Maine WC Alert: Appellate Division Affirms Finding That Narcotics May Not Be Compensable Based on Long-Term Risks

Maine Workers' Comp Alert

In Martin v. George C. Hall & Sons, Inc., WCB App. Div. No. 18-26 (October 3, 2018), the employee appealed a decision denying compensability of prescription medication, arguing that the administrative law judge (ALJ) erred by considering the risk of narcotic dependence in determining whether the treatment was “reasonable and proper” under § 206. The ALJ was not persuaded by the employee’s testimony that the benefit of narcotic pain medication outweighed the risk of long-term dependence. It found the employee’s treating physician expressed misgivings about his long-term use of narcotics and the § 207 examiner opined that the prescription regimen was inappropriate. Although the employee’s prescribing physician presumably disagreed, the ALJ did not err in resolving the disagreement in favor of non-compensability. “The fact that Mr. Martin’s treatment provided some limited benefit does not compel the conclusion that it is proper, given the competent evidence to the contrary.”

The decision is significant as it demonstrates that, with sufficient supporting evidence, an ALJ may find narcotic prescriptions are not compensable given the risk of dependence. This is particularly important given the recent general health concerns over ongoing narcotic use and the generally high claim costs associated with these medications.