usually seen in workers’ compensation cases. It was essential for this injured worker to be adequately represented at the Board level, but proving that the Department was correct in accepting the kidney condition would result in no fee generating benefits.

 

Therefore, the hours of representation required to secure the ultimately favorable Board decision were not compensable, but did enable the injured worker to obtain the lifesaving surgery. Even after the surgery had been performed, the self-insured employer appealed the Board’s determination to Superior Court. Again the injured worker required representation, without any assurance of compensation for the hours spent defending the Board’s decision at Superior Court. After three days of trial, a six person jury reached a verdict affirming the Board’s decision that the kidney condition should be accepted under the industrial injury. As a result the self-insured employer has agreed to pay our attorneys’ fees, an amount just over $20,000.

 

In this case our office firmly believed in our chances of securing a favorable outcome for the injured worker and was willing to accept the risks associated with representation. However, it goes without saying that some injured workers cannot find attorneys willing to take on the risks associated with appeals. These injured workers must either represent themselves pro se or give up the fight all together.

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