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Pa. Commonwealth Court rules that workers’ comp should cover medical marijuana cost

HARRISBURG — Commonwealth Court has ruled that workers’ compensation should cover the cost of medical marijuana for treatment of injuries suffered on the job.

The court on Friday handed down two decisions in cases brought by workers who were hurt on the job and were initially prescribed opioids for treatment. But in both cases, the workers sought to get their cost of medical marijuana covered by workers’ compensation, asserting that the marijuana has been more effective in treating their pain.

In Teresa L. Fegley, as Executrix of the Estate of Paul Sheetz v. Firestone Tire and Rubber (Workers’ Compensation Appeal Board), Sheetz had been injured at work in 1977, according to the opinion written by Judge Anne Covey. He underwent two back surgeries and over the years, he treated the pain with opioid and narcotics.

In 2019, “at the recommendation of his doctor,” he began using medical marijuana to deal with his back pain in the “hope of eliminating the need for the opiates and narcotics he had been taking for approximately 30 years. Medical marijuana afforded Claimant pain relief and reduced his need for the opiates and narcotics,” according to Judge Covey’s opinion. She added that Sheetz also reported that taking medical marijuana apparently provided psychological benefits and in 2019, he began seeking to have the cost of his medical marijuana covered by workers’ comp.

Sheetz died before the court made its decision and his estate continued the case.

In the case of Edward Appel v. GWC Warranty Corporation, Mr. Appel was injured at work in 2006 and was prescribed opioids for the pain. He obtained a medical marijuana card in April 2018 and by September of that year was able to “wean himself off all the opioid medications” despite suffering a “tremendous amount” of withdrawal during that process, according to a separate opinion also written by Judge Covey. In October 2018, he sought to get workers compensation to cover the cost of his medical marijuana.

In both cases, their claims were denied and the appeals board upheld those denials but Commonwealth Court’s decisions reversed the appeals boards’ decisions.

In the decisions, the court concluded that while the Medical Marijuana Law includes language specifically decreeing that insurance companies aren’t required to cover the cost of medical marijuana, it also includes language that medical marijuana patients should not be “denied any rights for lawful use of medical marijuana.”

As a result, the judges reasoned: “the General Assembly explicitly intended Commonwealth residents suffering from intractable pain to have the benefit of this therapy, and at the same time chose not to limit claimants from receiving their statutory rights.”

The judges also decreed that employers are not being ordered to break federal law because they are not being required to pay for the marijuana, but rather they would be reimbursing the patients for their medical costs.

Judge Christine Fizzano Cannon filed a dissenting opinion arguing that the law’s ban on requiring that insurers cover the cost of medical marijuana should be the deciding factor.

“Claimant argues that because the WC Act is to be liberally construed, the MMA should not be interpreted to preclude reimbursement that is otherwise required by the WC Act. The most obvious flaw in this argument is that prior to the enactment of the MMA, there was no legal medical marijuana in Pennsylvania, and therefore, no reimbursement was required for it under the WC Act.”

Judge Fizzano Cannon noted that the Legislature apparently didn’t require insurers to cover medical marijuana because the U.S. Food and Drug Administration has not approved the use of the drug for any medical conditions.

“In any event, the legislature, not the courts, must effect any change in the MMA’s stated policy and the balance struck regarding insurance coverage,” she wrote.

First Published March 21, 2023, 12:56pm

The Reality of Injuries for Some Young Athletes/Professionals

The New York Times recently wrote about the dangers associated with professional football and the lack of benefits available to players who aren’t stars and who are not vested in the pension plan and other post-career benefits. Such players need state workers’ compensation benefits to help them through the trauma on the road to recovery or the next part of their lives.

We at Abes Baumann have been honored to serve on the NFLPA workers’ compensation panel for many years and we take satisfaction in helping injured workers from all walks of life, whether they are athletes, construction workers, nurse’s aides, or healthcare workers.

Tom Baumann Discusses Workers Compensation in Pittsburgh

Tom Baumann discusses his landmark workers compensation victory – Mary Ann Protz vs. Workers Compensation Appeal Board – and other aspects of treatment for work-related injuries with Workers Compensation Experts.

Baumann’s work in the Protz case voided the use of the Sixth Edition of the American Medical Association’s Guide to Evaluation of Permanent Injuries as a reason to reduce severely injured workers status – and benefits – from permanently disabled to partially disabled.

“Our state does a reasonable job compensating minimally and moderately impaired workers,” Baumann said, “but the severely impaired … NO!”

The Pennsylvania legislature undid the court decision a year later, though the impairment rating level to move people from permanent to partial disability was reduced from 50% to 35%.

“It was a partial victory,” Baumann said. “A lot of people who had their benefits unfairly

reduced, saw total disability benefits reinstated. With the subsequent bill reducing the level to 35% impairment, more injured workers qualified for total disability benefits and that was a positive development. You’re always trying to come up with novel ways to help your client and I think we did that.”

Baumann goes on to discuss signs workers should see that their case needs help from an attorney; what workers compensation attorneys actually do to make a difference in the case’s outcome; and why it’s worth having an attorney on your side in a workers compensation claim.

Find the complete article here: Workers Comp in Pittsburgh

Tom Baumann featured in Tribune-Review article, provides expertise on workers’ compensation challenges with coronavirus

Partner Tom Baumann’s 35 years of experience with workers’ compensation law was highlighted when he was interviewed in a recent Tribune-Review article concerning coronavirus in the workplace.

Read the article below to learn more about new workers’ comp challenges and Baumann’s perspective on one recent case concerning an Allegheny County prosecutor who was denied workers’ comp after he contracted coronavirus.

Football Players – NOT Seasonal Employees

By Sandra Weigel Kokal

In follow-up to our prior posting – the Commonwealth Court of Pennsylvania recently issued its Decision regarding the precedent that professional football players are “seasonal employees” under the Pennsylvania Workers’ Compensation Act. In the case of Pittsburgh Steelers Sports Inc v. Workers’ Compensation Appeal Board (Trucks), Attorney Baumann had argued that Mr. Trucks signed a yearly contract with the Steelers and as such was required to perform year-round obligations for the team. In opposition, the Steelers had argued Mr. Trucks was just a seasonal employee. 

The Court agreed with Attorney Baumann’s arguments. In rejecting the Steelers’ arguments and prior case law, the Court stated the facts and terms of Mr. Truck’s contract demonstrate that he was not a seasonal employee. Specifically, the Court stated Mr. Trucks’ contract covered 2 football seasons and included a number of performance obligations, which included the following: attend all mini-camps, pre-season training, all meetings, practice sessions, all pre-season, regular season and postseason games, any all-star games, cooperate with news media, attend 10 assigned appearances a year, and he was prohibited from playing football outside of employment. In exchange for performing these obligations, he received a yearly salary for those 2 seasons. Trucks obligations did not limit his activities to just the regular football season; therefore, the Court stated his employment was NOT seasonal. 

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