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POCTs, Insurance Coverage and the Case for Confirmation Testing

If your company doesn’t require confirmation testing on non-negative POCT drug screens or if you are considering this non-inclusion of confirmation testing as part of your testing policy, you should take a close look at recent trends in the insurance industry south of the border.  It is best practice to confirm non-negative POCT drug screen results through a laboratory analysis, and some insurance providers will only offer coverage if you follow this standard.

Just last week, the U.S.-based Drug and Alcohol Testing Industry Association (“DATIA”) issued a warning for employers to make sure they follow best practices  when it comes to drug and alcohol testing, meaning  mirroring the spirit and structure of the U.S. Department of Transportation (DOT) testing regulations for all non-DOT testing programs however conducted.  DATIA says the number of insurance claims made and paid out is increasing substantially and the vast majority of cases are due to drug test results being reported based solely on screening/POCT device results where such technology has been used.

In some cases, insurance companies are stipulating that only results reported after being confirmed through laboratory-based testing are covered under their insurance policy – a clear indication that companies are expected to follow industry best practice. It is possible Canadian employers could have similar problems here if an insurer were to learn that its client failed to use best practices by doing POCT screening only without laboratory confirmation testing of non-negative POCT specimens.

It’s true that U.S. liability insurance carriers are very familiar with DOT regulations and gold standards in the non-DOT arena, whereas some Canadian insurance carriers may not. However, you would be amazed at how quickly insurance carriers can become familiar with these best practices once an employer faces a claim! Once Canadian insurers catch wind of what’s happening in the U.S., it could pave the way for similar trends here.

What is the best practice for non-DOT regulated employers?

When performing laboratory drug testing, the standard practice is and has always been to perform an immunoassay screening test and then perform a confirmation test (using GC/MS or a similar mass spectrometry  technology) on all specimens that screen non-negative. When point of collection drug testing (POCT) kits first entered the market to be used in place of the initial laboratory screening test, DATIA issued a policy statement indicating that it endorsed the use of POCT devices provided that all specimens with non-negative results are sent to the laboratory for confirmation testing.

An express test or POCT is a portable test that is done in the field, instead of at the lab. It gives employers a quick snapshot that may or may not reflect the actual result. The POCT also uses immunoassay technology but its accuracy rate is slightly lower than lab-based immunoassay testing, depending on the brand of kit used and the drugs tested for. While POCT devices do show a “positive” result as one type of outcome, it is important to note that that finding is based solely on screening test science. Only with a more precise, laboratory confirmation method such as GC/MS can one be confident in the accuracy of a positive result.

The lab-based drug test has two stages. The first is an initial screen test completed at an accredited laboratory using immunoassay technology, a type of biochemical test that has an accuracy rate of over 99%. If the screen test is non-negative, a GC/MS confirmation test follows. The GC/MS technology is the gold standard, and is highly technical and accurate scientific analytical equipment that precisely identifies different drugs and their quantities.

If the laboratory confirmation result is positive, the result should be reviewed by a Medical Review Officer for final determination. Part of the MRO process involves identifying whether or not a valid medical explanation exists to explain a positive test result, thereby ensuring a worker is not declared to be in violation of the employer’s testing policy where a valid medical reason is verified.

These industry standard/best practices relating to POCT are meant to protect the employer, the employee, and the service provider.

Was this post helpful? If you would like more information on best practices for alcohol and drug testing or have any questions around POCT drug screening and laboratory testing, we encourage you to reach out to us!