Can You Get Medical Marijuana on Workers’ Comp in Pennsylvania?

Pennsylvania is a state where medical marijuana has been legal for quite some time, with its medical efficacy widely documented.  Injuries often indicate medical marijuana as a potential treatment to help with pain management and other issues.  If you are on Workers’ Comp and want to get medical marijuana, it is quite possible that it could be paid for as part of your benefits.

First, medical marijuana costs are only reimbursed when a doctor recommends it for treatment for your work injury.  If you are receiving benefits but want medical marijuana for an unrelated condition, Workers’ Comp likely will not pay for it.  Second, it should be noted that marijuana is still illegal under federal law, and many interstate insurance carriers might be reluctant to pay for it, but Pennsylvania courts have ruled that it should be paid for under Workers’ Comp.

For help getting benefits, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 today.

When Does Pennsylvania Workers’ Comp Pay for Medical Marijuana?

To get medical marijuana paid for under Workers’ Comp, you usually have to meet three requirements:

Work-Related Accident

Before you can get any benefits through Workers’ Comp, you need to show that the injury at the center of your claim was work-related.  Benefits cannot be paid for injuries that happened on your off time or that had nothing to do with work tasks.  Additionally, insurance carriers can deny claims when the injury did not stem from an “accident” and was instead caused by their own intentional actions, drug use, or alcohol use.

If our Pennsylvania Workers’ Comp lawyers can help you meet this requirement with evidence and doctor testimony, then we can often get any treatment related to your injury paid for, including prescription marijuana.

Medical Marijuana is Needed

For a therapy or treatment to be paid for under Workers’ Comp, it usually needs to be reasonable and necessary.  This is sometimes disputed and checked with a “utilization review” (UR), usually requested by the insurance carrier/employer.  At this review, they can check with another medical professional to see if the medication or treatment was indeed necessary and reasonable, and if it was not, they can get out of having to pay for this treatment or medication.

Our attorneys can provide evidence and reports from your doctor showing that the medication is necessary and reasonable.  The bar for “necessary” does not have to be as high as saying it is absolutely required to save your life, as most medical care and physical therapy is not going to meet that standard.  However, if we can show specific evidence that medical marijuana is usually indicated for treating your condition and that it has been helpful for you, it may very well meet these standards.

You Have Not Settled Your Case

If you are receiving ongoing benefits and you want to start getting medical marijuana costs reimbursed, it may be possible to do so.  However, if you already accepted a settlement for your claim and signed a compromise and release agreement, the insurance carrier likely cannot be required to pay for any further care or treatment, including medication.

Even if your condition worsens and you already settled, you cannot go back and reopen a case.  However, if your case is still open or benefits have slowed but the case can be reopened, it is possible to request payment for additional medical care.

Is Medical Marijuana Legal for Insurance Carriers to Cover in Pennsylvania?

Under a somewhat recent Pennsylvania Commonwealth Court case from 2023, Fegley v. Firestone, the court affirmed that medical marijuana should be paid for under Workers’ Comp when it is medically necessary.  The insurance carrier in that case pointed to some issues with the Medical Marijuana Act – the law that authorizes medicinal marijuana in Pennsylvania – but the carrier ultimately lost that case and was required to pay for marijuana as part of a Workers’ Comp claim.

In that case, they tried to point to a section of the Medical Marijuana Act that says that nothing in that Act should be read to require an insurance carrier to “cover” medical marijuana.  Additionally, many interstate insurance carriers may be afraid that federal law – which still deems marijuana a Schedule I drug as of the writing of this article – could be used to punish them for covering medical marijuana.

Ultimately, the rule that the Commonwealth Court arrived at was based on a strict interpretation of the wording of the statute.  The court held that while insurers cannot be required to “cover” medical marijuana, they can be required to “reimburse” claimants for the cost of getting themselves medical marijuana.  Thus, under these rules, the insurance carrier usually will not pay the provider or dispensary directly, but patients seeking medical marijuana under Workers’ Comp can get the marijuana on their own and then seek reimbursement from Workers’ Compensation.

How Do I Get Medical Marijuana Paid for Under Workers’ Compensation in Pennsylvania?

To discuss this as a practical matter, you can often get medical marijuana under Workers’ Comp by taking a few steps.

First, talk to your doctor about it.  You are going to need a doctor to approve medical marijuana for you.  Usually, recommendations for medical marijuana come from the doctor in the first place rather than the patient suggesting it, so you may have already had this conversation.  To legally obtain medical marijuana, you will also need an approved medical marijuana ID card, which requires a doctor to sign off.

Second, talk to your attorney about it.  You will often need to include a claim for reimbursement as part of your case, and you may need to fight a UR and obtain evidence to get payments approved in the first place, all of which our attorneys can help you with.

Once all of this has been approved, you can obtain medical marijuana on your own and then get the costs reimbursed.

Call Our Workers’ Compensation Lawyers in Pennsylvania Today

For help with your Workers’ Comp claim, call Cardamone Law’s Philadelphia Workers’ Comp attorneys at (267) 651-7945.