In a landmark Opinion rendered on March 17, 2023, the Commonwealth Court of Pennsylvania, in T.L. Fegley vs. WCAB, held that a claimant can seek reimbursement for out-of-pocket expenses relating to medical marijuana that were reasonable, necessary, and related to the work injury.
The Case: Reimbursement for Medical Marijuana Expenses for Work Injuries
The claimant suffered a serious work injury in 1977. He was prescribed opiates and narcotics for pain relief and used them for decades.
In 2019, his doctor prescribed medical marijuana to reduce the need for opiates and narcotics. Medical marijuana helped him tremendously. In September 2019, a Utilization Review found medical marijuana to be reasonable and necessary.
In October 2019, the Claimant filed a Petition for Penalties alleging that the Employer violated the Act by failing to pay for his medical marijuana. The Workers’ Compensation Judge denied the Penalty Petition. The WCAB affirmed, and an appeal was taken to the Commonwealth Court of Pennsylvania.
The Question: Is Medical Marijuana Legal For Medical Conditions?
The Court first reminded us that the Act Pennsylvania Workers’ Compensation Act is remedial in nature and has a humanitarian objective. The Court then turned its attention to the Federal Controlled Substance Act, noting that it’s unlawful to knowingly distribute, dispense, or manufacture a controlled substance. However, the Court noted that the FCSA leaves room for a state to enact its own law where the two can stand together consistently.
The Court then stated the Medical Marijuana Act contains language from the General Assembly, in part:
- Scientific evidence suggests that medical marijuana is one potential therapy that may mitigate suffering in some patients and also enhance the quality of life.
- The Commonwealth is committed to patient safety. Carefully regulating the program which allows access to medical marijuana will enhance patient safety while research into its effectiveness continues.
- It is the intent of the General Assembly 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.
- Provide a safe and effective method of delivery of medical marijuana to patients.
Essentially, the Court, here, was reminding us that medical marijuana is legal in Pennsylvania for serious medical conditions.
The Verdict: Insurers Must Reimburse The Claimant For Medical Marijuana Expenses Incurred
Having summarized the relevant statutes at play, the Court turned to analyze who an “insurer” is under the Medical Marijuana Act. It concluded because Work Comp carriers are insurers under the Insurance Law, “this Court cannot hold that they are not insurers for purposes of the MMA.”
Then it addressed the Claimant’s argument that the MMA only prohibits insurers be compelled to provide coverage for medical marijuana, not reimbursement for out-of-pocket expenses already incurred.
This is really the key point in this case: the claimant was not asking for coverage, but instead, reimbursement.
This was a clever argument that the Court agreed with. If the General Assembly wished that insurers be prohibited from reimbursing medical marijuana costs, it would have said so in the statute. It didn’t.
Indeed, as the Court said, “Under the doctrine of expressio unius est exclusio alterius, the inclusion of a specific matter in a statute implies the exclusion of other matters. Similarly, [the Pennsylvania Supreme] Court has long recognized that as a matter of statutory interpretation, although one is admonished to listen attentively to what a statute says[,] one must also listen attentively to what it does not say.”
Finally, the Employer argued that reimbursement of medical marijuana would cause them to violate Federal Law. The Court disagreed here, citing the fact that the Employer would not be “knowingly or intentionally– to manufacture, distribute, or dispense, or possess with intent to manufacture, distribute, or dispense, a controlled substance[.]” under the Federal Drug Act.
This Case Has Paved The Way for More Doctors To Prescribe Medical Marijuana
This well-written, well-reasoned, precedential Opinion has now paved the way for more injured workers to pursue medical marijuana for their chronic, intractable pain. If you have any questions, please let us know!,
Here is a link to the written Opinion in Teresa L. Fegley, as Executrix of the Estate of Paul Sheetz vs. Firestone Tire and Rubber (WCAB).
Contact a Top Pennsylvania Workers’ Compensation Lawyer Experienced with Medical Marijuana
We are here to help you, 7 days a week. Contact Cardamone Law, LLC for a free consult and analysis of your case at (215) 206-9068 or email Michael@CardamoneLaw.com We have offices in Eastern and Central PA or will come visit you, or we’re happy to do a Zoom call of course. Call the Pennsylvania Work Comp Medical Marijuana Lawyers at (215) 206-9068