CBD Oil And PA Workers’ Compensation Cases
PA Supreme Court Expands Access To Nontraditional Health Services
Injured workers in Pennsylvania often struggle to obtain approval for treatments outside traditional prescription drugs. A recent decision in Schmidt v. Schmidt, Kirifides and Rassias, P.C., No. 32 MAP 2024 directly addresses that issue. The ruling clarifies when employers must pay for nontraditional health services, including CBD oil and similar therapies.
This important decision gives injured workers access to alternative pain management and emerging medical treatments.
How Did It Start?
In this case, the claimant suffered a work injury and later used CBD oil to manage chronic pain related to that injury. A licensed health care provider recommended the product as part of the treatment plan. The claimant then sought reimbursement under the Pennsylvania Workers’ Compensation Act.
The employer denied payment. The employer argued that CBD oil did not qualify as a covered “medicine or supply” under the Act. The dispute moved through the workers’ comp system and reached the Pennsylvania Supreme Court.
Legal Question
Does a product like CBD oil count as a “medicine or supply” under the PA Workers’ Compensation Act? This applies when a licensed health care provider prescribes it for a work injury. The Court also addressed if the cost containment billing rules apply when an injured worker personally seeks reimbursement.
These questions directly affect injured workers who rely on nontraditional health services for pain relief and recovery.
How Did The Court Rule?
Did They Consider CBD Oil A Covered Medical Supply?
Yes, when a licensed health care provider prescribes an item as part of treatment for a work injury. The Court concluded that item can qualify as a “medicine or supply” under the Act.
The Court did not limit coverage only to FDA-approved prescription drugs. Instead, the Court focused on whether a provider prescribed the item for treatment of a compensable work injury. Under that reasoning, CBD oil prescribed for injury-related pain falls within the scope of covered medical benefits.
This interpretation strengthens injured workers’ rights to pursue reimbursement for medically recommended nontraditional therapies.
What About Cost Containment?
Employers often rely on cost containment regulations to deny payment. Those regulations require health care providers to submit bills using specific forms and procedures.
In Schmidt, the Court clarified that those billing rules apply to providers. They do not apply to injured workers who seek reimbursement directly. When workers buy a prescribed item and submit receipts, they do not need to comply with provider billing regulations.
This removes a large procedural barrier. Injured workers no longer face denial simply because they submitted receipts instead of formal provider billing forms.
What This Means For Injured Workers In PA
Many injured workers turn to treatments such as:
- CBD oil
- Acupuncture
- Ketamine therapy
- Hyperbaric oxygen therapy
- Other pain management approaches
Employers frequently fight these treatments, saying that they fall outside traditional medicine. The Supreme Court’s reasoning undercuts that argument when a licensed provider prescribes the treatment for a work injury.
Could This Affect These Types of Claims?
It could, when a licensed provider includes non-traditional recommendations in a treatment plan for a payable work injury. While the Court focused on CBD oil, the same statutory language may support reimbursement claims for many other treatments.
Each case still depends on facts, documentation, and medical support. But, Schmidt strengthens arguments in favor of coverage for nontraditional pain management under the Workers’ Compensation Act.
For Reimbursement, What Must Injured Workers Do?
The injured worker should have a prescription or clear written recommendation from a licensed health care provider.
Workers Should Request:
- A written prescription or recommendation
- Office notes explaining medical necessity
- Clear language linking the treatment to the accepted injury
Strong documentation increases the likelihood of success. Pennsylvania Workers’ Comp only covers treatment connected to a work-related injury. Workers should confirm that their doctor links the nontraditional treatment to the accepted work injury.
Injured Workers Should Keep:
- Copies of prescriptions
- Treatment notes
- Receipts for purchased products
- Proof of payment
Can Employers Still Challenge Nontraditional Treatment?
Yes. Employers retain the right to challenge whether a treatment remains reasonable and necessary. They may request utilization review or present medical testimony to dispute the effectiveness of a nontraditional therapy.
The Court’s decision does not eliminate disputes. Instead, it clarifies that nontraditional treatments do not automatically fall outside the definition of covered “medicines and supplies.”
Does This Ruling Guarantee Payment?
No decision guarantees payment in every case. Each claim depends on:
- The quality of medical evidence
- The clarity of the prescription
- The connection to the accepted work injury
- The credibility of expert testimony
What Does This Mean For Access To Care In PA?
By interpreting “medicines and supplies” broadly, the Court reinforced access to nontraditional health services within the workers’ comp system. This gives injured workers more treatment options.
Workers who rely on CBD oil or similar therapies for pain now hold more legal support when seeking repayment. Employers must consider prescribed treatments based on medical evidence rather than outdated assumptions on medical care.
How We Can Help
Legal guidance often improves outcomes in complex medical benefit disputes. Nontraditional treatment claims often trigger resistance from insurers. An experienced Pennsylvania workers’ compensation attorney can help protect your rights and maximize available benefits.
If you have questions about reimbursement for nontraditional health services under Pennsylvania Workers’ Compensation, give us a call. Reach out to our offices 24/7 at (215) 609-4183 for a free consultation.
