What to do when a claimant is on benzodiazepines long-term

Managing the risks and complexities of long-term benzodiazepine prescribing in insurance claims

Published: 3 April 2026 | Updated: 3 April 2026

Why this is your problem

You've noticed a claimant has been on benzodiazepines for years. The prescription keeps getting renewed. Nobody seems to be questioning whether this is still appropriate, and you're left wondering: should I be funding this indefinitely? What's my liability if something goes wrong? Is there a dependency issue I need to address?

You're right to be concerned. Long-term benzodiazepine use is one of the clearest gaps between what clinical evidence supports and what actually happens in practice. Your claim, your risk, your responsibility.

The clinical reality you need to understand

Benzodiazepines are effective for acute anxiety and insomnia. The clinical evidence strongly supports short-term use (2-4 weeks maximum). After that, efficacy declines, dependence develops, and risks escalate substantially. Yet many claimants end up on them for months or years.

Here's what the evidence tells us about long-term benzodiazepine use:

• Tolerance develops: Within weeks, the medication becomes less effective. Users need escalating doses to achieve the same effect
• Dependence is inevitable: Physical dependence develops in roughly 30-40% of users within 2-4 weeks. Psychological dependence often develops faster
• Withdrawal is difficult: Stopping benzodiazepines after long-term use can trigger severe rebound symptoms; tapering must be slow (weeks to months)
• Cognitive impacts accumulate: Long-term use is associated with memory impairment, attention deficits, and slower processing speed
• Fall risk increases significantly: Particularly important for older claimants; fractures and injuries from falls add substantial cost and morbidity
• Interaction risks multiply: Combined with pain medications, antidepressants, or other CNS depressants, risk of oversedation and respiratory depression rises

Your assessment framework

When you discover long-term benzodiazepine use, work through these questions:

Your options and decision pathways

Option 1: Initiate a medication review and deprescribing plan

When to use this: Claimant on benzodiazepines for 3+ months, especially if doses are escalating or alternatives haven't been explored.

Request a pharmacy review with an explicit focus on deprescribing. A pharmacist can assess the claimant's dependency level, design a safe tapering schedule, identify potential withdrawal syndrome precursors, and recommend alternative medications or therapies. This is the evidence-based approach.

The goal isn't punitive; it's to move the claimant toward safer, more evidence-based treatment. Deprescribing requires active planning and monitoring. You can make funding conditional on the claimant engaging with a deprescribing program.

Option 2: Require prescriber justification and ongoing monitoring

When to use this: Benzodiazepine use that has a clear ongoing clinical indication (e.g., seizure management post-TBI) but warrants scrutiny.

Write to the prescriber requesting documented justification for continued benzodiazepine use at the current dose. Ask them to specify: the ongoing clinical indication, whether alternatives have been trialled, expected duration, and monitoring plan. Request updates every 3-6 months. This creates accountability without immediately ceasing a medication they've prescribed.

Often, prescribers haven't formally reconsidered the medication for months. Your inquiry prompts a reassessment. Sometimes they'll recognize it's no longer needed and initiate deprescribing themselves.

Option 3: Decline to fund continuing benzodiazepines; fund deprescribing support instead

When to use this: Long-term benzodiazepine use with no clear ongoing indication, or when prescriber can't justify continuation.

You can decline to fund indefinite benzodiazepine prescriptions, but you must fund the process of stopping them safely. Deprescribing support might include: pharmacy medication reviews, general practitioner consultations focused on tapering, psychological support (anxiety management coaching, CBT), and alternative medications needed during the transition.

This approach protects the claimant and your scheme. You're not abandoning them; you're redirecting funding toward a safer, evidence-based path.

Option 4: Investigate whether this is actually a workers compensation cost

When to use this: Benzodiazepines prescribed long after the acute injury phase, especially if the claimant has comorbid mental health conditions unrelated to the injury.

If a claimant has been injured, recovered from the acute injury but is now on long-term benzodiazepines for generalized anxiety disorder (unrelated to the injury), should your workers compensation scheme be funding this indefinitely? Probably not. This might transition to private or Medicare funding. Clarifying the causation link between the injury and the ongoing medication need is important.

Practical triggers for intervention

You don't need to question every benzodiazepine prescription. Focus your effort on these red flags:

• Prescribed continuously for 3+ months: Short-term guidelines have been exceeded
• Dose increasing over time: Suggests tolerance or escalating use
• Prescriber is a GP and indication is anxiety/insomnia: Specialist review may be warranted
• Multiple CNS depressants combined: Opioids + benzodiazepines + anticholinergics = high-risk polypharmacy
• Claimant age over 65: Benzodiazepines carry elevated fall risk in older adults
• Claimant injury is resolving but benzodiazepines continue: Is this still injury-related?
• Early refills or requests for dose increases: Possible misuse

Managing the conversation with prescribers

Many prescribers feel defensive about benzodiazepine inquiries; they may interpret your question as criticism. Frame it constructively:

• Lead with: "We're supporting best-practice medication management. Can you help us understand the ongoing clinical indication for benzodiazepines in this case?"
• Don't say: "Why is this person still on benzos after two years?" (sounds accusatory)
• Don't assume the prescriber is negligent. Often, they've simply renewed the prescription without actively reconsidering it
• Offer solutions: "If you think the claimant would benefit from exploring alternatives or a structured tapering plan, we can fund a pharmacy review to assist"

Deprescribing: what you need to know

If you decide to support benzodiazepine deprescribing, understand that it's not a simple stop. Abrupt cessation after prolonged use is unsafe and can trigger severe rebound symptoms, seizures, or psychiatric crises. Effective deprescribing requires:

• Slow tapering: Typically 5-10% dose reduction every 1-2 weeks; may take months to complete
• Medical supervision: Doctor or pharmacist monitoring for withdrawal symptoms
• Psychological support: Therapies addressing underlying anxiety to prevent relapse
• Alternative medications: SSRIs or other agents to manage anxiety during transition
• Claimant engagement: They must understand the plan and be motivated to complete it

Deprescribing isn't quick and it isn't cheap, but the long-term cost of continued benzodiazepine funding (medical complications, falls, prolonged dependence) typically exceeds the cost of structured deprescribing support.

Key takeaways

• Long-term benzodiazepine use contradicts clinical evidence and creates substantial risks
• Use your six-question assessment to evaluate whether continuation is justified
• Prioritize deprescribing, but do it safely through structured tapering and support
• Request prescriber justification and ongoing monitoring for any long-term benzodiazepine prescription
• Refer for a pharmacy review when you're uncertain or when deprescribing is planned
• Frame your interventions constructively; most prescribers will engage if approached respectfully