Pa. Court Draws Line Between Coverage and Reimbursement for Medical Marijuana

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.