The Commonwealth Court of Pennsylvania (Commonwealth Court) recently handed down a decision drawing a line between insurance coverage and reimbursement by an insurer for medical marijuana. The case is Fegley v. Firestone Tire & Rubber Workers' Comp. Appeal Bd., 2023 Pa. Commw. LEXIS 26 (Pa. Commw. Ct. 2023). The claimant in the case below, Paul Sheetz, filed this appeal in June 2021; after his death in early 2022, Teresa Fegley, Sheetz's wife and executor of his estate, was substituted as the petitioner. 

In September 1977, Sheetz suffered a compensable, work-related injury that required two back surgeries. His treating physician prescribed opioids and narcotics for pain management. In 2019, Sheetz's physician recommended he begin taking medical marijuana "with the hope of eliminating the need for the opioids and narcotics he had been taking for approximately 30 years." The hope was fulfilled; Sheetz ceased using the drugs Diazepam and Oxycontin after seeing improvement in his social life and mental health due to his use of medical marijuana, which was found "reasonable and necessary" by a utilization review in September 2019. 

Sheetz's employer, Firestone Tire & Rubber, refused to reimburse Sheetz for the costs of the medical marijuana. Sheetz filed a Penalty Petition, claiming Firestone's refusal violated Pennsylvania workers compensation law because the medical marijuana had been found both reasonable and necessary. A workers compensation judge (WCJ) determined the refusal was not a violation of state workers compensation law, which was affirmed by the workers compensation board (the Board). On appeal to the Commonwealth Court, Sheetz made two key arguments related to reimbursement for medical marijuana: first, the Pennsylvania Medical Marijuana Act only forbade requiring coverage for medical marijuana; second, the Board failed to review the WCJ's claim that compelling Firestone to reimburse Sheetz for the medical marijuana would force them to violate federal law.