Massachusetts High Court Says Comp Insurer Need Not Pay for Medical Marijuana

Yesterday, in a decision that is certain to draw attention in a host of other jurisdictions, the Supreme Judicial Court of Massachusetts, quoting Larson’s Workers’ Compensation Law, held a workers’ compensation insurer may not be ordered to reimburse an employee for medical marijuana expenses [Wright’s Case, 2020 Mass. LEXIS 658 (Oct. 27, 2020)]. Describing the current legal landscape of medical marijuana as “a hazy thicket” [Opinion, p. 2], the Court stressed that while the reviewing board of the Department of Industrial Accidents (Department) concluded that marijuana’s status as a federally illicit substance preempted any State level authority to order a workers’ compensation insurer to pay for the claimant’s medical marijuana expenses, the Court based its own decision on the fact that the Massachusetts medical marijuana act explicitly alleviated insurers from the burden of reimbursing for medical marijuana expenses.

Background

In October 2010, Wright injured his right knee in a work-related accident, while working for Unitek Global Services (Unitek). He underwent surgery, recovered, and sought new employment. He eventually went to work for Pioneer Valley Electric (Pioneer) as an electrical apprentice. In May 2012, he sustained a second injury to his right knee at work. Wright underwent another surgery, which resulted in numerous postoperative complications. He developed deep vein thrombosis and eventually was diagnosed with complex regional pain syndrome. As a result, Wright began to suffer from chronic leg pain, difficulty sleeping, and anxiety, and he became quick to anger. In August 2013, Wright was evaluated for, and was issued, a certification to enroll in Massachusetts’s medical marijuana program. Wright subsequently began using medical marijuana to manage his chronic pain. Wright’s use of medical marijuana reduces his pain, increases his mobility, improves his sleep, and reduces his anxiety and anger. Wright has also been able to eliminate the use of any opioids as a result of his medical marijuana use.

Settlement of Workers’ Compensation Claim

In 2014, Wright filed a workers’ compensation claim for PTD benefits with the Department. In May 2016, Wright settled his claim against Unitek’s insurer as well as his claim against Pioneer’s insurer, Central Mutual Insurance Company (Central Mutual). Pursuant to the settlement agreements, Wright was provided with lump sums to compensate him for the medical expenses incurred as a result of his injuries. The settlement agreement with Central Mutual also provided that Central Mutual agreed to accept ongoing liability for the right knee with the caveat that payment of future medical treatment must be “reasonable and necessary and causally related” to Wright’s injury.

In October 2016, Wright sought compensation for $24,267.86 of medical marijuana expenses to treat chronic pain stemming from the work-related injuries. His claim was denied by an administrative judge, and the denial was affirmed on appeal by the Department. The Supreme Judicial Court, on its own initiative, transferred the case from the Appeals Court.

Initially, the Court described the legal landscape in which marijuana is illegal at the Federal level and has been deemed under Federal law to have no medicinal purposes, yet Massachusetts, as well as the majority of States, have legalized medical marijuana and created regulatory schemes for its administration and usage. Complicating and confusing matters further, said the Court, Congress has placed budgetary restrictions on the ability of the U.S. Department of Justice to prosecute individuals for marijuana usage in compliance with a State medical marijuana scheme, and the Department of Justice has issued, revised, and revoked memoranda explaining its marijuana enforcement practices and priorities, leaving in place no clear guidance.

The Court continued by noting that the Commonwealth’s original medical marijuana act, St. 2012, c. 369 (act or medical marijuana act), was carefully drafted by its sponsors to take into account this most difficult regulatory environment, with provisions specifically designed to avoid possible conflicts with the Federal government. For example, one such provision of the law expressly states that “[n]othing in this law requires any health insurance provider, or any government agency or authority, to reimburse any person for the expenses of the medical use of marijuana.” St. 2012, c. 369, § 7 (B). See G. L. c. 94I, § 6 (i). The Court continued:

We conclude that this specific language, and the Federal concerns it seeks to address and avoid, is controlling and not overridden by the general language in the workers’ compensation laws requiring workers’ compensation insurers to reimburse for reasonable medical expenses. A contrary reading of this specific language, which states that health insurers and government agencies and authorities are not required to reimburse medical marijuana expenses, would have been completely misleading to those who voted on it. It is one thing for a State statute to authorize those who want to use medical marijuana, or provide a patient with a written certification for medical marijuana, to do so and assume the potential risk of Federal prosecution; it is quite another for it to require unwilling third parties to pay for such use and risk such prosecution. The drafters of the medical marijuana law recognized and respected this distinction [Opinion, 3-4].

General Language of Workers’ Compensation Law Does Not Require Payment

Quoting Larson’s Workers’ Compensation Law, § 94.06, the Court added that its understanding of the reimbursement limitations was consistent with the way in which most other states had approached the matter. The Court said it rejected any interpretation contending that the general language of the workers’ compensation statute requiring reimbursement for reasonable and necessary medical expenses requires third-party reimbursement because medical marijuana use is legalized under the medical marijuana act. Such an interpretation, stressed the Court, ignored the fact that marijuana was previously illegal under Massachusetts law, that it remained illegal under Federal law, and that the medical marijuana act itself expressly stated that it does not require such reimbursement. The Court also stressed that the medical marijuana act could not, on the one hand, state on its face that third-party reimbursement was not required and then, on the other hand, be interpreted to require reimbursement under other laws on the basis of the act’s legalization of medical marijuana.

If this were the case, then the express language in the medical marijuana act would disguise the provision’s actual meaning, parading as its opposite [Opinion, p. 24].

In sum, said the Court, health insurance providers may not be compelled to reimburse claimants for expenses for the medical use of marijuana. The decision of the Department’s reviewing board was accordingly affirmed.