The LAT Awards Applicant over $20,000 in Reasonable and Necessary Medical Marijuana

By Hooman E. Zadegan Jul 30, 2020

The applicant’s spouse and children were injured in a car accident on July 4, 2015. While he was not involved, the applicant alleged suffering psychological impairments including PTSD, anxiety, depression and insomnia in relation to the injuries suffered by his family. His treating physicians prescribed medical cannabis to help manage his symptoms. The insurer initially paid 7 invoices claiming for medical cannabis, but then later stated that this medication is not reasonable and necessary. The applicant applied to the Tribunal, disputing entitlement to $20,067.67 in denied invoices for medical cannabis.

The applicant submitted that medical cannabis is reasonable and necessary because it was prescribed by regulated healthcare professionals who are medical doctors and it alleviates his accident related psychological symptoms. The insurer submitted that the applicant had not established that the claimed cannabis is intended to treat accident related injuries since he was a long time marijuana user well before this accident. The insurer alleged that the marijuana was actually intended to treat pre-existing conditions and/or was for recreational purposes.                                                           

The applicant did not dispute having used marijuana for recreational purposes before the accident, but stated that this was well before the date of loss while he was in university. The applicant also admitted to having used medical cannabis to treat both physical and psychological symptoms, including PTSD and insomnia, just 8 months prior to the subject accident. However, clinical notes and records from his family doctors confirmed that marijuana had only been used to treat minor and temporary pre-accident physical impairments. While a treating psychiatrist at the Centre for Addiction and Mental Health did not recommend or even mention medical cannabis in his notes, the applicant provided documents from 2 family physicians and 2 medical doctors from a rehab facility stating that he either requires medical cannabis to treat accident related psychological symptoms or expressing support for same. These doctors were all aware of the applicants medical history.

The insurer did not present any evidence to support the contention that the claimed cost is excessive.

Notably, the applicant had not reported any accident related psychological symptoms until 2 years following the accident and had even lost his job during this time, unrelated to the accident. However, writing for the Tribunal, Adjudicator Therese Reilly noted that prescription medication was exempt from the pre-approval requirements of section 38 and that no treatment and assessment plan was required before incurring the cost of the marijuana.  Ultimately, the adjudicator was satisfied that the medical evidence presented by the applicant supports his position that the disputed cost of over $20,000 in medical cannabis was reasonable and necessary to treat his accident related injuries.   

Hooman Zadegan is the author of this blog and member of the LAT group at the firm. If you have a question about a cannabis claim or this decision, please contact Hooman at 416-777-5235.

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