We often have issues regarding whether a particular medical expense is payable by the workers’ compensation insurance carrier. The issue could be whether it is a “medical” treatment at all, whether it is related to the work injury, or whether it is “reasonable or necessary.” A recent case from the Commonwealth Court of Pennsylvania examined a few of these issues.
In M.R. Schmidt v. Schmidt, Kirifides and Rassias, PC (Workers Compensation Appeal Board), the injured worker (Claimant) suffered an “aggravation of a preexisting degenerative disc disease at the levels of L4-5 and L5- S1 with radiculopathy” while he was loading files into a bag. The injured worker litigated, and won, a Claim Petition to have this injury accepted as compensable. Despite his injury, Claimant continued to work with the assistance of pain management. In an effort to avoid increasing the amount of Oxycodone and/or OxyContin he was taking, the pain management physician prescribed cannabinoid (CBD) oil. Since the dosages of the opioids has not been increased again, and Claimant has been able to avoid surgery, the use of CBD oil appears to have been successful.
The Pennsylvania Workers’ Compensation Act (Act) requires that the insurance carrier pay for all reasonable and necessary medical treatment related to the work injury. As such, Claimant provided the insurance carrier with the prescription for the CBD oil, as well as his out-of-pocket receipts. The insurance carrier refused to reimburse these expenses, alleging that CBD oil is not a “pharmaceutical drug.” As a result, Claimant filed a Petition for Penalties.