Medical Marijuana, Workers’ Compensation, and the CSA: Hazy Outlook for Employers As States Wrestle With Cannabis Reimbursement as a Reasonable Medical Expense

While each state has its own unique workers’ compensation program, workers’ compensation generally requires employers to reimburse the reasonable medical expenses of employees who are injured at work. Depending on the injury, these expenses can include hospital visits, follow-up appointments, physical therapy, surgeries, and medication, among other medical care. In recent years, medical cannabis has become increasingly common to treat a myriad of ailments—as of February 2022, 37 states, the District of Columbia, and three territories now allow the use of medical cannabis.

While that is good news for patients seeking treatment for issues like chronic pain, medical cannabis laws can cause a major headache for employers. The federal law known as the Controlled Substances Act (CSA) classifies cannabis as a Schedule I substance, meaning that under federal law, it is not currently authorized for medical treatment anywhere in the United States and is not considered safe for use even under medical supervision. So, what happens when an employee is injured at work, is eligible for workers’ compensation, and is prescribed medical cannabis to treat their work-related injury in a state that authorizes medical cannabis?

Employers are faced with a tricky dilemma: They can reimburse the employee’s medical cannabis as a reasonable medical expense and risk violating the federal prohibition against aiding and abetting the possession of cannabis. Or, they can refuse to reimburse the otherwise reasonable medical expense and risk violating the state’s workers’ compensation law.

Usually, where it is impossible for an employer to comply with both state and federal law, federal law wins—a legal concept called conflict preemption. Unfortunately for employers, however, clarity on this issue will have to wait—the U.S. Supreme Court recently declined two requests to review state supreme court cases on this issue and definitively decide whether the CSA preempts state workers’ compensation laws that require reimbursement of medical cannabis. In the absence of federal guidance, national employers with workers in different states must follow the decisions of the handful of state courts that have taken up the question. The state courts who have decided the issue have come to inconsistent conclusions—thus, whether an employer should reimburse medical cannabis will vary depending on the state where the employee is injured.

For example, in Maine and Minnesota, both states’ highest courts have concluded that employers are not required to pay for their injured employees’ medical cannabis. These courts reasoned that employers would face liability under the CSA for aiding and abetting the purchase of a controlled substance. The employer, if reimbursing employees for using medical cannabis, would knowingly subsidize the employee’s purchase of marijuana in direct violation of federal law. However, in such a case, the employer would also violate state law for refusing to reimburse the employee’s reasonable medical expenses. Deeming it impossible for the employer to comply with both laws, these states’ courts concluded that the federal prohibition on cannabis preempts the state workers’ compensation laws.    

States such as New Jersey have gone the other way, requiring employers to reimburse employee’s medical cannabis. The New Jersey Supreme Court concluded that there was no conflict between the prohibitions of the CSA and the demands of the New Jersey workers’ compensation law. Thus, the federal law did not preempt New Jersey’s state law, and employers were required to comply by reimbursing medical cannabis as a reasonable reimbursement.

Meanwhile, Massachusetts followed Maine and Minnesota’s approach, but did so based on its own medical marijuana statute, not the CSA. The Massachusetts law explicitly exempts health insurance providers or any government agency or authority from the reimbursement requirement because doing so violates federal law.

Given this patchwork of state decisions, employers should be cautious in determining whether to approve or deny medical cannabis as a reasonable medical expense under state workers’ compensation laws. While the answer is relatively clear (for now) in the states discussed above, there are still over 30 states with medical cannabis programs that have not addressed this issue. It is important to note that many state medical cannabis laws include provisions like Massachusetts that exempt employers from reimbursing employees for cannabis—a clear indicator that these laws were designed with federal prohibitions in mind. But these provisions are not necessarily determinative—New Jersey’s medical cannabis law has a similar provision, yet New Jersey employers are still required to reimburse for medical cannabis.

The bottom line is that federal CSA violations can be hefty, including a mandatory $1,000 fine, possible incarceration of up to one year, and possibly more if “aggravating factors” are found, such as prior convictions. Employers should therefore pay careful attention to their respective state medical cannabis laws, workers’ compensation laws, as well as the CSA and consult with counsel to determine the best approach in their particular jurisdiction. It is likely that more of these cases will be brought in the future, so be sure to check back for further developments in this evolving area of law.

This article was prepared with the assistance of 2022 summer associate Zack Sikora.