Pennsylvania Court Decided That Workers’ Compensation May Be Responsible for Reimbursing the Cost of Medical Marijuana

The Pennsylvania Commonwealth Court recently made the decision that workers’ compensation benefits must reimburse expenses for medical marijuana in certain circumstances. This is great news for workers who use medical marijuana to alleviate their pain and suffering while recovering from various workplace injuries and illnesses. Some people were surprised by the ruling, but Pennsylvania is not the only state to make this type of decision. In fact, Connecticut, New Hampshire, New Jersey, New Mexico, and New York have made similar rulings.

About the case that led to the Court’s decision

Paul Sheetz experienced a back injury while at work in the late 1970s. He suffered chronic pain and several other issues due to the injury for over four decades. Sheetz had undergone a few back surgeries which were unsuccessful in giving him the relief that he needed, and opioids were causing him to experience poor side effects. After speaking with his physician about his desire to quit opioids, the physician helped him stop taking the very strong and heavily addictive OxyContin. Instead, he was prescribed medical marijuana, which was a lifesaver in his recovery.

However, the workers’ compensation insurance carrier refused to cover his medical marijuana even though Mr. Sheetz was saving them a fortune by weaning himself from the opioids and the routine drug testing. After a very lengthy court process, Sheetz prevailed. The court case was Fegley v. Firestone & Rubber, which was decided by the Pennsylvania Commonwealth Court in March 2023.

What does this ruling mean for injured workers in Pennsylvania?

According to Insurance Journal, Pennsylvania’s ruling now implies that “injured workers in Pennsylvania are entitled to be reimbursed for medical marijuana costs under the state’s workers’ compensation laws.” This does not mean that all medical marijuana expenses will be automatically covered.  Pennsylvania employers will now be required to reimburse “reasonable and necessary medical treatment,” which may include medical marijuana, once an independent review is conducted to evaluate the treatment. This review looks at many factors, including whether the medical records show that the treatment is benefitting the individual, whether there has been a reduction in the reliance on opioids, and whether the patient is complying with all treatment parameters, among other factors. Sheetz’s use of medical marijuana was found to be both necessary and reasonable, as he was able to better manage his pain and stop taking opioids.

When did Pennsylvania start allowing medical marijuana?

In 2016, Pennsylvania passed the Medical Marijuana Act, which allows the use of medical marijuana as long as it is only given to patients who have certifications. The goal of the Medical Marijuana Act is to “provide a program of access to medical marijuana which balances the need of patients to have access to the latest treatments with the need to promote patient safety.”

What are Pennsylvania workers’ compensation benefits?

Workers’ compensation is a benefit for injured or hurt workers. It provides individuals who were hurt on the job with wage loss and medical coverage  for their injuries. They may be stressed and overwhelmed by losing their income and not being able to pay their growing pile of medical bills, as well as afford their family’s daily necessities. However, workers’ compensation can take away this stress and frustration by giving a certain amount of money to replace part of their lost wages as well as cover their medical expenses while they are unable to work.

Deadlines to remember when reporting your injury and filing for workers’ compensation in Harrisburg, PA

If you were injured on the job and want to file for workers’ compensation, you have 120 days to report your injury to your supervisor or manager. You cannot simply tell a coworker or a person in the office; it must be reported to an individual who is in a supervisory or management position. It is also recommended that you report your injury in writing and save a copy for your records.

While you have 120 days to report your injury, the sooner that you can make this report, the more likely that your claim will be approved the first time. Insurance companies see delays as a red flag and will try to say that your injury was not serious enough to immediately report it.

After you have reported your injury to a manager or supervisor, you have three years from the date of injury to file a workers’ compensation’ claim. It is crucial that you do not miss this deadline, or you will not be able to receive any workers’ compensation benefits for your work-related injury.

How can a workers’ compensation lawyer help with my case?

When you need assistance filing a claim, the Harrisburg workers’ compensation lawyers at KBG Injury Law are here to help. Our experienced, skilled, and knowledgeable team will help you with the following:

• Determining the cause of your work-related accident
• Filing a workers’ compensation claim
• Gathering documents from your physician stating when you can go back to work
• Collecting necessary evidence
• Handling all communication with insurance companies
• Reviewing any decisions made regarding your workers’ compensation benefits
• Filing any third-party lawsuits
• Appealing denials

If you were injured while at work, please reach out to KBG Injury Law as soon as possible. Our workers’ compensation attorneys will listen to your experience and provide you with the best legal advice possible. We are dedicated to helping our clients navigate the long and difficult workers’ compensation process, ensuring that all paperwork is filed on time and that any problems that arise are addressed promptly. Please call our office or submit our contact form to begin discussing your claim today. Our team helps injured workers throughout all of South Central Pennsylvania, including York, Lancaster, Harrisburg, Gettysburg, and Hanover.