Does Workers’ Compensation Cover the Cost of Treatments with “Alternative Medicine?”

Workers’ compensation provides valuable support for employees who get injured or become ill on the job, but that support is limited. Wage benefits don’t cover all lost pay. And workers’ comp won’t pay for every medical expense just because it provides relief.

Expenses must be “reasonable and necessary” and related to the work injury in order to be covered by workers’ compensation insurance. This means that insurers that provide workers’ compensation coverage will contest a medical expense whenever they believe they can prevail in having it denied. Claimants frequently have to fight for their right to reasonable medical needs in court.

However, it is still often unclear when an expense is considered reasonable and necessary under Pennsylvania’s Workers’ Compensation scheme. Questions frequently arise concerning treatments that go beyond traditional methods and that are considered “alternative medicine.” While we cannot explore every type of treatment in this article, here are some examples of how Pennsylvania law has been clarified on this issue.

What is Alternative Medicine?

Any treatments or practices that are not considered part of the “standard” medical care traditionally prescribed by physicians can be considered alternative medicine. This could include using manipulative and massage practices instead of surgery, or herbs instead of standard chemically-produced medications. Many physicians now recommend treatments that are still considered “alternative” by traditional standards, particularly when these options are used to complement standard medical treatments. The use of standard and alternative therapies in combination is often referred to as integrative or complementary medicine.  

Cannabinoid Oil (CBD)

CBD oil is a product with the active ingredient cannabidiol extracted from the hemp plant, which is closely related to marijuana. Although CBD is a prevalent active ingredient in marijuana, the component itself does not cause the “high” or impairment of marijuana because it lacks THC.

Cannabidiol has been praised as a treatment for conditions such as:

• Epilepsy
• Anxiety
• Chronic pain
• Insomnia
• Inflammation

Although the U.S. Food and Drug Administration has approved a medicine containing CBD as a treatment for certain seizure disorders, the substance is not approved for treating other conditions at this time. Nevertheless, it is frequently recommended by doctors for pain relief applied topically and internally.

The Pennsylvania Supreme Court recently ruled that an employer was required to reimburse an employee for the purchase of CBD oil prescribed by his doctor to supplement medications for severe back pain. Although the Pennsylvania Workers’ Compensation Act requires employers to pay for “medicines and supplies,” the employer had argued that CBD oil could not be considered a supply under the Act because the FDA had not concluded that the substance was either safe or effective for treating pain.

Although an administrative judge initially ruled in favor of the employee, the decision was overturned on appeal in favor of the employer’s interpretation. Ultimately, however, the Supreme Court sided with the employee. Pennsylvania’s highest court concluded that the obligation to pay for “medicines and supplies” under the Workers’ Compensation Act includes “any item that is part of a health care provider’s treatment plan for a work-related injury” regardless of whether the item is precisely defined as a medicine or supply. The question, according to the Court, is not whether an item is a medicine or supply but rather whether it is part of the treatment plan prescribed for the injury. In addition, the Court observed that nothing in the Workers’ Compensation Act requires covered medicines and supplies to be approved by the FDA.

While this ruling by the Court addressed a particular worker’s situation, the ruling could have broad implications for the coverage of alternative medicine in workers’ compensation cases.

Chiropractic Treatment

Chiropractic care, which uses manual therapy to improve the function of the spine and other parts of the musculoskeletal system, is not considered a conventional medical treatment and therefore it is usually treated as alternative medicine. However, the Pennsylvania Workers’ Compensation Act specifically includes chiropractors among the list of health care providers whose services should be covered by an employer when an employee is receiving treatment for a work injury.

Employees are required to see health care providers who are approved by the employer, but the Pennsylvania Supreme Court has held that if an employer’s list of approved providers does not include a chiropractor, the employer can be required to pay for treatment provided by an outside professional if the treatment was reasonable and necessary.

Other Forms of Alternative Medicine

Determining whether a treatment is reasonable and necessary is not a clear-cut issue. Courts have held acupuncture to be a covered treatment even when evidence indicated that the pain relief provided lasted only a couple of days. The treatments provided pain management that enabled the employee to refrain from using opioid drugs, and that may have played a large role in the decision. 

Many acupuncture clinics advertise that their services are covered by workers’ compensation if they are considered medically necessary—but they also admit that they are in no position to determine medical necessity.

Courts have also held that while employers do not have to cover purchases of medical marijuana directly, they must reimburse employees for purchasing the substance when it is prescribed as reasonable and necessary.

Licensing can sometimes play a role in determining whether a service will be covered. Workers have been denied coverage of treatment by a massage therapist, even though the services were prescribed by a doctor. The denial was based on the therapist’s lack of licensure or supervision. Similarly, a Pennsylvania court denied an employee’s request for reimbursement for Ayurvedic treatment because the services were not provided under the supervision of, or by referral from, a physician licensed in Pennsylvania.

When Workers’ Compensation Benefits are Denied, Vanasse Law Fights for Justice

When you need medical treatment and wage benefits because of a workplace injury, the insurance companies that handle workers’ compensation claims just don’t seem to care. They try to deny everything to keep their profit levels as high as possible.

At Vanasse Law, we fight for the rights of injured employees, and we know how to achieve the optimum results in a workers’ compensation claim. To learn how we may be able to assist with your workers’ compensation claim, call us at 717-397-1010 or contact us online now.