John Claimant injured his back while lifting a heavy object at work in 2002. He subsequently underwent two failed lumbar discectomies and from September of 2004 forward was deemed totally incapacitated as a result his back injury. Mr. Claimant underwent pain management from 2004-2014, primarily relying on opioids and palliative care. Then, in 2014, Mr. Claimant’s treating physician prescribed medical marijuana as reasonable and necessary to alleviate the back pain stemming from the work injury. Not surprisingly, a petition was filed asking our client to reimburse Mr. Claimant’s medical marijuana purchases, which totaled approximately $25,000.00 for his first year of use. Fortunately, as a result of our close review and securing medical expert testimony, we prevailed in denying John Claimant’s petition for medical marijuana reimbursement. Read on to see how and why.
Overview of Medical Marijuana in Workers’ Compensation Cases
Claims such as the one above are increasingly becoming the norm as the current legislative climate has spurred an influx of medical marijuana usage. It should be no surprise that claimants are requesting employers, carriers, and TPAs to foot the bill for medical marijuana. Like every workers’ compensation claim, however, a close look often reveals facts and circumstances that warrant denial of the request. Serious consideration of such claims is particularly important given the relatively poorly-regulated frontier in which medical marijuana currently operates.
The health and fiscal concerns for employers, carriers, and TPAs regarding medical marijuana in workers’ compensation cases are well-founded. Forgoing the fact that marijuana remains on the Federal Controlled Substance list and is not recommended as viable medical treatment by the American Medical Association (AMA) due to the dearth of reputable studies, there remains a highly practical reason for hyper-vigilance in these cases: there are no fee schedule rates for medical marijuana in our jurisdiction. As a result, the costs of medical marijuana cannot be reliably estimated and thus the financial implications can be astronomical.
In spite of this lack of clarity in the legal and medical communities, assuming a medical professional opines that medical marijuana is “reasonable and necessary” in relation to an accepted work injury, employers, carriers, and TPAs may very well have a fight on their hands to deny a claim. Nevertheless, bear in mind that medical treatment and medication must be reasonable and necessary in relation to the claimant’s treatment history and symptoms as well as accepted by doctors at the national level in order to be compensable. Pola v. Health-Tex, Inc., 605 A.2d 1321 (R.I. 1992).
Our Trial with John Claimant
During John Claimant’s trial, we focused on his prior medical history as well as the timeline regarding his use of medical marijuana. We placed great emphasis on his prior issues with drug dependency. We delved into his history of opioid usage and dredged up prior treatment records which called into question the claimant’s credibility regarding his pain complaints when on and off medical marijuana. We also secured a medical expert who is preeminent in the field of addiction, who opined this claimant’s use of medical marijuana was harming him based on his personal health profile. After numerous hours of testimony and the review of subpoenaed medical records, the Court found in our favor and determined our client is not responsible for paying for this claimant’s medical marijuana.
Implications for Every Medical Marijuana Claim
While the facts and circumstances of our client’s case above may well be inapplicable to other cases, the potential financial burdens of medical marijuana claims make them so rife with fiscal peril that each and every case should be put under a microscope. Targeted discovery must be conducted immediately. Please don’t hesitate to contact our office should you require any assistance dealing with this type of request. Our successful defense in the circumstances above afforded our firm a unique view of the complex issues involved in medical marijuana workers’ compensation claims, and we stand ready to aid employers, carriers, and TPAs in navigating this challenging new area of medicine and law.