JACKSONVILLE, Fla. - Kenneth Smith 63, recently learned that his insurance company will no longer pay for his opioid prescriptions.
Smith uses hydrocodone, Nucynta and tizanidine to treat the pain in his neck and shoulders.
"It is a sharp pain," Smith said. "These fingers go to sleep sometimes during the day when I am doing something.
Smith's life of pain began an accident in 2006. He said he was driving his employer's vehicle when he was hit.
"I've been in pain ever since," he said.
The injury impacted him and his family so badly, Smith filed a workers compensation claim with the State of Tennessee.
Why there? He lived and worked in Tennessee at the time of the accident.
"My outcome of the claim was I was supposed to have permanent medication and care by the doctors," he said.
What was promised in his claim, it changed after January 5, 2018.
Smith received a letter from the Bureau of Workers Compensation confirming his meds were being cut off.
The letter read in part that his medical records were reviewed and they (workers comp) agreed with Sedgwick, his insurance company, to deny coverage.
No explanation if the decision was related to the opioid crisis or not or if a review determined there was abuse.
"They didn't say," he said. "They said according to their doctors I no longer need the pain medicine."
Smith and his wife are worried about his well being going forward.
"I was very upset," he said. "I'm afraid of going into withdrawals."
The Navy Veteran is very concerned about what will happen next. How will his body handle it?
Being on a fixed income he said he cannot afford to pay $480 per prescription.
The January letter did leave room for weaning him off. It stated:
"Continuation of one of the opioids for the purpose of weaning is necessary.It is suggested to discontinue one of the opioids and document the functional improvement afforded by any of the medications. "
"I understand their concerns, but people like me that is not abusing them they need to come up with something to give us for pain because our pain doesn't go away," Smith said.
We contacted both the insurance company and the Bureau of Workers Compensation in Tennessee for comment. No comment from Sedgwick, but the bureau of workers compensation provided the following statement:
"There are many legacy workers’ compensation cases in Tennessee that have been using a large amount of opioids for extended periods of time. Because of this, the workers’ compensation law has a utilization review process that exams the amount of opioids a physician is prescribing each month and uses a second Tennessee physician to review the case for another opinion. After that utilization review, the insurance carrier can recommend weaning a person off of opioid medications. The claimant can appeal that decision with the Tennessee Bureau of Worker’s Compensation’s independent medical director."
Smith did go through the Bureau’s utilization review appeals process.