Schmidt v. Schmidt, Kirifides & Rassias: PA Supreme Court Expands Workers’ Comp Medical Benefits
Workers’ compensation lawyer Mark R. Schmidt won a major decision from the Supreme Court of Pennsylvania on March 20, 2025, expanding protection for injured workers seeking reimbursement for doctor-prescribed items used to treat a work injury.
The ruling addressed an important question under Pennsylvania workers’ compensation law: when a health care provider includes an item in a work injury treatment plan, can the insurance company refuse reimbursement simply because the item is not a traditional prescription drug?
The case arose after CBD oil was prescribed as part of treatment for a work-related back injury. The insurance company refused to reimburse the cost, arguing that Pennsylvania workers’ compensation law only required payment for pharmaceutical drugs. The Pennsylvania Supreme Court disagreed.
The Court held that an item prescribed by a health care provider as part of a treatment plan for a work-related injury may fall within the phrase “medicines and supplies” under the Pennsylvania Workers’ Compensation Act.
Case at a Glance
What Did the Pennsylvania Supreme Court Decide?
In Schmidt v. Schmidt, Kirifides and Rassias, PC, the Pennsylvania Supreme Court ruled that doctor-prescribed items used as part of a work injury treatment plan can qualify as reimbursable “medicines and supplies” under the Workers’ Compensation Act.
What Was This Pennsylvania Workers’ Compensation Case About?
The case arose from Mark Schmidt’s own work-related back injury. Conventional treatment did not sufficiently relieve his pain. After discussing treatment options with his doctor, CBD oil was prescribed as an alternative to increasing pain medication or moving toward surgery.
Mark paid for the CBD oil out of pocket and sought reimbursement through workers’ compensation. The insurance company refused to pay.
The insurer argued that CBD oil was not a pharmaceutical drug and therefore did not qualify for reimbursement under the Workers’ Compensation Act. Mark disagreed and pursued the issue through Pennsylvania’s workers’ compensation courts.
From the Workers’ Compensation Judge to the Pennsylvania Supreme Court
A Workers’ Compensation Judge originally ruled in Mark Schmidt’s favor and ordered reimbursement.
The insurance company appealed. The Workers’ Compensation Appeal Board reversed the judge’s decision. Mark then appealed to the Commonwealth Court of Pennsylvania, which ruled in his favor.
The insurance company appealed again to the Supreme Court of Pennsylvania.
On March 20, 2025, the Pennsylvania Supreme Court affirmed the Commonwealth Court and ruled in favor of Mark Schmidt.
What Did the Pennsylvania Supreme Court Decide?
The Pennsylvania Supreme Court held that an item prescribed by a health care provider as part of a treatment plan for a work-related injury can fall within the meaning of “medicines and supplies” under the Pennsylvania Workers’ Compensation Act.
That matters because workers’ compensation medical benefits are not limited only to traditional prescription drugs.
The Court also held that an injured worker seeking reimbursement is not subject to the same billing rules, forms, and reimbursement limits that apply to health care providers. An injured worker is not a health care provider.
In practical terms, an insurance company cannot automatically deny reimbursement simply because a prescribed treatment item is not a pharmaceutical drug or because the injured worker did not submit provider billing forms.
What This Means for Injured Workers in Pennsylvania
This decision is important because insurance companies often look for narrow reasons to deny payment for medical treatment after a work injury.
The ruling may help injured workers seek reimbursement for doctor-prescribed items that are part of a treatment plan, including certain non-traditional medical items, when those items are used to treat a work-related injury.
This decision may help when:
- A doctor prescribes or recommends an item as part of treatment for a work injury
- The injured worker pays for the item out of pocket
- The insurance company refuses reimbursement because the item is not a traditional prescription drug
- The insurer argues that the worker failed to follow billing rules meant for medical providers
- The treatment is connected to the accepted work injury
Does This Mean Every Medical Item Must Be Reimbursed?
No. This decision does not mean every product, supplement, or over-the-counter item must automatically be paid for by workers’ compensation.
The item still needs to be connected to the work injury and part of a health care provider’s treatment plan. The insurance company may also have the right to challenge whether treatment is reasonable and necessary through Pennsylvania’s Utilization Review process.
But the decision makes one thing clear: an insurance company cannot use an overly narrow reading of “medicines and supplies” to deny reimbursement for a doctor-prescribed item used to treat a work injury.
Why This Case Matters Beyond CBD Oil
This case is not just about CBD oil.
The larger issue is whether injured workers can be reimbursed for medical items that help treat a work injury when those items are prescribed by a health care provider but do not fit neatly into the insurance company’s preferred definition of a drug.
The Pennsylvania Supreme Court’s decision recognizes that medical treatment can involve more than traditional prescriptions. For injured workers, that can make a real difference.
When you are hurt at work, out-of-pocket treatment costs can add up quickly. This decision gives injured workers stronger support when seeking reimbursement for prescribed treatment-related items that are part of their care.
The Continuing Impact of the Schmidt Decision
The impact of this decision has continued beyond this case. In later Pennsylvania Supreme Court workers’ compensation decisions, the Court has relied on the reasoning from Schmidt when addressing medical treatment, reimbursement, and the broader purpose of the Workers’ Compensation Act.
Read more about how we helped shape recent Pennsylvania Supreme Court workers’ compensation decisions.
About the Firm Behind This Pennsylvania Supreme Court Case
This Pennsylvania Supreme Court victory was won by Mark R. Schmidt, a founding partner of Schmidt, Kirifides, Rassias & Rio and a Certified Workers’ Compensation Specialist. For more than 30 years, Mark has represented injured workers in Pennsylvania workers’ compensation claims, including complex litigation and appellate matters.
Schmidt, Kirifides, Rassias & Rio was founded to give injured workers a higher standard of Workers’ Compensation representation. Every workers’ compensation partner at the firm is certified as a specialist under Pennsylvania law, and the firm has handled more than 100 appellate matters, including cases before the Commonwealth Court of Pennsylvania and the Pennsylvania Supreme Court.
The firm’s attorneys have recovered more than $100 million for injured workers and bring more than 100 years of combined workers’ compensation experience to cases involving denied claims, stopped checks, medical treatment disputes, hearings, appeals, and settlements.
This case reflects the kind of work Schmidt, Kirifides, Rassias & Rio has done for decades: protecting injured workers, challenging insurance company denials, and helping shape Pennsylvania workers’ compensation law.
Injured at Work in Pennsylvania?
If your workers’ compensation claim was denied, your checks stopped, your treatment is being delayed, or the insurance company refuses to reimburse you for medical care connected to your work injury, our office can help.
Schmidt, Kirifides, Rassias & Rio represents injured workers throughout Delaware County, Philadelphia, and across Pennsylvania.
Call 610-892-9300 for a free consultation or contact us online.
You can also learn more about your rights on our Pennsylvania Workers’ Compensation Guide.