The News You Need for Jan. 27

We preview a CLM Alliance (Claims and Litigation Management Alliance) Focus Conference Session, look at the impact of the recent Walgreens case, and dig into a West Virginia question.

5 Questions on High-Risk Industries, CLM Session with Michele Punturi & Michelle Leighton

Frank Ferreri

In advance of the?CLM Focus Conference?coming up Feb. 11-12, we're presenting a series of conference-preview pieces to better understand what the sessions will offer and why they're relevant to the workers' compensation industry. Today, we catch up with Michelle Leighton, AIC Michele Punturi , who will be presenting Workers Comp Risk Management Best Practices: Insights from High-Risk Industries alongside Casey Flynn, CRIS and David Shoaff .

Q. How would you define or describe the need for education and learning in high-risk industries, and why is it important that workers' compensation professionals in that space attend a session like this??

Leighton & Punturi: High-risk industries face unique and constant challenges in workers’ compensation, where workplace injuries can have a profound impact on an employer’s financial health and operational stability. Education and learning in high-risk industries are vital because these environments are inherently dynamic, with constantly changing risks, regulations, and technologies. Workers’ compensation professionals are at the forefront of managing employee well-being and mitigating organizational liability, making it essential for them to stay informed. This session will explore innovative strategies for injury prevention, risk mitigation, and cost management, helping professionals reduce the frequency and severity of claims. Attendees will learn best practices for implementing tailored risk management strategies, from effective talent acquisition and safety programs to streamlined injury management and post-injury employee reintegration.?

Q. Who should attend this session, and who stands to learn the most and apply the insights??

L&P: This session is designed for all stakeholders involved in workers’ compensation claims, including employers, safety professionals, claims adjusters, brokers, defense counsel, and medical providers. Each attendee will gain practical, actionable insights to enhance their ability to manage return-to-work programs and implement best practices within high-risk industries such as construction, retail, and healthcare. By attending, these individuals can learn practical strategies to improve claims outcomes, adopt proactive risk management techniques, and ensure a safer, more resilient workplace.?

Q. What experiences have led you to focus on this topic and present on it??

L&P: With over 30 years of legal experience exclusively dedicated to defending self-insured entities, insurance carriers, and employers in workers’ compensation matters, I (Michele Punturi) have developed a deep understanding of the challenges faced by high-risk industries. My co-presenter, Michelle Leighton, brings equally extensive risk management expertise as a claims advocate and consultant in an insurance brokerage landscape, working closely with employers to develop strategies that balance employee support and cost containment. Together, we have partnered with clients in sectors like construction, retail, and healthcare to tackle complex issues related to risk management, return-to-work programs, and workplace safety. These experiences have shaped our insights, and we are excited to share them with peers. We will also be joined by panelists Casey Flynn and David Shoaff, who will share their insights as employers in high-risk industries.??

Q. What will attendees gain from this session that they didn’t have before??

Attendees will leave with a deeper understanding of how to optimize and apply their existing tools in innovative ways, enhancing their effectiveness in managing workers’ compensation challenges. They will also gain a deeper understanding of how to navigate the complexities of workers’ compensation in high-risk industries, including innovative approaches to claims advocacy, proactive risk mitigation, and effective medical management and return-to-work programs.?

Q. What makes you proud about presenting on this topic and session??

Managing and defending workers’ compensation claims in high-risk industries plays a crucial role in strengthening a company’s financial health, fostering a culture of safety, and maintaining compliance with regulatory standards. There is a lot of pride with presenting this topic because it highlights the critical role workers’ compensation professionals play in supporting employees and protecting businesses. It is deeply rewarding to share knowledge that can help employers reduce liability, improve operational efficiency, and contribute to safer and more sustainable workplaces. This session is an opportunity to share insights and strategies that can truly make a difference—not just in reducing claims or costs, but in fostering safer workplaces and better outcomes for injured workers. Supporting professionals in these industries allows us to make a meaningful impact together.?

Walgreens Lawsuit: Ripple Effects on Workers’ Compensation and the Opioid Crisis?

Dr. Claire C. Muselman

The recent Department of Justice (DOJ) lawsuit against Walgreens sends shockwaves through multiple industries, including workers' compensation. The lawsuit alleges that Walgreens knowingly filled millions of prescriptions for controlled substances that lacked legitimate medical purposes. This development highlights the ongoing complexities of the opioid epidemic, a public health crisis that significantly impacted the workers' compensation system and programs across the United States. With penalties potentially exceeding $80 billion, this case highlights the dire consequences of unchecked pharmaceutical practices. For the workers’ compensation industry, it serves as both a cautionary tale and an urgent call to action.??

A Troubling Pattern of Negligence in Pharmaceutical Practices?

The DOJ’s lawsuit against Walgreens alleges that the pharmacy chain knowingly filled prescriptions for opioids and other controlled substances without legitimate medical purposes. Among the most concerning allegations is the claim that Walgreens dispensed combinations of drugs known as the “trinity”—a mixture of opioids, benzodiazepines, and muscle relaxants notorious for its potential to cause deadly overdoses. This negligence mirrors the practices highlighted in the Purdue Pharma case, where aggressive marketing and distribution of OxyContin fueled widespread opioid misuse. Both cases reveal a troubling pattern: when profit-driven decisions override ethical obligations, vulnerable populations—including injured workers—bear the consequences. As it pertains to the workers’ compensation industry, this lawsuit reinforces the need for vigilance. Pharmacies, medical providers, and insurers must work collaboratively to ensure that medications prescribed to injured workers are appropriate, monitored, and administered with care.?

The Opioid Crisis and Workers' Compensation?

Opioids have long been a double-edged sword in workers’ compensation. Initially prescribed to manage pain, these medications often lead to addiction, delayed recovery, and increased costs for employers and insurers. The misuse of opioids by injured workers has escalated into a significant challenge, with downstream effects on workforce participation, productivity, and health outcomes. The allegations against Walgreens amplify the urgency to address opioid misuse within the workers’ compensation system. When pharmacies disregard red flags or prioritize profits, injured workers may find themselves trapped in cycles of addiction that hinder their recovery and reintegration into the workforce. For employers and insurers, these cases translate into longer claims durations, higher costs, and, tragically, lives lost to preventable overdoses.?

Parallels with Purdue Pharma: Lessons Learned?

The Walgreens case draws striking parallels to the Purdue Pharma litigation. Both involve large-scale entities accused of fueling the opioid epidemic through negligent practices. However, the outcomes of these cases differ in significant ways. The Purdue Pharma settlement, now increased to $7.4 billion, aims to fund addiction treatment, prevention programs, and community recovery efforts. The decision to strip the Sackler family of liability protections marked a significant victory for accountability. Similarly, the Walgreens case has the potential to reshape how pharmacies are held responsible for their role in the opioid crisis. For workers’ compensation, these cases illustrate the importance of ethical leadership and systemic change. Employers, insurers, and claims adjusters must advocate for policies that prioritize injured workers’ well-being over cost-cutting or convenience such as adopting checks and balances to ensure prescriptions align with legitimate medical needs.?

Why This Matters for Workers’ Compensation: Three Main Reasons?

1. Increased Costs and Liability. The financial impact of opioid misuse is staggering. Extended claims durations, higher medical expenses, and potential legal liabilities strain workers’ compensation budgets. Lawsuits like the one against Walgreens serve as a wake-up call for stakeholders to reevaluate how medications are managed within claims.?

2. Trust and Accountability. The workers’ compensation process relies heavily on trust. Injured workers must trust that the system prioritizes their recovery, while employers and insurers must trust providers to act ethically. Allegations like those against Walgreens erode this trust, underscoring the need for transparency and accountability at every level.?

3. The Need for Comprehensive Oversight. This case highlights the gaps in oversight that allow harmful practices to persist. For workers’ compensation, this translates into a need for stricter protocols around prescription monitoring, pharmacy partnerships, and provider accountability. Employers and insurers must also educate injured workers about safe medication use and available alternatives.?

Proactive Steps for Workers' Compensation Programs?

Addressing the ripple effects of this lawsuit requires a proactive, multi-faceted approach:?

For Employers:?

Advocate for responsible pharmacy partnerships.?Employers should establish relationships with pharmacy benefit managers committed to ethical practices, ensuring injured workers receive appropriate and necessary medications without risk of misuse. This approach strengthens trust and aligns with the organization's responsibility to support recovery. Partnering with PBMs that prioritize compliance, and patient care also mitigates legal and reputational risks.?

Educate employees about opioid risks.?Implement ongoing education initiatives to help employees understand the dangers of opioids and the importance of proper medication use. Equip workers with the knowledge to make informed decisions about their treatment options, reducing the likelihood of misuse or dependence. Include resources on alternative pain management strategies to empower employees.?

Promote a recovery-oriented culture.?Foster an environment where injured workers feel supported throughout their recovery journey. Encourage open communication about treatment concerns and offer access to resources like employee assistance programs or wellness initiatives. By focusing on holistic recovery, employers can demonstrate their commitment to employee well-being.?

For Claims Adjusters:?

Monitor prescriptions closely.?Establish systems to track prescription patterns and flag concerning trends, such as excessive refills or high-risk combinations like the “trinity.” This vigilance helps ensure injured workers receive medications that align with evidence-based care. Collaborate with medical providers to address concerns proactively.?

Advocate for non-opioid solutions.?Encourage providers to explore alternative treatments such as physical therapy, acupuncture, or cognitive behavioral therapy. By promoting these options, adjusters can reduce dependency risks and support sustainable recovery paths. Advocate for the injured worker’s best interests while adhering to cost-effective practices.?

Enhance communication with injured workers.?Build rapport by regularly checking in with injured workers about their treatment plans and experiences. Clear and compassionate communication fosters trust and allows adjusters to address potential red flags early, preventing complications in the claims process.?

For Insurers:?

Implement robust prescription monitoring programs.?Leverage technology to identify high-risk prescribing behaviors, ensuring compliance with medical guidelines. For example, programs can alert insurers to dangerous patterns such as early refills or prescriptions for excessive dosages. This proactive monitoring minimizes risks and ensures responsible medication management.?

Support addiction prevention and recovery initiatives.?Allocate resources to community programs that address addiction treatment and prevention. Contributions to public health efforts not only align with corporate social responsibility but also reduce long-term claims costs by addressing the root causes of opioid misuse.?

Streamline collaboration with providers.?Establish clear protocols for communication and collaboration with healthcare providers. By fostering partnerships built on transparency and shared goals, insurers can ensure injured workers receive appropriate care while maintaining cost efficiency. This approach also helps providers align their practices with the insurer’s expectations.?

Building a Safer, More Ethical System?

The Walgreens lawsuit is only a legal battle. This is a powerful reminder of the human cost of negligence. For injured workers, the consequences of unethical pharmaceutical practices can be life-altering, delaying recovery and compounding emotional and physical pain. It can also cost a person their LIFE. For the workers’ compensation industry, this case is a red flag for us to build a safer, more ethical system. How? This begins with a cultural shift that places well-being above profit in an ecosystem that profits on human suffering. Employers, insurers, and adjusters must commit to prioritizing transparency, education, and proactive oversight. By fostering collaboration and advocating for systemic change, the workers’ compensation community can help mitigate the devastating effects of the opioid crisis while supporting injured workers on their path to recovery. Human lives depend on it in a system designed to support a back to work approach.??

A Collective Responsibility?

The DOJ lawsuit against Walgreens is yet another chapter in the ongoing fight against the opioid epidemic. While the financial penalties and legal consequences are significant, the true cost of this crisis lies in the lives affected by addiction and loss. For the workers’ compensation industry, this moment is an opportunity to reflect, learn, and lead. Let this be a reminder that accountability is not just a legal obligation—it is a moral imperative to build a workers’ compensation system that prioritizes humanity.?

Did Past Falls Justify Trashing Part of Garbage Man’s Compensation for Concussion?

Chris Parker

In West Virginia, employees are not entitled to compensation for the portion of an injury that is the result of pre-existing conditions. One case shows why it’s important for employers to ensure that at least one doctor considers those conditions before a workers’ compensation judge or board rules on the claim.

The claimant, a man named “Workman,” was working for a solid waste authority when he fell several feet off a truck and was knocked unconscious. He sustained permanent partial disability based on: a concussion; a scalp abrasion; and a right shoulder contusion.

Prior to the incident, Mr. Workman had a history of vertigo, falling, and concussions. He and the solid waste authority disputed the extent to which his current injuries were compensable under the workers' compensation statute.?

Three doctors provided opinions concerning apportionment:

Dr. M:?

5%?Vertigo from concussion; 0%?Abrasion of scalp; 1%?Contusion of shoulder. Dr. M. found?6% whole person impairment.

Based on this recommendation, the claim administrator granted Mr. Workman a 6% permanent partial disability award .

Dr. G.

9%?Disequilibrium 5%?Reduced range of motion from shoulder contusion Dr. G. found a?14% whole person impairment.

Dr. K.

9%?Disequilibrium 5%?Reduced range of motion from shoulder contusion

Dr. K. diagnosed a myriad of conditions including concussion and memory loss for a total of a14% whole person impairment.

Dr. S. 7%?Shoulder contusion

Dr. S. assessed 9% whole person impairment but found that all of it was due to prior injuries.?

Regarding the shoulder contusion, Dr. S. assessed a 7% whole person impairment. Dr. S. found just 3% was due to compensable injury, with 4% due to preexisting injuries). He found a?3% whole person impairment.

Under West Virginia law, injured workers, unless they are permanently totally disabled, cannot receive compensation for any portion of the injury that’s preexisting. The employer, however, has to show what portion of the injury is due to a pre-existing condition.

Was 6% apportionment proper?

A.?No.?Dr. G and Dr. K recommended 14 percent.

B. Yes.?The two doctors who recommended more didn’t address the prior injuries.

If you selected B, you agreed with the court in Workman v. Raleigh County Solid Waste Authority, No. 24-231 (W. Va. 01/14/25), which held that the Authority showed that it was proper to award?6%.

First, the employee had a prior history of multiple head injuries resulting in dizziness and issues with disequilibrium.?

Second, Dr. M. acknowledged the preexisting conditions and attributed five percent impairment to the employee’s compensable concussion-related complaints.?

Third, Dr. S. apportioned all of the 9% impairment that he found to the natural progression of the employee’s pre-existing disease, bolstering the conclusion that the prior injuries played a major role in the employee’s current state of health.

Fourth, the recommendations of Dr. G and Dr. K were not reliable for establishing impairment, the court stated, because each physician failed to tie any of the impairment to the prior injuries.

“Dr. [M’s] 6% whole person impairment, as noted by the [appeals court], closely resembles the true impairment arising from the compensable injury,” the court wrote.

The court affirmed that decision.