Highlights of Noteworthy Decisions

Decision 1615 22
A. Patterson
  • Health care (medical aid) (marijuana)

The issue under appeal was whether the worker was entitled to purchases of medical cannabis from March 1, 2019, under the April 29, 1999 accident claim.

The appeal was denied.
OPM Document No. 17-01-10 sets out the requirements for entitlement to medical cannabis. It provides the following direction as to the general characteristics of what constitutes "an appropriate clinical assessment" as the fourth requirement. The Vice-Chair noted that the use of the qualifier "generally" suggests that most, but not necessarily all, of the characteristics listed in the description of "appropriate clinical assessment" should be present.
In the present appeal, it was concluded that an appropriate clinical assessment of the worker was not provided to the Board. There was no initial report setting out the treatment goals, or outlining potential risks particular to the worker, taking into consideration the multiplicity of his compensable and non-compensable organic and non-organic conditions. In addition, there was no specification of the potency in CBD or THC required. No clinical rationale was provided for the worker's prescription. The Vice-Chair noted that clinical assessments and reassessments are necessary for the Board to establish entitlement to medical cannabis as a health care benefits under section 33(1) of the Act.
Furthermore, the Vice-Chair found that the sixth requirement, that "the dose and route of administration authorized for the worker are appropriate," had not been met under OPM Document No. 17-01-10. The cannabis products for which the worker sought reimbursement greatly exceeded the THC concentration guidelines of 9%, set out in OPM Document No. 17-01-10. The worker had failed to substantiate why the medical cannabis, which exceeded the Board limits on dosage and administration, was "necessary, appropriate, and sufficient" and should be reimbursed. As a result, the worker did not meet all seven requirements under the policy, and was not entitled to reimbursement of medical cannabis purchased.