May 10, 2023

The mandate from the Workers’ Compensation Act that employers must reimburse workers for reasonable and necessary out-of-pocket costs of treatment that were attributed to a workplace injury includes costs associated with the use of medical cannabis according to a ruling by the Commonwealth Court of Pennsylvania in the case of Fegley v. Firestone Tire & Rubber. While the Pennsylvania Medical Marijuana law does not require insurers or self-insured employers to provide coverage for medical cannabis as a general standard of care, this ruling marks a significant win for medical cannabis patient rights when it comes to workers compensation claims involving the use of medical cannabis.

The claimant was injured on the job and received treatment that included prescribed opioids for pain over the past 30 years until his doctor recommended he use medical cannabis.  Despite the doctor recommendation and a subsequent utilization review approving the claimant’s medical cannabis use, a Workers’ Compensation Judge denied the claimant’s petition to be reimbursed for his medical cannabis treatment. The decision was then appealed to the Workers’ Compensation Board and then to a state court to receive a favorable ruling.

An interesting aspect of the case was the court’s review of whether the reimbursement of medical cannabis expenses would cause an insurance carrier to violate federal law.  The court found that when insurance carriers reimburse claimants for out-of-pocket costs for the legal use of medical cannabis, they do not violate the federal Controlled Substances Act because the carriers are not manufacturing, distributing, or dispensing a controlled substance. This court decision could lead to legislation that either requires or allows insurance providers to cover or reimburse medical cannabis costs to patients.