NORCAL Group claims involving opioid therapy in chronic pain management patients generally involve overdose deaths. Allegations supporting negligence claims against physicians include: excessive opioid prescribing; failure to refer the patient for pain management, addiction, and/or behavioral health treatment; failure to discover the patient was doctor shopping; failure to recognize suicide risk; and negligent tapering. This article uses NORCAL Group closed claims, policyholder inquiries, and a recent medical board action to support pain treatment plans that optimize function, quality of life, and productivity while minimizing risks for opioid misuse and harm.