For many injured workers, medical marijuana sits at the intersection of pain relief, paperwork, and policy. Workers’ compensation is designed to cover “reasonable and necessary” care for work-related injuries, but cannabis remains illegal under federal law. That federal-state tension is why the rules around coverage and reimbursement can look completely different depending on where the injury happened.

Workers’ comp is not a single national program. It’s a state-by-state system, shaped by statutes, agency guidance, and court decisions. In some states, judges have ordered employers or insurers to reimburse an injured worker’s out-of-pocket medical cannabis costs when a treating provider recommends it and the use fits the state’s medical program. New Jersey’s Supreme Court, for example, held that medical marijuana could qualify as reasonable and necessary care under the state’s workers’ compensation law.
Maine’s high court likewise addressed reimbursement questions in Bourgoin, focusing on whether workers’ comp counts as a “private health insurer” under the state program there itself.

Other states have reached the opposite result, often based on federal preemption arguments under the Controlled Substances Act (CSA). Minnesota’s Supreme Court held in Musta v. Mendota Heights Dental Center that the CSA preempted an order requiring an employer to pay for an employee’s medical cannabis purchases. And in 2022, the U.S. Supreme Court declined to hear petitions from similar Minnesota cases, leaving the national split in place.

Some states try to reduce uncertainty through legislation. NCCI (a major workers’ comp research and rating organization) has noted that only a handful of states explicitly say an employer or workers’ comp insurer is not required to reimburse medical marijuana—Florida is one example NCCI highlighted in its discussion of state approaches.

So, what should a worker actually do if medical marijuana is part of a recovery plan?

Start with documentation. Workers’ comp decisions typically turn on medical necessity, causation (is it tied to the work injury?), and proof. If cannabis is recommended, the claim is stronger when the treating provider’s rationale is clear, the worker is properly certified under the state medical program, and receipts show what was purchased and when.

Next, expect utilization fights. Even in reimbursement-friendly jurisdictions, insurers may challenge whether cannabis is “reasonable,” whether other therapies should be tried first, or whether the quantity is excessive. Some jurisdictions have tried to add structure with fee schedules or multi-part tests for reimbursement.

Also, don’t confuse “covered treatment” with “protected workplace use.” Workers’ comp can pay for a medical service while an employer still enforces safety rules and drug-free workplace policies. In safety-sensitive jobs—driving, heavy equipment, aviation, healthcare—impairment concerns can trigger discipline, job restrictions, or disputes about return-to-work status.

Finally, treat this as both a medical and legal issue. Outcomes can hinge on details like how the state’s medical cannabis law defines “health insurance,” how workers’ comp is categorized, and how courts view federal conflict. If reimbursement is being denied (or employment consequences are looming), many claimants consult a workers’ compensation attorney licensed in their state.

Medical marijuana may be a practical tool for symptom management, but in workers’ compensation, the rules are still catching up. The best approach is to document everything, follow the state program closely, and assume the answer depends on your state’s law and current case precedent for your specific claim.

Learn more: How Cannabis Supports Chronic Pain Management