Workers’ Compensation and Narcotic Pain Medicine

A Pennsylvania appellate court made the unusual announcement that it was constrained to deny an injured worker prescription narcotic painkillers despite “profound sympathy” for the worker’s circumstances.

The worker was employed by a mental health agency and was injured at work. The injury caused her to suffer back problems that led to several surgeries and chronically worsening spinal deterioration and accompanying pain. After years of treatment, the worker’s physician prescribed narcotic lozenges for “breakthrough pain.” The particular lozenges prescribed by the worker’s physician carry a package insert indicating that the lozenges are approved by the FDA only for pain associated with cancer or AIDS, due to the highly addictive nature of the narcotic drug.

After protracted review and hearing procedures, the case was appealed. The Pennsylvania Commonwealth Court held that all workers’ compensation benefits payments must be for reasonable and necessary treatment only. Because the lozenges were not approved for the purpose for which the worker’s doctor had prescribed them, the employer’s insurance company was not responsible to pay for injured workers do have the right to explore alternative treatment or secure medical treatment that is not “reasonable and necessary” in the eyes of the workers’ compensation courts. But if they do so, they must do so at their own expense or through another benefit or insurance plan.