Mark Schmidt Presents Oral Arguments in Landmark Case Before the Pennsylvania Supreme Court

Oral argument before The Supreme Court of Pennsylvania En Banc in the case of Schmidt v. Schmidt, Kirifides & Rassias took place on November 20, 2024. The issue involved a Workers’ Compensation insurer’s responsibility to reimburse an injured worker for out of pocket costs they incur for “medicine and supplies”, such as CBD oil (specifically), herbal remedies and supplements (generally) and other items that do not require a formal prescription; and secondarily, whether the cost containment rates, and submission of proper billing forms are required from the injured worker.

Counsel for the employer was questioned by the Supreme Court Justices for slightly over one hour. The argument primarily focused on the danger presented by CBD oil specifically, though many of the questions sought to change the subject to other types of items. Several Justices suggested stronger arguments defendant may have - such as the lack of sufficient records from the treatment provider to establish the specific item in this case was documented to be part of the treatment plan.

Claimant’s comparatively short presentation began by specifically addressing the Justices’ concerns brought up during defendant’s argument.  He stated that the Provider did submit his records to the insurer, a Utilization Review was performed and a different Judge Ruled in favor of claimant. The issue regarding the reasonableness and necessity of the item involved is not before This Court, nor was it before the Worker’s Compensation Judge because it was handled as a separate petition. Claimant also argued that the Medical Cost Containment provisions of the Workers’ Compensation Act expressly apply only to “Providers” - an entity specifically defined by the Act. The rates an insurer must pay for “drugs” and billing rules and requirements do not apply to an entity that is not a “Provider”. The Act uses the word “drugs” in these provisions, demonstrating that the General Assembly knew the difference between “medicine and supplies” and “drugs.”

It is impossible to determine simply from the questions asked which direction any Justice may be leaning. There are certainly issues and arguments raised in each parties’ briefs that will impact the Final Decision. The Supreme Court of Pennsylvania will soon determine whether the words “medicine and supplies” are broad, and the item at issue (CBD oil) could fit the definition of either a medicine (as determined by the Commonwealth Court) or a supply (as decided by the Worker’s Compensation Judge and the Commonwealth Court’s concurring opinion). The result will surely impact the availability of treatment options for all injured workers in the future. Reach out online now to hear more from Mark Schmidt.