PA Insurer in Violation for Failure to Reimburse Claimant for Medical Marijuana | Weber Gallagher Simpson Stapleton Fires & Newby LLP

The Pennsylvania Commonwealth Court decided today that under the Commonwealth’s Medical Marijuana Act (“MMA”), Federal law and the Pennsylvania Workers’ Compensation Act, it is not a violation of Federal Law prohibitions for an insurance company to reimburse a claimant’s out-of-pocket costs to obtain Medical Marijuana – that is, if that substance is obtained legally under Pennsylvania’s MMA. In its opinion, which is now the law of our state, the Court focused on a combined analysis of 

  1. the Pennsylvania Workers’ Compensation Act’s “humanitarian purposes”, 
  2. the Federal Drug Act’s provision rendering marijuana distribution illegal
  3. the Pennsylvania Legislature’s “express intent” to provide Commonwealth citizens with Medical Marijuana access
  4. the Pennsylvania’s MMA’s inclusion of an immunity provision protecting patients from government sanctions.

In weaving together all of these varying pieces of legislation and of legislative intent, an insurance company’s or third party administrator’s failure to reimburse an injured worker for out-of-pocket expenses for legally obtained medical marijuana will subject that entity to penalties, the amount of which will be decided by the workers’ compensation Judge. T.L. Fegley, as Executrix of the Estate of P. Sheetz v. Firestone Tire & Rubber (WCAB) – 680 C.D. 2021 FILED: March 17, 2023, and E. Appel v. GWC Warranty Corp. (WCAB) – 824 C.D. 2021 FILED: March 17, 2023.

The matters now have been remanded to the Pennsylvania Workers’ Compensation Appeal Board, for further remand to the presiding workers’ compensation judge, to assess the penalty. Whether a penalty is assessed, whether the matter settles before that timeframe, or whether the matter ultimately makes its way back to the Pennsylvania Supreme Court – remains to be seen. 

Comment: We are advising our clients to carefully revise internal policies of denying reimbursement payments for legally obtained medical marijuana when physician prescribed, and we are available for the inevitable discussions surrounding individual cases that, most likely, will be very fact specific and nuanced. 

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