Medical marijuana’s impact on workers compensation can be seen during all stages of a workplace injury, according to members of the Workers’ Compensation Committee for the American Academy of Actuaries who authored a new brief on the subject, Navigating Workers’ Compensation and Medical Marijuana.

The findings suggest a labyrinth of conflicting case, state, and federal laws making the handling of workers compensation claims involving medical marijuana much harder to resolve.

Though many states have approved medical marijuana for medical and recreational use, the fact it remains classified as a Schedule 1 drug by the U.S. Drug Enforcement Administration means that its use remains illegal at the federal level. It’s an important distinction because research on the drug is limited due to its federal classification.

A bill recently signed into law late last year (HR 8454 Medical Marijuana and Cannabidiol Research Expansion Act), will give rise to research on medical marijuana. The act allows registered entities, like higher education, practitioners, and manufacturers, to manufacture, distribute, dispense, or possess marijuana or cannabidiol (CBD) for the purposes of medical research.

Six states — Connecticut, Minnesota, New Hampshire, New Jersey, New Mexico and New York — currently allow reimbursement for injured workers use of medical marijuana through a court or administrative ruling or via an administrative rule. While another six states — Maine, Massachusetts, Florida, North Dakota, Ohio and Washington — prohibit reimbursement for use by an injured worker, mainly because it is not a FDA-approved treatment.

Insurers in fourteen states — Arizona, Arkansas, California, Colorado, Delaware, Illinois, Iowa, Michigan, Missouri, Nevada, Oregon, Pennsylvania, Utah and Vermont — aren’t required to reimburse injured workers who use medical marijuana as part of their treatment. The brief suggests that in these states there is the possibility for voluntary reimbursement, if a carrier chooses.

The authors of the brief found three main questions courts sought to answer in cases involving workers compensation and the use of medical marijuana.

1. Do federal laws supersede state laws that compel insurers and employers to reimburse employees for medical marijuana costs associated with treatment of pain related to work injury?
2. Was the use of medical or recreational marijuana the proximate cause of the injury? This question is difficult to answer given that marijuana use will show up on a test even if a significant amount of time has lapsed since its actual use.
3. Were other treatments tried prior to medical marijuana and was it a reasonable and necessary treatment for the injuries sustained?

The conflict between federal and state will continue to be played out in the court system until changes are made to the federal classification of marijuana.

Because of the various limitations on reimbursement, confusion abounds for insurers and Third Party Administrators (TPAs) tasked with reimbursing claims.

TPAs may deny coverage in states when not mandated to pay, other times TPAs may follow whatever an employer’s position is on the matter. To date, the authors found that TPAs have received few requests for reimbursement for medical marijuana use in conjunction with treatment for a workplace injury, and few employees advocating its use.

The impact of marijuana use, whether recreational or medical, has a significant impact on employment. In safety sensitive industries, such as transportation, oil and gas, its use would be in direct conflict with the drug free workplace mandate put in place in 1988.

The nuances of industry safety, varying state laws and unreliable THC testing, complicate matters.

Findings that medical marijuana use is better than using opioids because of its less addictive nature are questionable, the authors indicate, given the lack of FDA testing and the fact that potency labeling isn’t regulated.

While the debate to decriminalize medical marijuana continues, federal level, states, workers compensation carriers, and TPAs must continue to monitor the legal and societal landscape when reviewing reimbursement requests related to its use in the treatment of workplace injuries.

It is suggested that workers compensation actuaries work closely with claims departments to better understand medical marijuana laws and their impact on claims.