On March 17, 2023, the Commonwealth Court of Pennsylvania issued two decisions ordering a workers’ compensation insurance company to reimburse the injured workers’ cost to obtain medical marijuana.
The Pennsylvania Workers’ Compensation Act requires an insurer to pay for “reasonable medicines and supplies… as and when needed” (emphasis by the Court).
The WC Act is intended to benefit injured workers. Once an injury is determined to be work-related, it is not the claimant’s obligation to prove treatment is reasonable, necessary and related to the injury; rather, it is the employer’s burden to prove treatment does not satisfy those requirements. Following a detailed summary of the WC Act, the Medical Marijuana Act (MMA) and Federal Law, the Court held that it is not a violation of Federal Law for an insurance company to reimburse claimant’s out-of-pocket cost to obtain Medical Marijuana (in a manner that is legal under the MMA). In a footnote, the Court stated it would not violate Federal Law even for insurers to provide direct coverage (paying legal medical marijuana providers directly).
Going even one step further, the Court held that it is a violation of the WC Act to deny payment for medical marijuana to treat a work-related injury – meaning that penalties may be imposed against the insurance company.
T.L. Fegley, as Executrix of the Estate of P. Sheetz v. Firestone Tire & Rubber (WCAB) – 680 C.D. 2021 FILED: March 17, 2023
(See also E. Appel v. GWC Warranty Corp. (WCAB) – 824 C.D. 2021 FILED: March 17, 2023)
Every Injured Worker NEEDS a lawyer who not only knows the law – as it is developing – but also stays one step ahead. The Certified Workers’ Compensation Specialist lawyers at Schmidt, Kirifides & Rassias have already brought the next issue to the Court’s attention: The right of injured workers to be reimbursed for over-the-counter medicines and supplies. Attorney Mark Schmidt argued this issue before the Court in November, 2022 – and the Court’s decision is expected shortly. His argument raised many of the same issues and reasons cited in today’s decision – 4 months ago!