Highlights of Noteworthy Decisions

Decision 1799 21
K. Jepson
  • Jurisdiction, Tribunal (final decision of Board)
  • Merits and justice
  • Health care (medical aid) (marijuana)
  • Board Directives and Guidelines (health care) (cannabis)

The worker, a firefighter, was granted entitlement for post-traumatic stress disorder (PTSD) with an accident date of January 30, 2017, including a NEL award of 20%. He appealed a decision of the Appeals Resolution Officer (ARO) denying reimbursement of the cost of medical marijuana.

The appeal was allowed in part.
A preliminary issue arose regarding jurisdiction. The ARO stated that only purchases made after March 1, 2019 were in issue because the Nurse Consultant's decision denying entitlement applied the Board's policy on Cannabis for Medical Purposes. However, the policy states that it applies to purchases made on or after March 1, 2019, as opposed to decisions made on or after March 1, 2019. As the worker submitted receipts and requested reimbursement for purchases made prior to March 1, 2019, the ARO erred in limiting the issue to coverage as of March 1, 2019. The ARO's refusal to decide the issue was an effective denial of the relief sought and was a final decision on that issue. The Tribunal therefore had jurisdiction over reimbursement for purchases made both before and after March 1, 2019.
For purchases prior to March 1, 2019, Tribunal decisions have set out the principles to be applied in determining entitlement. The worker met the test for entitlement in Tribunal case law. Decision No. 746/21 found that the test was broad enough to include psychological symptoms or emotional pain caused by PTSD. The medical evidence showed that cannabis was prescribed by the worker's doctors for sleep problems caused by his PTSD and that other medications had been tried unsuccessfully.
With respect to purchases made on or after March 1, 2019, however, the Board policy provides a more restrictive test for entitlement. One of the requirements of the policy is that the worker has a designated condition. As PTSD was not a designated condition, the worker did not have entitlement.
The merits and justice policy did not apply, as the denial of entitlement was not an unintended or anomalous result of the policy. The Board considered medical evidence on the efficacy of medical cannabis for a range of conditions and determined that PTSD was not a condition for which entitlement would be granted.