Mark R. Schmidt v. Schmidt, Kirifides and Rassias, PC

Summary

The Supreme Court of Pennsylvania held that an item prescribed by a health care provider as part of a treatment plan for a work-related injury falls within the Workers’ Compensation Act’s phrase “medicines and supplies,” including CBD oil. The Court further held that the Act’s cost-containment provisions applicable to health care providers do not apply to claimants seeking reimbursement for such out-of-pocket expenses. The Court affirmed the Commonwealth Court’s order requiring reimbursement.

Holdings

1. The phrase "medicines and supplies" is a broad-encompassing phrase that includes any item that is part of a health care provider's treatment plan for a claimant's work-related injury. An item need not be classified separately as either a medicine or a supply, and CBD oil therefore falls within the statutory phrase when prescribed as part of such a treatment plan.
2. FDA approval is not a prerequisite for an item to qualify as a medicine or supply under Section 306(f.1)(1)(i), and the employer could not avoid reimbursement merely by asserting generalized concerns about CBD products without establishing that the CBD oil used by Claimant was illegal.
3. The Workers' Compensation Act's cost-containment provisions and attendant Department regulations do not apply to a claimant who is not a health care provider.
4. A non-provider claimant seeking reimbursement for an item prescribed as part of treatment for a work-related injury is not required to submit the provider billing forms or periodic medical reports required of treatment providers.

Questions Presented

1. Whether the phrase "medicines and supplies" in Section 306(f.1)(1)(i) of the Workers' Compensation Act includes any item prescribed by a health care provider as part of a treatment plan for a work-related injury, including CBD oil.
2. Whether the Workers' Compensation Act's cost-containment provisions and related Department of Labor regulations apply to a claimant who is not a health care provider.
3. Whether a non-provider claimant must submit provider billing forms, medical reports, or other specified documentation before obtaining reimbursement for out-of-pocket expenses for medicines and supplies.

Disposition

affirmed