NCCI’s Court Case Update, Pennsylvania – March 2023

Fegley v. Firestone Tire & Rubber and Appel v. GWC Warranty Corp 

On March 17, 2023, the Commonwealth Court of Pennsylvania, in the cases Fegley v. Firestone Tire & Rubber and Appel v. GWC Warranty Corp., held that an employer or workers compensation (WC) carrier (E/C) may be required to reimburse an injured claimant for medical marijuana treatment costs despite a provision in the state’s Medical Marijuana Act (MMA) stating that nothing in the MMA should be construed to require an insurer or health plan to provide coverage for medical marijuana.

In these separate cases, injured employees began using medical marijuana to treat the pain associated with work-related injuries and sought E/C reimbursement for their medical marijuana treatment. The court analyzed section 2102 of the MMA—which provides that nothing in [the MMA] shall be construed to require an insurer or a health plan to provide coverage for medical marijuana— and found that the word coverage referred to an insurer paying a provider directly for a medical service. The court next analyzed the WC Act requirement that carriers reimburse claimants for necessary and reasonable out-of-pocket costs of medical treatment and interpreted the word reimbursement as referring to the insurer paying the patient for costs incurred. Relying on its analysis that the MMA does not require coverage for medical marijuana, and coverage is distinct from reimbursement under WC, the court concluded that there is no statutory language prohibiting carriers from reimbursing claimants who lawfully use medical marijuana to treat an accepted work injury when such treatment is medically reasonable and necessary.

The court then turned to the interplay between a provision in the Federal Controlled Substances Act that makes it unlawful to manufacture, distribute or dispense a controlled substance, and a section of the MMA which states that nothing shall require an employer to commit any act that would knowingly or intentionally violate federal law. The court concluded that medical marijuana reimbursement would not cause an employer to violate federal law because the reimbursement is not the manufacturing, distribution, or dispensing of medical marijuana.

In addition, in the Fegley decision, the court ruled that the employer’s failure to reimburse was a violation of the WC Act and, in Appel, the court held that the WC Act mandates employers to reimburse claimants for out-of-pocket costs of medical treatment which has been found to be reasonable and necessary for their work-related injuries. With these decisions, the court reversed the orders of Workers’ Compensation Judges denying the employees’ reimbursement claims.

These cases could be appealed. NCCI will monitor further developments.

For more information on other cases monitored by NCCI’s Legal Division, visit previous Court Case Updates and Court Case Insights under the Legal section of INSIGHTS on ncci.com.

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