A common concern we hear from clients is that the insurance carrier is denying their treatment and medications, and they would like to turn to medical marijuana to try and relieve their chronic pain, headaches, nerve issues, etc.
Will workers’ compensation cover medical marijuana?
California voters recently approved Proposition 64 allowing adults over the age of 21 to consume, possess and grow cannabis.
The California Compassionate Use Act enacted in 1996 had already made it legal for patients and their primary caregivers to possess and cultivate marijuana for medical use where such use was recommended or approved by a California licensed physician. So, what we know is that it is legal in California under certain circumstances to use marijuana for both personal and medical purposes. Whether a workers’ compensation insurer/administrator will cover costs associated with medicinal marijuana is another issue.
First, doctors providing treatment under workers’ compensation are required to provide treatment consistent with evidence-based guidelines. In other words, treating doctors must choose treatments scientifically proven to cure or relieve work-related injuries/illnesses. This is the case with medical marijuana as much as it is with massage therapy, acupuncture or any other treatment.
Marijuana for medical purposes is not within the evidence-based guidelines (MTUS) currently used within the CA workers’ compensation system. As such, a problem is presented for any physician requesting such a treatment and another problem is created should the doctor wish to bill for the service.
Additionally, CA Health & Safety Code Section 11362.785 indicates that no governmental, private or any other health insurance provider or health care service plan is liable for any claim for reimbursement for the medical use of marijuana.
At this time, worker's’ compensation insurance is not responsible for costs associated with medical marijuana.
As marijuana remains to be considered a controlled substance by the Federal Government, it is likely that insurance carriers will escape liability for providing treatment and reimbursement. But, as more and more states legalize marijuana for both personal and medical purposes it is likely we will see more studies done and hopefully more evidence that suggests marijuana has been shown to assist with the problems injured workers currently have to take heavy opioids for. Should that become the case, we’ll have to keep a close eye on our legislature in Sacramento to see if they wish to make insurance carriers responsible for medical marijuana.
Gerald Brody & Associates
In the meantime, when workers’ compensation doesn’t cover something it is our position that you should be able to self-procure the treatment – if you can afford it and it’s recommended by a physician. You’ll also want to make sure you inform your treating providers so they are aware of the treatment you’re getting on your own to avoid any medication conflicts.