PA Supreme Court Upholds Coverage for all “Medicines and Supplies” Related to Work Injury

Back in November, 2023, we discussed the case of M.R. Schmidt v. Schmidt, Kirifides and Rassias, PC (Workers Compensation Appeal Board).  As you may recall, this case addressed an issue regarding payment for CBD oil used in conjunction with treatment for a work-related injury.  The Workers’ Compensation Judge (WCJ) ordered such bills paid, though the Workers’ Compensation Appeal Board (WCAB) reversed that decision.  The Commonwealth Court of Pennsylvania then reversed the WCAB, determining that the initial decision authored by the WCJ was correct.

Since that time, the matter was appealed to the highest Court in the State, the Supreme Court of Pennsylvania.  Recently, that Court issued an opinion which affirmed the decision of the Commonwealth Court of PA (saying the WCJ was correct in requiring coverage for the CBD oil).

The Court was very specific in its opinion, stating, “we hold that any item that is part of a health care provider’s treatment plan for a claimant’s work-related injury falls within the purview of the broad-encompassing phrase ‘medicines and supplies’ as provided in Section 306(f.1)(1)(i). We further hold that, in such circumstances, the cost containment provisions of the (Pennsylvania Workers’ Compensation Act) and the attendant Pennsylvania Department of Labor regulations, both of which apply to a health care provider, do not apply to a claimant.”

Objections to the effectiveness of CBD oil posed by the insurer were dismissed by the Court as not a basis to deny payment in this situation.  Instead, this is the function of Utilization Review (which, when done in this case, came back finding the CBD oil to be “reasonable and necessary”). When the insurer noted that the use of CBD oil has not been approved for use by the U.S. Food & Drug Administration, the Court observed, “there is nothing in the statute that requires ‘medicines and supplies’ to be regulated by the FDA.”

When viewed objectively, this must be seen as a victory not only for the injured workers across the State of Pennsylvania, but also common sense and human compassion.  Injured workers do not benefit financially from obtaining medical treatment, whether such treatment is directly provided by a doctor or an adjunct to such treatment (such as CBD oil).  For the insurance industry to fear that there will be a flood now of requests for payment for products which can relieve pain or improve lives is rather troubling.  Should the insurance industry be dismissing the benefits of less pain or better function so openly?  Simply put, these adjuncts to direct physician care can help avoid the devastating effects, at least in part, from the pain and limitations which can come with a work injury.