State legislation supporting medical marijuana has increased in recent years. This trend may lead to a change in the federal policy. Workers’ compensation insurers and employers should take such legislative trends into account and begin developing organizational policies regarding the use and management of medical marijuana.
According to Milliman consultant Tom Prince’s article “Developments in federal marijuana policy and workers’ compensation insurance,” there are four key issues these stakeholders need to consider: medical research, testing procedures, reimbursement, and fraud.
Here is an excerpt from the article:
A specific challenge to the workers’ compensation industry is that much of the already limited existing evidence focuses on the drug’s potential as treatment for conditions and illnesses such as epilepsy, post-traumatic stress disorder (PTSD), Alzheimer’s disease, Parkinson’s disease, cancer pain, and others… Of more particular concern are considerations of the effectiveness of marijuana in treating acute, chronic, and neuropathic pain—symptoms most commonly associated with workplace injuries. In this vein, the benefits for chronic pain and neuropathic pain sufferers are fairly well established, but there remains dissent within the medical community, which is particularly due to the lack of substantial clinical trials evaluating the long-term safety of medical marijuana treatment….
A primary area of concern stemming from this inability to reliably test intoxication/impairment levels lies in determining the compensability of a claim… Proving that intoxication was the major—in some jurisdictions sole—contributing factor to the injury is a difficult defense to win regardless of the substance in question, and the lack of precision in marijuana testing casts further doubts on using a positive test as grounds for denial… Without a standardized and medically accepted measurement of marijuana impairment, this issue will remain problematic….
One of the foremost practical obstacles to those seeking insurance compensation for medical marijuana has been the lack of a standardized reimbursement rate. The difficulty in establishing appropriate costs is a legitimate concern for insurers. The conventional approach to standardized reimbursement rates for a drug is to receive FDA approval and a corresponding National Drug Code (NDC). This scenario is implausible without federal rescheduling to a Schedule II (or lower) classification and subsequent approval by the FDA. Further complicating this process are the limitations in medical research discussed earlier and the nonuniformity of the drug. THC levels found in marijuana can vary substantially from one sample to the next, making the determination of a standard “dose” difficult if not impossible.
A common and long-standing concern of the insurance industry regarding medical marijuana legalization is the potential emergence of a new class of fraudulent claims. Will insureds begin to claim some subjective malady (such as back pain) with the sole intent of procuring insurance-sponsored medical marijuana?
Unfortunately, the magnitude of this issue will not reveal itself until after potential legalization takes hold.