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March 17, 2023
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In Fegley v. Firestone Tire & Rubber, the Commonwealth Court of Pennsylvania determined that, when medical marijuana treatment has been found to be reasonable and necessary to treat an employee’s work-related injury, an employer is required to reimburse the employee for the costs of obtaining their medical marijuana treatment.
Here, an employee suffered a work-related injury to his back in September of 1977 and received ongoing medical treatment, including several back surgeries and prescriptions for opiates and narcotics over the course of 30 years. In January of 2019, the employee began taking medical marijuana at the recommendation of his doctor, with the hopes of eliminating the need for prescription opiates and narcotics to treat his ongoing pain in his legs and back. As a result of the medical marijuana, the employee was ultimately able to wean himself off the other prescription drugs, and in September of 2019, a utilization review (UR) determined that the employee’s use of medical marijuana was reasonable and necessary. A month later, the employee filed a penalty petition, alleging that his employer violated the Pennsylvania Workers Compensation Act (WC Act) by failing to pay for his medical marijuana treatment, despite the UR determination declaring that such treatment was reasonable and necessary.
In reviewing the employee’s petition, the Court said that the WC Act requires reimbursement to employees for reasonable and necessary expenses resulting from work-place injuries, including medical marijuana treatment where such treatment had been designated accordingly. The Court observed that the Pennsylvania Medical Marijuana Act (MMA) deems marijuana to be a legitimate treatment of medical issues under proper circumstances, and that medical marijuana patients cannot be “denied any right or privilege, … solely for [their] lawful use of medical marijuana.”
Distinguishing the MMA’s “Conflict” provision, the Court found that the absence of the term “reimbursement” was significant. Specifically, the MMA’s “Conflict” provision states that “[n]othing in [the MMA] shall be construed to require an insurer or a health plan, … to provide coverage for medical marijuana.” The Court reasoned that, while the MMA does not require “coverage” for medical marijuana, there is no express language in the MMA that precludes a WC carrier from reimbursing a claimant for medical expenses that are reasonable and necessary to treat a work-related injury. The Court noted this conclusion is consistent with both the WC Act’s reimbursement requirement, and the MMA’s endorsement of medical marijuana and corresponding prohibition against denying rights or privileges based solely on medical marijuana use.
- Review and update applicable workers’ compensation policies.
- Consult with legal counsel when evaluating claims for reimbursement to employees for work-related medical treatment expenses, including claims for reimbursement of medical marijuana treatment and expenses.
- Subscribers can call our HR On-Call Hotline at (888) 378-2456 for further assistance.
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