Landmark PA Supreme Court Ruling Expands Workers’ Compensation Benefits
Workers’ compensation lawyer Mark Schmidt won a landmark decision from the Supreme Court of Pennsylvania on March 20, 2025, which benefits ALL injured workers across Pennsylvania. The issue arose from his own work-related back injury. Conventional treatment did not sufficiently relieve his pain. After discussing a variety of options with his doctor, it was decided to try CBD oil rather than increasing the dose of pain medicine or undergoing the risk and lengthy recovery from surgery.
The Case: Why Mark Schmidt Fought Back
The insurance company refused to reimburse the cost for this legal, non-prescription item, arguing that the law only requires an insurance company to pay for pharmaceutical drugs. Schmidt, a Certified Workers Compensation Specialist Lawyer representing himself, disagreed with the insurance company and filed a petition against them.
The Legal Battle: From Judge’s Ruling to the PA Supreme Court
The judge found in Schmidt’s favor, resulting in an insurance company appeal. The Workers’ Compensation Appeal Board Reversed the judge, followed by Schmidt’s appeal to the Commonwealth Court. That Court again ruled in Schmidt’s favor, only to be appealed again to Pennsylvania’s highest court.
The Supreme Court’s Decision & What It Means
In a unanimous en banc Decision, the Supreme Court of Pennsylvania held that any item that is part of a healthcare provider treatment plan for a work-related injury falls within the broad encompassing phrase “medicines and supplies” as provided in the Workers Compensation Act and must be covered by the insurance company.
The court further held that the injured worker may be reimbursed for their full cost and is not subject to the rules, requirements, and reimbursement rates that apply to healthcare providers because the injured worker is not a healthcare provider as defined by the law. (The Court did note an insurer’s ability to challenge whether treatment is reasonable and necessary through a separate process called Utilization Review.)
How This Ruling Benefits All Injured Workers
This decision benefits all injured workers across Pennsylvania as follows:
- Expands insurance coverage for necessary treatments
- Ensures injured workers can receive alternative medical options without paying out-of-pocket
- Confirms that insurers must cover documented treatment expenses
It entitles them to reimbursement for the costs they incur out of their own pocket to obtain items to treat their work-related injuries, provided the items are documented as part of their treatment provider’s plan.
Your Workers’ Compensation Lawyer Fees May Be Covered
Pennsylvania law requires insurance companies to pay attorney fees for cases involving medical treatment disputes—meaning you may get free legal representation when challenging unfair claim denials.
Previous decisions issued by Pennsylvania’s highest court enable injured workers to obtain skilled attorneys to represent them at the insurance companies’ cost! Where an issue in a Worker’s Compensation case involves only medical treatment (and does not involve the worker‘s wage loss benefits), previous Pennsylvania Supreme Court decisions held that the insurance company must pay the fee of the claimant’s lawyer.
Injured at Work? Get Legal Help Today
If you or someone you know was injured at work, you need an experienced workers’ compensation lawyer. Learn more about Pennsylvania’s workers’ compensation laws in our Workers’ Comp Benefits Guide. For a free consultation, contact the Certified Workers’ Compensation Specialist attorneys at Schmidt, Kirifides, Rassias, and Rio at 610-892-9300 or online at https://www.pahurtatwork.com/.