Hamberger & Weiss LLP

Board Announces New Opioid Weaning Process

The Board has announced a new hearing process for opioid weaning issues. The RFA-2 form has been modified to include a new hearing purpose under the “Medical Issues” section of the form labeled “Opioid Weaning under Non-Acute Pain Guidelines.” To use this section of the form, the Board is requiring an Independent Medical Examination or records review which states weaning is appropriate and provides a weaning program or resource. There is no requirement for an IME or record review within the regulations or the Medical Treatment Guidelines. The burden is on the attending physician to comply in the first place. In fact, there are some Board Decisions that direct weaning without an IME or record review, or when such a report was already precluded. Nevertheless, we always recommend an IME or record review as they tend to provide appropriate alternatives and weaning plans.

Once the employer, carrier, or administrator files the RFA-2 for opioid weaning, the claimant is to obtain a report from his or her prescribing physician, which must be filed by the date of the hearing. The hearing should be held approximately 45 days after the Board notifies the claimant of your request for a hearing. If the claimant wishes to depose the IME, such transcript must be submitted to the Board before the hearing. If the claimant submits contrary medical, the employer/carrier may request cross-examination of the provider at the hearing.

The WCLJ will issue a ruling that either directs weaning, weaning and enrollment in an addiction treatment program or no weaning. The employer/carrier will be required to cover the cost of any addiction treatment program or weaning protocol. If the WCLJ orders enrollment in an addiction treatment program, after 30 days the employer/carrier will only be liable for payment of narcotic prescriptions written by an addiction treatment program physician. The Board has developed a brochure with the cooperation of the NYS Office of Alcoholism and Substance Abuse Services with information regarding addiction treatment services available throughout the State.

Certainly, these are continuing moves in the right direction on this issue.

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