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Workers' Compensation

Why Medical Marijuana Is Covered by Workers’ Comp. in Pennsylvania

— April 4, 2024

You still need approval from your treating physician and proper registration for a medical marijuana card, and medical marijuana is not going to be right for everyone.

Medical marijuana is sometimes controversial, but since Pennsylvania made marijuana available as a therapeutic in 2018, millions of Pennsylvanians have found it helpful in treating many serious conditions. All kinds of uses have been proposed and studied for medical marijuana, including pain management, appetite improvement, and managing anxiety. As such, it is not surprising that Pennsylvania’s Workers’ Compensation Act requires coverage for medical marijuana.

In a recent 2023 ruling, the Commonwealth Court of Pennsylvania held that medical marijuana costs do need to be reimbursed under the Workers’ Compensation Act. The ruling is a bit complex and has some intricate interactions with federal law and the Medical Marijuana Act that are worth investigating to understand how and why medical marijuana is covered under Pennsylvania’s Workers’ Compensation laws.

Marijuana is Illegal Under Federal Law, So How Can Pennsylvania Cover It?

One of the biggest controversies surrounding marijuana for medical or recreational use is that it is illegal under federal law. The United States criminalizes the possession, use, and distribution of marijuana, calling marijuana a Schedule I drug. For a drug to be classified as Schedule I, it is supposed to have no therapeutic use and a high risk of addiction that justifies making it unreachable even for many research purposes, let alone personal medical or recreational use.

Many studies have shown that marijuana does indeed have many therapeutic uses, and states have begun to legalize marijuana as medication for decades now – and some states have even started legalizing it for recreational use. This means that, under state law, it is legal to use it as prescribed by a doctor.

In Pennsylvania, you need to have a medical marijuana ID card, and it can only be bought from licensed dispensaries, keeping it well-regulated and available only to those with a doctor-approved medical need for it.

How Does Workers’ Compensation Cover Medical Marijuana in Pennsylvania?

In Fegley v. Firestone (2023), the Commonwealth Court of Pennsylvania affirmed that the Workers’ Compensation Act did require insurance companies to pay for medical marijuana just as it does any other necessary medical treatment. Still, the ruling is a bit confusing and relies on some interesting legal interpretations.

Medical Marijuana Act vs. Workers’ Compensation Act

Pennsylvania’s Medical Marijuana Act surprisingly says that insurance companies cannot be forced to cover medical marijuana for their insurance customers. This puts this law in direct contention with the Workers’ Compensation Act’s requirement that any and all medically necessary care be covered under Workers’ Compensation. How the court resolved this issue is actually quite interesting.

First and foremost, the Medical Marijuana Act’s phrasing says only that insurers cannot be required to provide “coverage” for medical marijuana. The court in this case determined that “coverage” means actually paying for the costs directly, meaning that it was perfectly legal to require insurance carriers to instead reimburse workers for their medical marijuana expenses. This might create some additional complications that you should speak to a Pennsylvania Workers’ Compensation lawyer about, but it should ultimately mean that your medical marijuana gets paid for as part of your claim, regardless of whether it is “covered” or “reimbursed.”

There was also some technical discussion over the fact that the Workers’ Compensation carrier is the employer’s insurance company, not the worker/patient’s insurance company, so these “coverage” bans don’t squarely apply to the worker’s care in this case anyway.

Workers’ Comp. Act Coverage for Necessary Medication

The case also held that the Pennsylvania Workers’ Compensation Act’s general requirement that the employer cover medical care, medication, and other care needs naturally includes medical marijuana. In the same way that your employer will need to pay for your surgeries, doctor’s visits, pain medication, or physical therapy, they will also have to pay for your medical marijuana – if it is medically required.

In the case at hand, the patient’s utilization review – a review performed by a doctor to determine what care is necessary – did find that medical marijuana was “reasonable and necessary.” A utilization review is usually going to be the controlling decision on what medical care needs to be provided to treat your injury, and both insurance carriers and the Workers’ Compensation Appeal Board often need to challenge these medical experts’ claims if they want to refuse paying for your treatment. Of course, if that review is wrong and denies you need certain care or medication, you might be able to get an outside examiner to provide a new report and use that to challenge the decision in your case.

Antidiscrimination Rules for Medical Marijuana Users

Another important facet of the Medical Marijuana Act in Pennsylvania is that it prevents discrimination on the basis that the patient uses medical marijuana. The court held that it would be denying that antidiscrimination right to patients if they gave insurance companies the ability to deny medical marijuana coverage.

This means that your employer’s Workers’ Compensation insurance carrier needs to treat medical marijuana like any other necessary medication and provide payment for it.

Will Medical Marijuana Help with My Workers’ Comp. Treatment?

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The patient at the center of the Fegley case – Paul Sheetz – apparently saw medical marijuana as a new opportunity to deal with his pain from a work injury. He had been dealing with his injury since 1977, facing back and leg pain that was treated with narcotics and other powerful medication. That included OxyContin, another controversial drug often considered to be the spark that caused the opioid crisis in America.

The doctors deemed medical marijuana in this case to be a safer alternative, and Sheetz was able to wean off of opioids and narcotics and instead start using medical marijuana to treat his pain in 2019. Like many patients, he was able to follow the advice of his doctors and use the right tool to treat his pain.

You still need approval from your treating physician and proper registration for a medical marijuana card, and medical marijuana is not going to be right for everyone. But, like other care and medication under Workers’ Compensation, you should not have to pay for it if you were injured at work.

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