Pa. Court Rules Workers’ Comp Insurer Must Pay for Injured Worker’s CBD Oil

Eight months after it ruled that medical marijuana is covered under workers’ compensation, a Pennsylvania appeals court has concluded that an injured worker’s cost of CBD oil is also reimbursable.

A Commonwealth Court has found that CBD oil qualifies under the state’s workers’ compensation law as a “medicine” and a “supply” for reimbursement.

In a 5-2 opinion rejecting arguments against qualifying CBD, the court strongly affirmed the role of workers’ compensation judges as exclusive fact-finders in claims reviews and stressed that “neither the Workers’ Compensation Board nor the court has authority to reweigh the evidence.”

The court rebuked the WC Board for overstepping its authority when it overturned a judge’s ruling that was in favor of the injured worker’s CBD oil claim.

The injured worker, Mark R. Schmidt, sued his employer, the Schmidt, Kirifides and Rassias law firm, and the WC Board, over their rejection of his request for reimbursement of the costs for CBD oil that he used for a work-related back injury.

Medical research has been limited but some studies indicate CBD, or cannabidiol, may help with insomnia, chronic pain, inflammation due to arthritis, and anxiety. It does not produce a “high” effect in users.

Schmidt’s doctor prescribed CBD along with Oxycodone and other treatments and medications for his back injury. The CBD eased his pain, obviated the need to increase his dosage of painkillers, and helped him avoid back surgery.

Schmidt did not actually use his doctor’s prescription for CBD; instead he bought his oral and topical CBD over the counter at a natural therapy store.

Claims Denied

His employer refused to reimburse for the CBD, arguing that buying unregulated CBD oil at an unlicensed health food store did not qualify as medical treatment or “medicines and supplies” as the law requires. The firm also argued that reimbursing for CBD oil would violate Federal Drug Administration (FDA) policy.

After a review of the claim, a workers’ compensation judge in the Springfield district ruled in Schmidt’s favor, finding that the employer was liable to pay for Schmidt’s CBD oil because it qualified as a medical supply under the statute and was part of his reasonable and necessary medical treatment.

On appeal, the WC Board reversed the workers’ compensation judge and sided with the employer.

In reversing the judge’s decision, the WC Board concluded that CBD oil cannot be a reasonable and necessary medical treatment because it did not come from a medical provider and an insurer or employer cannot be required to pay for it since the FDA has warned firms marketing CBD products about violating federal law.

The WC Board also theorized that adoption of CBD oil “would open the floodgates” for employees to present “personal receipts for homeopathic remedies” for reimbursement.

Appeal

Schmidt appealed that WC Board decision to the court. In his appeal, Schmidt argued that a workers’ compensation judge has exclusive authority to act as fact-finder in such situations and that the WC Board went beyond its authority by disregarding the judge’s findings of fact. He said the board also failed to answer whether CBD oil is a medicine or supply under the law.

Schmidt contended that nothing in the act restricts compensable medicine and supplies to items which can only be obtained through a pharmacist, nor is there any statutory language prohibiting reimbursement for medicines and supplies obtained over the counter.

In its ruling, the Commonwealth Court stressed, as Schmidt had, the “well-settled law” that the workers’ compensation judge has “exclusive authority to act as fact-finder, determine credibility of witnesses, and weigh the evidence.” Furthermore, the judge’s findings are not to be disturbed “if they are supported by substantial, competent evidence.”

In the opinion written by Judge Anne E. Covey, the court sided with Schmidt on classifying CBD oil and quoted the workers’ compensation judge that since the workers’ compensation act is “remedial in nature and intended to benefit the worker,” it must be “liberally construed to effectuate its humanitarian objectives.” Thus it liberally construed “medicine” and “supply” to include CBD oil.

The court seconded Schmidt’s criticisms of the WC Board. “Instead of addressing the legal issues, the Board has completely disregarded” the judge’s findings of fact, “which are supported by substantial evidence, and proceeded to do its own fact finding to support its preferred conclusions,” the court stated.

As for the concern over the FDA warning, the court commented that FDA approval of a treatment is not a requirement under the state statute and the fact that some CBD marketing may contain unsubstantiated therapeutic claims or otherwise violate federal law does not make an employee’s use or employer’s reimbursement for CBD oil illegal.

The court added that in the case of medical marijuana, the employer is not prescribing marijuana, but rather reimbursing the claimant for lawful use and thus the employer is not in violation of federal law.

The court also noted that the law’s utilization review process is the appropriate place for disputes over whether treatments are reasonable and necessary. While the employer in this case did not pursue this remedy until the case was already before the courts, a utilization review came to the same conclusion that CBD qualifies for reimbursement.