A Pennsylvania appeals court found that injured employees could be reimbursed for medical marijuana that was deemed necessary by a physician.
In the March 17, 2023, decision in Teresa L. Fegley, Executrix to the Estate of Paul Sheetz v. Firestone Tire & Rubber, the appeals court determined that an injured worker was entitled to reimbursement for medical marijuana that his doctor prescribed.
Medical weed used to wean him off OxyContin, diazepam
Paul Sheetz was employed by Firestone Tire & Rubber. Sheetz was injured on the job on Sept. 19, 1977, and received continuing medical reimbursement from Firestone. He had to undergo two back surgeries. and was prescribed painkillers, including OxyContin, according to law firm Wilson Elser.
In January 2019, Sheetz began receiving recommendations for medical marijuana, which he used to wean himself off of OxyContin and diazepam. Firestone refused to pay for the medical marijuana, leading Sheetz to file for workers’ compensation.
A workers’ compensation judge denied the claim and the state’s Workers’ Compensation Board upheld the judge’s decision, which led to an appeal in the Commonwealth Court of Pennsylvania.
Sheetz died at some point while the legal proceedings were ongoing and his estate took over the workers’ compensation claim.
State law doesn’t exclude reimbursement under MMA
The court acknowledged the conflict between Pennsylvania state law, which recognizes medical marijuana as a legitimate form of treatment and federal law, which considers any form of marijuana illegal.
Firestone hadn’t waived a provision of the state’s Medical Marijuana Act (MMA) that states the act doesn’t mandate insurers to provide coverage for medical marijuana treatment, according to the court. This meant that Firestone couldn’t be “excluded from the undefined term ‘insurer’ under the MMA with respect to its duties to provide workers’ compensation benefits to its former employee.”
While Firestone couldn’t be compelled to provide insurance coverage under the MMA, the act also states that employees couldn’t be denied rights or privileges based on their medical marijuana use.
Several states specifically exclude reimbursement from their medical marijuana laws and “Pennsylvania’s failure to do so must be inferred as reflecting an intention that the MMA does not intend to exclude an insurer’s ‘reimbursement’ obligations.”
Denial isn’t justified for ‘medically necessary, legal treatment’
A workers’ compensation insurer can’t deny reimbursement for a medically necessary and legal treatment that the MMA recognizes as a valid treatment for chronic pain, the court said.
The court also found that providing reimbursement for medical marijuana prescribed by a physician under the MMA wouldn’t cause the workers’ compensation provider to violate federal law.
One judge dissented with the majority, finding that reimbursement of medical marijuana equates to dispensing a controlled substance under federal drug laws.
The majority decision is a matter of first impression in Pennsylvania, according to Wilson Elser, and is consistent with similar holdings in Connecticut, New Hampshire, New Jersey and New Mexico.