Court Decides Who Should Pay for Injured Worker’s Chronic Back Pain Treated with Medical Marijuana
In 2006, Edward Appel suffered a work-related herniated disc while on the job as an employee for GWC Warranty Corporation.
Appel went on to receive two lower back surgeries. He continues to experience chronic low back pain and symptoms in his legs, for which he’s been prescribed opioids.
By 2018, Appel was looking for an alternative pain management approach. After self-weaning off opioids, and dealing with the fallout of withdrawal symptoms, Appel’s request for a medical marijuana card was issued in April 2018.
By October that year, Appel filed a review medical petition “seeking a determination that his use of medical marijuana was causally related to his work injury and an order directing Employer to reimburse him for the cost thereof,” per court filings.
He testified that the medical marijuana had been more effective as a pain management medication than any other he’d taken for his chronic back and leg pain, including opioids.
Not until 2020 did a workers’ comp judge partially deny the review medical petition sighting that while Appel had met his burden of proving his medical marijuana use was related to an accepted work injury, he “failed to prove that Employer must reimburse him for his out-of-pocket medical marijuana expenses.”
The judge had reviewed the Medical Marijuana Act for guidance on this decision. Appel appealed the ruling, bringing the claim to the Workers’ Compensation Appeal’s Board for the Commonwealth of Pennsylvania.
The board concluded, in 2021, that “based on the plain language of the Medical Marijuana Act … an insurer or employer cannot be required to pay for medical marijuana.”
Again, Appel appealed.
The court reviewed all relevant filings surrounding Appel’s case.
First, it looked at the workers’ comp judge’s decision to partially deny Appel’s reimbursement request. In that conclusion, it was deemed that Appel’s medical marijuana use was lawful because his injury was casually related to the injury sustained at work.
Next, the board reviewed Pennsylvania workers’ comp laws, including the Workers’ Compensation Act.
The Act “mandates employers to reimburse claimants for out-of-pocket costs of medical treatment [that] have been found to be reasonable and necessary for their work-related injuries.”
Further, the Medical Marijuana Act, the review board concluded, does not prohibit insurers from covering medical marijuana use.
When the employer further questioned its legal standing should it pay for medical marijuana, the review board concluded that “since Employer is not prescribing marijuana, but rather reimbursing [Appel] for his lawful use thereof,” the employer would not be in violation of any federal laws regarding marijuana.
Scorecard: The review board overturned the initial workers’ comp judge’s partial denial.
Takeaway: When it comes to workers’ comp and medical marijuana, decisions can be, well, in the weeds. It’s a finite line and 50 states to take into account when it comes to payment and law. Employers and their insurers should work together to decide how to approach it in comp before injuries occur. &