eNotes: Workers’ Compensation – April 2023 – Pennsylvania

SIGNIFICANT CASE SUMMARIES

Pennsylvania Case Summaries

E. Appel v. GWC Warranty Corp.
PA Commonwealth Court
824 C.D. 2021

Decided: March 17, 2023

Where a WCJ finds medical marijuana casually related to a work injury, the employer is required to reimburse the claimant for out of pocket expenses for the medical marijuana.

Background

Here, a WCJ found that the claimant’s prescribed medical marijuana was causally related to the work injury. The employer argued that paying for the medical marijuana would violate the Federal Controlled Substance Act, which prohibits the unlawful distribution and dispense of controlled substances, which includes marijuana. 21 U.S.C. § 841(a). The employer further cited to Section 2102 of the MMA, which provides: “nothing in [the MMA] shall be construed to require an insurer or a health plan, whether paid for by Commonwealth funds or private funds, to provide coverage for medical marijuana” and Section 2103(b)(3) of the MMA, which provides: “nothing in [the MMA] shall require an employer to commit any act that would put the employer or any person acting on its behalf in violation of [f]ederal law.” 35 P.S. § 10231.2102; 35 P.S. § 10231.2103(b)(3).

The Court ruled in favor of the claimant, holding that Section 2102 of the MMA does not prohibit insurers from reimbursing payment for medical marijuana. The Court reasoned that since the employer was not prescribing marijuana, but rather simply reimbursing claimant for his lawful use thereof, employer would not be in violation of the Federal Controlled Substance Act. The Worker’s Compensation Act requires employers to reimburse claimants for out-of-pocket costs of medical treatment which has been found to be reasonable and necessary for their work-related injuries. Here, the WCJ found the medical marihuana reasonable and necessary and causally related to the work injury. Thus, the employer was required to reimburse the Claimant for his out-of-pockets expenses.

Holding

Because Section 2102 of the MMA does not prohibit insurers from reimbursing medical marijuana expenses, and the WCJ concluded that Claimant’s lawful medical marijuana use was causally related to the work injury, under Pennsylvania Workers’ Compensation Act the employer was required to reimburse the claimant for out-of-pocket costs of medical marijuana.

Takeaway

Employers are not exempt from reimbursing claimants for medical marijuana expenses where the medical marijuana is found to be reasonable and necessary and causally related to a work injury.

Questions about this case can be directed to Cailey Farinaro, Esquire at 610-332-7008 or cfarinaro@tthlaw.com.

T.L. Fegley, as Executrix of the Estate of P. Sheetz v. Firestone Tire & Rubber
PA Commonwealth Court
680 C.D. 2021

Decided: March 17, 2023

Where a Utilization Review Determination finds medical marijuana casually related to a work injury, the employer is required to reimburse the claimant for out of pocket expenses for the medical marijuana.

Background

Here, the claimant filed a penalty petition against the employer alleging that the employer violated the Workers’ Compensation Act by failing to pay for his medical marijuana treatment, despite a UR determination having declared that such treatment was reasonable and necessary. The employer argued that it was not required to pay for the medical marijuana, as the plain language of the MMA provides: “Nothing in [the MMA] shall require an employer to commit any act that would put the employer or any person acting on its behalf in violation of [f]ederal law.” 35 P.S. § 10231.2103(b)(3). Further, the Federal Controlled Substance Act specifically prohibits the unlawful distribution and dispense of controlled substances, which includes marijuana. 21 U.S.C. § 841(a).

The court found in favor of the claimant and required the employer to reimburse the expenses for the medical marijuana. The court reasoned that Section 2102 of the MMA only prohibits an insurer from being compelled to provide coverage for medical marijuana.” 35 P.S. § 10231.2102. “Coverage” refers to the insurer paying the provider directly for a medical service, while “reimbursement” signifies the insurer paying the patient for the costs of medical treatment already incurred and paid.

Holding

The employer was required to reimburse the claimant for his medical marijuana that the UR determination found reasonable and necessary.

Takeaway

While insurers cannot be compelled to provide coverage for medical marijuana under the MMA, they can be compelled to reimburse claimants for medical marijuana causally related to the work injury.

Questions about this case can be directed to Cailey Farinaro, Esquire at 610-332-7008 or cfarinaro@tthlaw.com.