Thursday, November 15, 2012

Death Benefits: More (Disturbing) Case Law

This morning's workcompcentral brings news of a Washington state decision that, in short, upheld surviving spousal benefits in light of an accidental death caused by a combination of six different medications and alcohol.  I'm not an attorney and won't dive into specifics (the article is here, the court decision here, and the dissent is here), but I was struck by two overarching facts:

First, this is just the beginning.  The work comp industry is going to see more and more accidental overdose deaths and courts are more likely than not to award death benefits as a result.  This is going to be expensive and has already caused some insurers and excess carriers to exit the work comp market.  Aggressively intervening in chronic pain cases with complex drug regimens is imperative or your claims organization is going to face liabilities not contemplated when the policy was underwritten. 

Second, note that the original 2004 claim for back injury was, in fact, closed.  And at the time the claim was closed in March 2005 (with no award for permanent partial disability), the injured worker was only taking ibuprofen.  Two years later, at 37 years old, the injured worker's wife found him dead.  Cause of death was determined to be accidental; the injured worker's blood alcohol level was actually lower than the state-presumed intoxication level, but traces of oxycodone, citalopram, desmethylcitalopram, alprazolam, Nortryptyline, amitriptyline, carbamazepine, Promethazine, and acetometophen were found in his system.  Quite a cocktail. 

The court determined that the causal link between the original injury and the accidental overdose had not been broken - not by the claim's closure, not by the time elapsed, not by the alcohol use, not by the mix of drugs consumed.  One could rationally argue, as the dissent in this case does, that the causal chain was, in fact, broken.

I happen to agree with the dissent.  But you know what?  Doesn't matter. 
Get ready to start paying more benefits related to accidental overdoses, perhaps even on claims you think are closed and never to be heard from again.

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