New Jersey Court Rules Injured Worker is No Longer Entitled to Opioid Medication 

    A New Jersey petitioner previously receiving opioid pain medication to treat pain from a work-related injury will no longer be compensated for the medication because he did not provide enough evidence that the opioids would heal or relieve his condition. This was true even though the petitioner provided medical expert testimony who stated that a long-term prescription of opioids would be reasonable in these circumstances. The New Jersey Appellate Court, however, deferred to the workers’ compensation judge’s decision to give more credibility to the conflicting testimony of the petitioner’s treating physician.

In this case, the petitioner, Samuel Martin III (Samuel), worked for the Newark Public School system (the School) and was injured in a work-related car accident in 2011. He began receiving workers’ compensation benefits for partial disability in 2014. When he was discharged by his treating physician in 2017 for reaching maximum medical improvement, the School refused to continue providing payment for Percocet prescriptions. The School relied on statements from Samuel’s treating physician, Dr. Grob, that the prolonged use of narcotics, like Percocet, would not manage Samuel’s injuries and could complicate his recovery, and that pain medication would not be sufficient to treat Samuel’s condition or heal his injuries. Rather, Dr. Grob recommended that Samuel undergo surgery as the only effective way to treat his condition. Samuel refused the recommended surgery.

To support his argument, Samuel presented an expert witness, Dr. Bram, who conducted a one-time examination of Samuel and testified that long-term prescription of opioids would be reasonable to treat his pain. Dr. Bram did admit, however, that the opioids only partially alleviated Samuel’s pain, and acknowledged that, at one point, Samuel stated that the opioids only provided “small pain relief.”  Given the conflicting testimony, the workers’ compensation judge determined that the testimony coming from Dr. Grob, who had treated Samuel for some six years, was more credible than Dr. Bram’s one-time examination.  As such, the judge held that Samuel failed to prove that the continued use of opioids would relieve or heal his condition because he did not show that the opioids would reduce his pain or permit him to function better.

Samuel argued that the workers’ compensation judge improperly gave more weight to Dr. Grob than Dr. Bram, but the Appellate Court held that the factual findings of workers’ compensations judges are accorded substantial deference because of the expertise acquired by those judges and that it was properly within the judge’s discretion to give more weight to a treating physician than to a one-time medical expert.

Samuel also claimed that the workers’ compensation judge improperly applied the legal standard for palliative care, as opposed to curative care. Workers’ compensation law focuses on compensating treatment that is curative, or necessary to restore an injured person to pre-injury status as much as possible. In order to receive compensation for treatment that is only palliative, a petitioner must show that the treatment is likely to relieve the petitioner’s symptoms and improve his ability to function. It is not enough to show that the petitioner would receive any benefit from the treatment. The Appellate Court again held that the workers’ compensation judge decided this properly because the only evidence that Samuel presented was that opioid prescriptions would be “reasonable,” and Dr. Grob testified that they would not help improve Samuel’s ability to function.

If you are an injured worker and have questions about long-term compensation for palliative care, including pain management, feel free to contact Ward, Shindle & Hall for legal advice.