Recent Pennsylvania case law has opened the door to possible reimbursement of medical marijuana costs in Workers’ Compensation cases. However, the law is still developing and is in flux. Read on to learn more about the current state of medical marijuana in Pennsylvania Workers’ Compensation.

Medical Marijuana for Pain Management

Some injured workers may have medical marijuana prescribed by their treating physician as a form of pain management. This is often done as an alternative to opioid medications which can be addictive and dangerous.

A problem workers may run into, however, is that employers and insurers generally do not want to pay for medical marijuana. They want to avoid paying for as much as they can, and denying payment for medical marijuana is one way to cut costs.

Additionally, marijuana use – even medically – is still illegal under the federal Controlled Substances Act (CSA). Some employers and insurers will refuse to pay for medical marijuana because they do not want to run afoul of this law.

And, there are many who still consider the use of marijuana socially unacceptable or who may be concerned about its use interfering with a worker’s ability to function properly on the job. This can be another reason for an employer to reject requests for payment of medical marijuana.

Conflict Between Workers’ Compensation and the Medical Marijuana Act

Pennsylvania’s Workers’ Compensation Act (WCA) does not bar medical marijuana as a treatment option. However, there is a possible conflict between the WCA and the Medical Marijuana Act (MMA).

Employers and insurers may claim that the language of the MMA prevents them from being required to pay for medical marijuana. And if the MMA was the only act governing medical marijuana, they would be correct.

But, employers and insurers also have to adhere to the Pennsylvania Workers’ Compensation Act and the Act gives injured workers the right to be compensated for reasonable and necessary treatments prescribed by their treating physician in relation to their work injury.

For injured workers, the most difficult hurdle will be proving, through medical testimony, that the prescription is for the work-related injury and not other ailments such as anxiety. This will be key to the success or failure of a claim for medical marijuana to be covered.

The doctor treating your injuries and being relied on for testimony in your case is usually different than the doctor approved to prescribe medical marijuana. And in some cases, the prescribing doctor may not be willing to testify or may not adequately document the cause for your prescription.

Reimbursement vs. Payment

In March of 2023, the PA Commonwealth Court issued opinions with the intent to clarify the possible conflict between the MMA and WCA.

The court found an insurance carrier may be ordered to reimburse an injured worker after they have paid out of pocket for medical marijuana that has been proven to be work-related. However, there is no clear guidance on whether the insurer may be billed directly or can be forced to pay the medical marijuana provider directly.

There is language in the recent decision that suggests direct billing/payment may be approved in the future. But, we are not there yet – the fight is still continuing.

Something else to consider is that even if you are able to prove the medical marijuana is related to your work injury, your employer/insurer may challenge the reasonableness or necessity of the treatment.

Decisions Likely to Be Appealed

The decisions regarding medical marijuana are not yet final, as they are likely to be appealed to the Pennsylvania Supreme Court. However, in the interim, the decisions stand.

If you have been prescribed medical marijuana and seek reimbursement or payment, call to discuss it with your attorney.

Contact Hillsberg Law

My name is Geoffrey Hillsberg, and I have been solely practicing workers’ compensation law in the State of Pennsylvania since 1995. If you have been injured on the job in Delaware County and have questions about whether your medical marijuana use can be reimbursed, give me a call today.

The advice offered above is general in nature and may not be applicable to every case. Consultation with an attorney is highly recommended. Reliance on this advice does not represent the formation of an attorney-client relationship in the absence of a fee agreement with Mr. Hillsberg.

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