Injured Worker’s Medical Marijuana Reimbursement Questioned in Court

Decades after this worker's injury, he is prescribed medical marijuana for pain management. But when the employer denies reimbursement, the conversation of coverage is brought into court.
By: | June 2, 2023

In 1977, Paul Sheetz suffered a work injury while on the job, working for Firestone Tire & Rubber. He required two back surgeries and suffered severe back pain and shooting pain in his legs. 

At the time, his doctor prescribed him a mix of narcotics and opiates, including oxycontin, to help reduce pain. Over 30 years later, Sheetz was still feeling the aftereffects of his injury and subsequent surgeries. His doctor recommended a pain relief switch to medical marijuana in January 2019. 

The switch did as intended — Sheetz’s dependence on opiate pain management began to wane as medical marijuana was introduced into the mix. Eventually, Sheetz weaned himself off diazepam and oxycontin entirely by September 2019. 

However, during this pain medication transition, Sheetz’s employer did not reimburse him for the medical marijuana. 

In October 2019, Sheetz filed a penalty petition against his employer, alleging it violated the Workers’ Compensation Act by failing to provide payment for his treatment. 

An initial court hearing with the workers’ comp judge ruled in favor of the employer in 2020, which was later affirmed by the Workers’ Compensation Board, based on section 2102 of the Pennsylvania Medical Marijuana Act (MMA).   

Section 2102 of the MMA states that “nothing in [the MMA] shall be construed to require an insurer or health plan … to provide coverage for medical marijuana.” 

Sheetz appealed to the Pennsylvania state Workers’ Compensation Appeal Board. 

In the initial hearing, Firestone did not raise section 2102 in its arguments against reimbursement. Sheetz argued that because of this, the board erred in raising this as an issue, with the intent “to use it as the sole basis for denying the requested relief.” 

The decision came down to the definition of the wording within section 2102. 

The appeal board reviewed the words coverage versus reimbursement 

Sheetz, who eventually passed away during the extent of the legal battle and whose estate was then handled by executrix Teresa Fegley, was asking for reimbursement for the medical marijuana used to treat his pain. Under the MMA, coverage would not be provided. 

However, the Sheetz estate pointed to the state’s Workers’ Compensation Act, which notes that carriers are required to reimburse claimants for necessary and reasonable out-of-pocket costs of medical treatments.  

The appeal board determined that, by the language within the two acts, reimbursement for medical marijuana is distinctly different from coverage for medical marijuana. Reimbursement, if further stated, would not violate federal law, because reimbursement is “not the manufacturing, distribution or dispensing of marijuana.” 

Scorecard: Firestone, through its workers’ compensation insurer, will have to reimburse the Sheetz estate for medical marijuana expenses incurred. 

Takeaway: More injured workers are turning to medical marijuana as a pain management tool. With each state having its own legalities around the drug, comp insurers and employers should be reviewing what they should do in terms of coverage and reimbursement. &

Autumn Demberger is a freelance writer and can be reached at [email protected].