Title: Daniel Wright's Case
Citation: N/A
Docket Number: SJC-12873
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: October 27, 2020

NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
volumes of the Official Reports.  If you find a typographical 
error or other formal error, please notify the Reporter of 
Decisions, Supreme Judicial Court, John Adams Courthouse, 1 
Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-
1030; SJCReporter@sjc.state.ma.us 
 
SJC-12873 
 
DANIEL WRIGHT'S CASE. 
 
 
 
Suffolk.     May 5, 2020. - October 27, 2020. 
 
Present:  Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, 
& Kafker, JJ.1 
 
 
Marijuana, Medical.  Workers' Compensation Act, Insurer, Medical 
benefits.  Words, "Health insurance provider." 
 
 
 
 
Appeal from a decision of the Industrial Accident Reviewing 
Board. 
 
 
The Supreme Judicial Court on its own initiative 
transferred the case from the Appeals Court. 
 
 
Katherine L. Lamondia-Wrinkle for the claimant. 
Leonard Y. Nason (James E. Ramsey also present) for the 
insurer. 
Wystan M. Ackerman, for American Property Casualty 
Insurance Association, amicus curiae, submitted a brief. 
Matthew J. Walko & Pauline A. Jauquet, for Mass General 
Brigham Incorporated, amicus curiae, submitted a brief. 
 
 
KAFKER, J.  In the instant case we are asked to determine 
                                                          
 
1 Chief Justice Gants participated in the deliberation on 
this case prior to his death. 
2 
 
 
whether an insurance company may be ordered to reimburse an 
employee for medical marijuana expenses pursuant to a general 
provision of the Massachusetts workers' compensation scheme that 
requires reimbursement of necessary and reasonable medical 
expenses.  The claimant, Daniel Wright, sought compensation for 
$24,267.86 of medical marijuana expenses to treat chronic pain 
stemming from two work-related injuries he sustained in 2010 and 
2012.  His claim was denied by an administrative judge, and the 
denial was affirmed on appeal by the reviewing board of the 
Department of Industrial Accidents (department).  The reviewing 
board concluded that marijuana's status as a federally illicit 
substance preempted any State level authority to order a 
workers' compensation insurer to pay for Wright's medical 
marijuana expenses.  We likewise conclude that the workers' 
compensation insurer cannot be required to pay for medical 
marijuana expenses, but do so based on the medical marijuana act 
itself. 
We recognize that the current legal landscape of medical 
marijuana law may, at best, be described as a hazy thicket.  
Marijuana is illegal at the Federal level and has been deemed 
under Federal law to have no medicinal purposes, but 
Massachusetts, as well as the majority of States, have legalized 
medical marijuana and created regulatory schemes for its 
administration and usage.  Complicating and confusing matters 
3 
 
 
further, Congress has placed budgetary restrictions on the 
ability of the United States Department of Justice to prosecute 
individuals for marijuana usage in compliance with a State 
medical marijuana scheme, and the Department of Justice has 
issued, revised, and revoked memoranda explaining its marijuana 
enforcement practices and priorities, leaving in place no clear 
guidance. 
The Commonwealth's original medical marijuana act, St. 
2012, c. 369 (act or medical marijuana act), was carefully 
drafted by its sponsors to take into account this most difficult 
regulatory environment, with provisions specifically designed to 
avoid possible conflicts with the Federal government.  One such 
provision of the law expressly states that "[n]othing in this 
law requires any health insurance provider, or any government 
agency or authority, to reimburse any person for the expenses of 
the medical use of marijuana."  St. 2012, c. 369, § 7 (B).  See 
G. L. c. 94I, § 6 (i).  This provision recognizes that when 
medical marijuana patients seek to recover the costs of such use 
from third parties, including insurance companies engaged in 
interstate commerce, the regulatory environment becomes even 
more problematic.  Under the plain language of this provision, 
those insurers are not required to reimburse medical marijuana 
expenses for a substance that remains illegal under Federal law.  
We conclude that this specific language, and the Federal 
4 
 
 
concerns it seeks to address and avoid, is controlling and not 
overridden by the general language in the workers' compensation 
laws requiring workers' compensation insurers to reimburse for 
reasonable medical expenses.  A contrary reading of this 
specific language, which states that health insurers and 
government agencies and authorities are not required to 
reimburse medical marijuana expenses, would have been completely 
misleading to those who voted on it.  It is one thing for a 
State statute to authorize those who want to use medical 
marijuana, or provide a patient with a written certification for 
medical marijuana, to do so and assume the potential risk of 
Federal prosecution; it is quite another for it to require 
unwilling third parties to pay for such use and risk such 
prosecution.  The drafters of the medical marijuana law 
recognized and respected this distinction.2 
1.  Background.  a.  Federal statutory landscape.  The 
Controlled Substances Act (CSA) provides the relevant Federal 
legislative backdrop against which the current litigation 
stands.  Passed in 1970, the CSA creates a "closed regulatory 
system making it unlawful to manufacture, distribute, dispense, 
or possess any controlled substance except in a manner 
                                                          
 
2 We acknowledge the amicus briefs submitted by the American 
Property Casualty Insurance Association and Mass General Brigham 
Incorporated, in support of Central Mutual Insurance Company 
(Central Mutual). 
5 
 
 
authorized by the CSA."  Gonzales v. Raich, 545 U.S. 1, 10, 13 
(2005) (Raich).  The CSA sets forth five schedules to classify 
and regulate the use of controlled substances.  Id. at 13.  "The 
drugs are grouped together based on their accepted medical uses, 
the potential for abuse, and their psychological and physical 
effects on the body."  Id.  "Schedule I contains the most severe 
restrictions on access and use, and [s]chedule V the least."  
Gonzales v. Oregon, 546 U.S. 243, 250 (2006).  Marijuana is 
classified under schedule I.3  See 21 U.S.C. § 812(c).  Pursuant 
to its schedule I classification, marijuana is deemed to have 
(1) a high potential for abuse; (2) no currently accepted 
medical use in the United States; and (3) a lack of accepted 
safety for use under medical supervision.  21 U.S.C. 
§ 812(b)(1).  See United States v. Oakland Cannabis Buyers' 
Coop., 532 U.S. 483, 493 (2001) ("Congress has made a 
determination that marijuana has no medical benefits worthy of 
an exception").  Accordingly, as a schedule I drug, marijuana 
may not be prescribed.  See id. at 491.  The United States 
Supreme Court has also rejected the contention that the CSA 
includes an implicit necessity defense for the manufacture and 
distribution of schedule I drugs on the basis of medical need.  
                                                          
 
3 Very recently, however, hemp-derived cannabidiol (CBD) was 
removed from schedule I.  See Pub. L. No. 115-334, § 12619, 132 
Stat. 4490, 5018 (2018). 
6 
 
 
Id. at 494. 
The consequences of marijuana's status as a schedule I drug 
are significant.  With one exception not relevant here,4 the 
manufacture, distribution, or possession of a schedule I 
substance is a Federal offense.  See 21 U.S.C. §§ 841(a)(1), 
844(a).  See also Raich, 545 U.S. at 14.  An individual found in 
possession of a schedule I substance may be sentenced to one 
year of imprisonment, a fine of at least $1,000, or both.  See 
21 U.S.C. § 844(a).  The same penalties also apply to anyone who 
"attempts or conspires to commit" such an offense.  See 21 
U.S.C. § 846.  Additionally, an individual who "aids, abets, 
counsels, commands, induces or procures" the commission of a 
Federal offense, including a violation of the CSA, may be 
subject to the same penalties as the principal.  See 18 U.S.C. 
§ 2(a).  Thus, it is a Federal crime not only to possess 
marijuana, but also to conspire to do so or to aid or abet the 
possession of marijuana.  Accordingly, regardless of the legal 
status of marijuana at the State level, marijuana users, and 
those who aid or abet the distribution or possession of 
marijuana, "remain[] potentially subject to Federal criminal 
                                                          
 
4 The Controlled Substances Act (CSA) provides a very narrow 
exception for the use of schedule I drugs in research studies 
that have been preapproved by the United States Food and Drug 
Administration.  See 21 U.S.C. § 823(f).  See also Gonzales v. 
Raich, 545 U.S. 1, 14 (2005). 
7 
 
 
prosecution."  Barbuto v. Advantage Sales & Mktg., LLC, 477 
Mass. 456, 460 (2017). 
b.  Massachusetts medical marijuana law.  In 2012, 
Massachusetts voters approved a ballot initiative to legalize 
the use of marijuana for medicinal purposes in the Commonwealth.  
See St. 2012, c. 369.5  The stated purpose of the act provides 
that "there should be no punishment under state law for 
qualifying patients, physicians and health care professionals, 
personal caregivers for patients, or medical marijuana treatment 
center agents for the medical use of marijuana, as defined 
herein."  See St. 2012, c. 369, § 1.  The act first sets out 
"the parameters of protection from State prosecution and 
penalties that the act respectively gives to physicians and 
health care professionals, qualifying patients and their 
personal caregivers, and licensed dispensary agents."  
Commonwealth v. Canning, 471 Mass. 341, 345 (2015).  Pursuant to 
the act, "[a]ny person meeting the requirements under this law 
shall not be penalized under Massachusetts law in any manner, or 
                                                          
 
5 In December 2018, St. 2012, c. 369 (act), was codified as 
G. L. c. 94I.  See St. 2017, c. 55, §§ 44, 82.  See also 
Commonwealth v. Richardson, 479 Mass. 344, 349 n.7 (2018).  
During the time period for which Wright seeks reimbursement, 
however, the act remained in effect as originally enacted.  
Moreover, the statutory provisions relevant to our analysis 
remain substantively unaltered by the codification in G. L. 
c. 94I.  For ease of reference, we will include parallel 
citations to the current statutory and regulatory scheme where 
appropriate. 
8 
 
 
denied any right or privilege, for such actions."  St. 2012, 
c. 369, § 4.  See G. L. c. 94I, § 2.  See also G. L. c. 94G, 
§ 7.  Further, "[a] qualifying patient or a personal caregiver 
shall not be subject to arrest or prosecution, or civil penalty, 
for the medical use of marijuana," provided he or she meets the 
requirements of the law.  St. 2012, c. 369, § 4.  See G. L. 
c. 94I, § 2.  See also G. L. c. 94G, § 7.  Additionally, "[t]he 
lawful possession, cultivation, transfer, transport, 
distribution, or manufacture of medical marijuana as authorized 
by [the act] shall not result in the forfeiture or seizure of 
any property."  St. 2012, c. 369, § 6 (A).  See G. L. c. 94I, 
§ 2 (b) (4).  The act then "establishes a medical marijuana 
registration or licensing regime . . . that covers nonprofit 
medical marijuana treatment centers, medical marijuana center 
dispensary agents, and qualifying patients and personal 
caregivers."  Canning, supra. 
At the same time, however, the act contains a number of 
limitations.  It provides that "[n]othing in [the act] requires 
the violation of federal law or purports to give immunity under 
federal law . . . [or] poses an obstacle to federal enforcement 
of federal law."  St. 2012, c. 369, § 7 (F), (G).  See 935 Code 
Mass. Regs. § 501.840(2)(f), (g) (2019).  Additionally, and most 
relevant here, the act states that "[n]othing in this law 
requires any health insurance provider, or any government agency 
9 
 
 
or authority, to reimburse any person for the expenses of the 
medical use of marijuana."  St. 2012, c. 369, § 7 (B).  See 
G. L. c. 94I, § 6 (i).  See also 935 Code Mass. Regs. 
§ 501.840(2)(b).  This language is substantially similar to 
reimbursement restrictions found in at least twenty-two6 other 
                                                          
 
6 See Ark. Const. amend. XCVIII, § 6 ("This amendment does 
not require . . . [a] government medical assistance program or 
private health insurer to reimburse a person for costs 
associated with the medical use of marijuana unless federal law 
requires reimbursement"); Colo. Const. art. XVIII, § 14(10)(a) 
("No governmental, private, or any other health insurance 
provider shall be required to be liable for any claim for 
reimbursement for the medical use of marijuana").  See also 
Alaska Stat. § 17.37.040(c) ("A governmental, private, or other 
health insurance provider is not liable for any claim for 
reimbursement for expenses associated with medical use of 
marijuana"); Ariz. Rev. Stat. § 36-2814 ("Nothing in this 
chapter requires . . . [a] government medical assistance 
program, a private health insurer or a workers' compensation 
carrier or self-insured employer providing workers' compensation 
benefits to reimburse a person for costs associated with the 
medical use of marijuana"); Cal. Health & Safety Code 
§ 11362.785 ("This article does not require a governmental, 
private, or any other health insurance provider or health care 
service plan to be liable for a claim for reimbursement for the 
medicinal use of cannabis"); Del. Code Ann. tit. 16, § 4907A 
("Nothing in this chapter requires . . . [a] government medical 
assistance program or private health insurer to reimburse a 
person for costs associated with the medical use of marijuana"); 
Fla. Stat. § 381.986(15)(f) ("Marijuana, as defined in this 
section, is not reimbursable under [Florida's workers' 
compensation statute]"); 410 Ill. Comp. Stat. 130/40(d) 
("Nothing in this Act may be construed to require a government 
medical assistance program, employer, property and casualty 
insurer, or private health insurer to reimburse a person for 
costs associated with the medical use of cannabis"); Me. Rev. 
Stat. tit. 22, § 2426 ("This chapter may not be construed to 
require . . . [a] government medical assistance program or 
private health insurer to reimburse a person for costs 
associated with the medical use of marijuana"); Mich. Comp. Laws 
10 
 
 
                                                          
 
§ 333.26427(c)(1) ("Nothing in this act shall be construed to 
require . . . [a] government medical assistance program or 
commercial or non-profit health insurer to reimburse a person 
for costs associated with the medical use of marihuana"); Mont. 
Code Ann. § 39-71-407(6)(c) ("Nothing in this chapter may be 
construed to require an insurer to reimburse any person for 
costs associated with the use of marijuana for a debilitating 
medical condition . . ."); Nev. Rev. Stat. § 453A.800 ("The 
provisions of this chapter do not . . . [r]equire an insurer, 
organization for managed care or any person or entity who 
provides coverage for a medical or health care service to pay 
for or reimburse a person for costs associated with the medical 
use of marijuana"); N.H. Rev. Stat. Ann. § 126-X:3(III)(a) 
("Nothing in this chapter shall be construed to require . . . 
[a]ny health insurance provider, health care plan, or medical 
assistance program to be liable for any claim for reimbursement 
for the therapeutic use of cannabis"); N.J. Stat. Ann. § 24:6I-
14 ("Nothing in [the medical marijuana scheme] shall be 
construed to require a government medical assistance program or 
private health insurer to reimburse a person for costs 
associated with the medical use of cannabis . . ."); N.D. Cent. 
Code § 19-24.1-34 ("This chapter does not require . . . [a] 
government medical assistance program or private insurer to 
reimburse a person for costs associated with the medical use of 
marijuana"); Okla. Stat. tit. 63, § 427.8 ("Nothing in this act 
. . . shall . . . [r]equire an employer, a government medical 
assistance program, private health insurer, worker's 
compensation carrier or self-insured employer providing worker's 
compensation benefits to reimburse a person for costs associated 
with the use of medical marijuana"); Or. Rev. Stat § 475B.794 
("Nothing in [the medical marijuana statutes] requires . . . [a] 
government medical assistance program or private health insurer 
to reimburse a person for costs associated with the medical use 
of marijuana"); 35 Pa. Cons. Stat. § 10231.2102 ("Nothing in 
this act shall be construed to require an insurer or a health 
plan, whether paid for by Commonwealth funds or private funds, 
to provide coverage for medical marijuana"); R.I. Gen. Laws 
§ 21-28.6-7(b)(1) ("Nothing in this chapter shall be construed 
to require . . . [a] government medical assistance program or 
private health insurer or workers' compensation insurer, 
workers' compensation group self-insurer, or employer self-
insured for workers' compensation . . . to reimburse a person 
for costs associated with the medical use of marijuana"); Utah 
Code Ann. § 26-61a-112 ("Nothing in this chapter requires an 
insurer, a third-party administrator, or an employer to pay or 
11 
 
 
States with medical marijuana programs.7 
c.  Recent developments in Federal enforcement.  Congress 
has not acted to change marijuana's classification as a schedule 
I drug since the legalization of medical marijuana in 
Massachusetts.  It remains illegal to possess or distribute.  
See 21 U.S.C. §§ 841(a)(1), 844(a).  Two years after the 
enactment of the Commonwealth's medical marijuana law, however, 
Congress passed an appropriations bill that included an 
amendment to restrict the Department of Justice's ability to 
prosecute medical marijuana patients.  The amendment provides 
that "[n]one of the funds made available in this Act to the 
Department of Justice may be used, with respect to [an 
                                                          
 
reimburse for cannabis, a cannabis product, or a medical 
cannabis device"); Vt. Stat. Ann. tit. 18, § 4474c(b)(4) ("This 
chapter shall not be construed to require that coverage or 
reimbursement for the use of marijuana for symptom relief be 
provided . . . for purposes of workers' compensation . . . ."); 
Wash. Rev. Code § 69.51A.060(2) ("Nothing in this chapter 
establishes a right of care as a covered benefit or requires any 
state purchased health care . . . or other health carrier or 
health plan . . . to be liable for any claim for reimbursement 
for the medical use of marijuana"). 
 
7 Four years after voters approved the medical marijuana 
ballot initiative, Massachusetts voters approved another ballot 
initiative legalizing the recreational use of marijuana.  See 
St. 2016, c. 334.  Use of the Commonwealth's medical marijuana 
program remains widespread even in the wake of the legalization 
of recreational marijuana, however.  In 2019, nearly 1.3 million 
ounces of medical-use marijuana were sold in Massachusetts.  See 
Cannabis Control Commission, The Cannabis Control Commission & 
Attorney General's Office Joint Report, at 8 (Feb. 2020).  As of 
January 2020, there were over 60,000 active medical marijuana 
patients in the Commonwealth.  Id. 
12 
 
 
enumerated list of States, including Massachusetts], to prevent 
such States from implementing their own State laws that 
authorize the use, distribution, possession, or cultivation of 
medical marijuana."  Pub. L. No. 113-235, § 538, 128 Stat. 2130, 
2217 (2014).  The amendment thus "prohibits [the Department of 
Justice] from spending funds from relevant appropriations acts 
for the prosecution of individuals who engaged in conduct 
permitted by the State Medical Marijuana Laws and who fully 
complied with such laws."  See United States v. McIntosh, 833 
F.3d 1163, 1177 (9th Cir. 2016).  The amendment presently 
remains in effect through December 11, 2020.  See Pub. L. No. 
116-159, §§ 101(2), 106(3) (2020); Pub. L. No. 116-93, § 531, 
133 Stat. 2317, 2431 (2019). 
At the same time, the Department of Justice has reversed 
its own stance toward the prosecution of medical marijuana cases 
multiple times.  The Department of Justice issued a series of 
memoranda during the administration of President Barack Obama 
advising Federal prosecutors not to prioritize the prosecution 
of individuals engaged in marijuana-related activities pursuant 
to a State medical marijuana law.  See D.W. Ogden, Deputy 
Attorney General, Memorandum for Selected United States 
Attorneys:  Investigations and Prosecutions in States 
Authorizing the Medical Use of Marijuana (Oct. 19. 2009); J.M. 
Cole, Deputy Attorney General, Memorandum for All United States 
13 
 
 
Attorneys:  Guidance Regarding Marijuana Enforcement (Aug. 29, 
2013).  This guidance was later rescinded under the 
administration of President Donald Trump.  See J.B. Sessions, 
Attorney General, Memorandum for All United States Attorneys:  
Marijuana Enforcement (Jan. 4, 2018). 
Following the rescission of the Obama administration 
guidance, the United States Attorney for the District of 
Massachusetts, Andrew Lelling, issued a statement that he could 
not "provide assurances that certain categories of participants 
in the state-level marijuana trade will be immune from federal 
prosecution."  See Department of Justice, United States 
Attorney's Office, District of Massachusetts, Statement from 
U.S. Attorney Andrew E. Lelling Regarding Federal Marijuana 
Enforcement (Jan. 8, 2018).  In another statement issued later 
the same year, Lelling reiterated that he would not "effectively 
immunize" Massachusetts residents from Federal marijuana law 
enforcement.  See Department of Justice, United States 
Attorney's Office, District of Massachusetts, Statement from 
U.S. Attorney Andrew Lelling Regarding the Legalization of 
Recreational Marijuana in Massachusetts (July 10, 2018).  He 
further stated, however, that he would focus prosecutorial 
resources on issues of overproduction, sales to minors, and 
organized crime and interstate transportation of drug proceeds.  
Id. 
14 
 
 
d.  Facts.  We turn now to the facts of the instant case.  
On October 19, 2010, the claimant, Wright, injured his right 
knee while stepping off a ladder in the course of his 
employment.  At the time, he was employed by Unitek Global 
Services (Unitek) as a cable installer.  He underwent surgery, 
recovered, and sought new employment.  He eventually went to 
work for Pioneer Valley Electric as an electrical apprentice.  
On May 15, 2012, he sustained a second injury to his right knee 
at work.  Wright underwent another surgery, which resulted in 
numerous postoperative complications.  He developed deep vein 
thrombosis and eventually was diagnosed with complex regional 
pain syndrome.  As a result, Wright began to suffer from chronic 
leg pain, difficulty sleeping, and anxiety, and he became quick 
to anger.  In August 2013, Wright was evaluated for, and was 
issued, a certification to enroll in Massachusetts's medical 
marijuana program.  Wright subsequently began using medical 
marijuana to manage his chronic pain.  Wright's use of medical 
marijuana reduces his pain, increases his mobility, improves his 
sleep, and reduces his anxiety and anger.  Wright has also been 
able to eliminate the use of any opioids as a result of his 
medical marijuana use. 
In 2014, Wright filed a workers' compensation claim for 
permanent and total disability benefits with the department.  On 
May 3, 2016, Wright settled his workers' compensation claim 
15 
 
 
against Unitek's insurer as well as his claim against Pioneer 
Valley Electric's insurer, Central Mutual Insurance Company 
(Central Mutual).  Pursuant to the settlement agreements, Wright 
was provided with lump sums to compensate him for the medical 
expenses incurred as a result of his injuries.  The settlement 
agreement with Central Mutual also provided that Central Mutual 
"agreed to accept ongoing liability for the right knee with the 
caveat that payment of future medical treatment must be 
reasonable and necessary and causally related" to Wright's 
injury." 
On October 19, 2016, Wright filed a claim for workers' 
compensation benefits under G. L. c. 152, §§ 13 and 30, seeking 
reimbursement for medical expenses incurred from his medical 
marijuana treatment.  The claim was initially denied on May 10, 
2017.  Wright appealed from the denial, and a hearing was held 
before an administrative judge.  At the time of the hearing, 
Wright was seeking $24,267.86 in reimbursement for medical 
marijuana expenses incurred from February 11, 2016, to August 
28, 2017.  Wright testified that he spent approximately one 
hundred dollars every one to two weeks on marijuana vaporizing 
products.  He further testified that, for the period during 
which he had purchased edibles, he spent approximately seventy-
five dollars per day. 
During the hearing, Central Mutual represented to the 
16 
 
 
administrative judge that it had entered into an agreement with 
the Workers' Compensation Trust Fund (trust fund) pursuant to 
G. L. c. 152, § 37,8 for the trust fund to reimburse Central 
Mutual for eighty percent of the maximum amount reimbursable by 
the trust fund for medical expenses.  Central Mutual further 
indicated that, if ordered to reimburse Wright for his medical 
marijuana expenses, it would in fact seek reimbursement from the 
trust fund. 
The administrative judge found that Wright's testimony as 
to the positive benefits he receives from medical marijuana was 
"entirely credible."  Nonetheless, the judge concluded that 
Central Mutual could not be ordered to pay in light of 
marijuana's illegal status at the Federal level.  He also 
determined that the medical marijuana act precluded him from 
ordering Central Mutual to reimburse the claimant. 
Wright appealed from the decision to the reviewing board of 
the department.  The reviewing board affirmed the administrative 
judge's denial.  It observed that the CSA "clearly and 
manifestly criminalizes" the activities for which Wright was 
seeking compensation, and that ordering Central Mutual to pay 
                                                          
 
8 The Workers' Compensation Trust Fund provides partial 
reimbursement to second insurers for payments made to employees 
who have previously suffered a prior injury.  See G. L. c. 152, 
§ 37, second par. 
17 
 
 
would put it at risk of Federal prosecution.  Wright appealed, 
and we transferred the matter to this court on our own motion.9 
2.  Discussion.  We examine the reviewing board's decision 
pursuant to the standards of G. L. c. 30A, § 14 (7).  Under 
§ 14 (7), "[w]e may reverse or modify the board's decision 
where, among other reasons, it is based on an error of law, or 
is arbitrary, capricious, or otherwise not in accordance with 
law."  Spaniol's Case, 466 Mass. 102, 106 (2013).  See G. L. 
c. 30A, § 14 (7) (c), (g).  The department's interpretation of 
the workers' compensation statute is entitled to deference.  See 
Camargo's Case, 479 Mass. 492, 497 (2018).  "However, where the 
statute is not one that the [department] administers, no 
deference is due."  Id.  In such instances, we exercise de novo 
review.  Id.  In the instant case, we conclude that the 
determinative legal questions involve interpretation of the 
Commonwealth's medical marijuana law and other Massachusetts and 
Federal laws not administered by the department.  We therefore 
exercise de novo review without deference to the reviewing 
board's legal interpretation. 
As outlined supra, prior to the passage of the medical 
marijuana act, marijuana was illegal under both Massachusetts 
                                                          
 
9 Another case involving a workers' compensation claim for 
medical marijuana reimbursement has been stayed in the Appeals 
Court pending the outcome of this case.  See St. Pierre vs. T.E. 
Greenwood Construction, Appeals Court docket no. 2018-P-0971. 
18 
 
 
and Federal law and was not a reasonable medical expense 
reimbursable pursuant to G. L. c. 152, § 30, under which "an 
employer is obligated to pay the reasonable and necessary 
medical expenses resulting from an employee's work-related 
injury."  McElroy's Case, 397 Mass. 743, 750 (1986).  See G. L. 
c. 152, § 13.  Federal law has not changed.  The only issue is 
the effect of the medical marijuana act.10  Thus, to determine 
whether medical marijuana expenses may be compensable at all, we 
must look to the provisions of the medical marijuana act.  We 
must also seek to avoid conflict with Federal law and possible 
preemption under the supremacy clause.  See Ajemian v. Yahoo!, 
Inc., 478 Mass. 169, 184 (2017), cert. denied sub nom. Oath 
Holdings, Inc. v. Ajemian, 138 S. Ct. 1327 (2018) (absent clear 
legislative intent to contrary, courts have duty to construe 
statutes in manner that disfavors preemption).  The act itself, 
we conclude, is drafted with these concerns in mind.  It 
expressly recognizes the Federal legal pitfalls and seeks to 
steer well clear of them by carving a narrow path through the 
marijuana regulatory thicket. 
a.  Meaning of reimbursement limitation provision.  The 
                                                          
 
10 Although possession of less than one ounce of marijuana 
was decriminalized by ballot initiative in 2008, it was still 
illegal at the time of the medical marijuana law's enactment.  
See Commonwealth v. Cruz, 459 Mass. 459, 473 (2011) 
("decriminalization is not synonymous with legalization"). 
19 
 
 
plain language of the reimbursement limitation provision states 
that nothing in the medical marijuana law "requires any health 
insurance provider . . . to reimburse any person for the 
expenses of the medical use of marijuana."  St. 2012, c. 369, 
§ 7 (B).  To fully understand and interpret this provision, we 
must also look to the broader context of the over-all medical 
marijuana scheme and regulatory environment.  As explained 
supra, the stated purpose of the act was to protect patients, 
caregivers, and medical professionals from prosecution or 
punishment under Massachusetts law for engaging in the voluntary 
medical use of marijuana.  See St. 2012, c. 369, § 1.  The act 
also recognized that marijuana possession and distribution 
remain illegal under Federal law and that the Commonwealth has 
no authority to alter the illegal status of marijuana at the 
Federal level.  St. 2012, c. 369, § 7 (F), (G).  See Raich, 545 
U.S. at 29.  "The Supremacy Clause unambiguously provides that 
if there is any conflict between federal and state law, federal 
law shall prevail."  Raich, supra.  Providing authorization for 
medical marijuana use in this environment remains somewhat of a 
high wire act, and the statute seeks to minimize the possibility 
of Federal prosecution or Federal preemption by carefully 
20 
 
 
setting forth the scope of its protections.11  It is within this 
context that the statute expressly states that nothing in the 
law requires health insurers to reimburse any person for medical 
marijuana expenses. 
As the statute recognizes, requiring companies that insure 
the health of medical marijuana patients to pay for their 
marijuana usage raises the stakes much higher.  If insurers were 
required to make such payments, the size and scope of the 
legalization of medical marijuana would be substantially 
expanded, raising concerns about Federal enforcement and 
preemption.  First, unlike the patients and doctors covered by 
the act, insurance companies would not be participating in the 
                                                          
 
11 Indeed, in Bourgoin v. Twin Rivers Paper Co., 2018 ME 77, 
¶¶ 29-30, the Supreme Judicial Court of Maine concluded that the 
CSA preempted Maine's medical marijuana law where a claimant 
sought reimbursement for medical marijuana expenses.  Other 
courts that have been skeptical of the preemption argument in 
the context of compulsory reimbursement of marijuana have relied 
on the recent changes in Federal enforcement of the CSA.  See 
Appeal of Panaggio, 172 N.H. 13, 19 & n.2 (2019) (remanding case 
for further analysis of preemption issue where court had been 
"left to speculate" about whether insurer would be exposed to 
criminal prosecution, while noting existence of Obama 
administration's medical marijuana policy and appropriations 
amendment); Lewis v. American Gen. Media, 2015-NMCA-090, ¶ 32 
(2015) (rejecting preemption argument as speculative in light of 
Department of Justice guidance and appropriations amendment, 
which demonstrate "equivocal federal policy").  However, the 
recent rescission of the Obama administration's medical 
marijuana guidance demonstrates that enforcement is transitory 
and subject to change.  Further, as the court in Bourgoin 
observed, such guidance "was directed only to the question of 
enforcement of laws but did nothing to challenge their 
existence" (emphasis in original).  Bourgoin, supra at ¶ 27. 
21 
 
 
patient's use of a federally proscribed substance voluntarily.  
It is one thing to voluntarily assume a risk of Federal 
prosecution; it is another to involuntarily have such a risk 
imposed upon you.  As discussed supra, possession and 
distribution of marijuana remain federally illegal, as does 
aiding or abetting such possession or distribution.  See 18 
U.S.C. § 2(a); 21 U.S.C. § 844(a).  It is not unreasonable, 
given the current hazy regulatory environment and shifting winds 
of Federal enforcement, for insurance companies to fear that 
paying for a claimant's marijuana could expose them to potential 
criminal prosecution.  Further, insurance companies are 
typically involved in interstate commerce, thereby raising 
Federal regulators' concerns.  Requiring interstate insurers to 
participate in the Massachusetts medical marijuana scheme would 
extend the reach of the Massachusetts act well beyond the 
Commonwealth's borders.  Reimbursement may also increase usage 
and the amounts of money at stake, thereby further expanding the 
scope of the statute, and thus Federal concerns.  By providing 
that the act does not "require" insurers to reimburse medical 
marijuana expenses, the reimbursement limitation provision 
protects third parties from being compelled to pay for the use 
22 
 
 
of a federally proscribed substance.12 
We have previously considered the question of involuntary 
involvement under the act in Barbuto.  In that case, a medical 
marijuana patient with Crohn's disease was terminated from her 
employment after testing positive for marijuana use.  Barbuto, 
477 Mass. at 458.  In our decision, we indicated that, in 
seeking to use marijuana to address an illness specifically 
delineated by the statute, she was simply exercising her rights 
under the act.  See St. 2012, c. 369, § 2 (C) (definition of 
"debilitating medical condition" under medical marijuana act 
explicitly includes Crohn's disease).  See also St. 2012, 
c. 369, § 4 (act declares that patients shall not be denied "any 
right or privilege" on basis of their medical marijuana use). 
The medical marijuana patient in Barbuto commenced an 
action for handicap discrimination, in violation of G. L. 
c. 151B, § 4 (16), along with a number of other related claims.  
Barbuto, 477 Mass. at 458-459.  She was not seeking third-party 
reimbursement.  Rather, her complaint asserted that she was a 
"handicapped person" within the scope of the Commonwealth's 
handicap discrimination law, and that her medical marijuana use 
                                                          
 
12 Additionally, by prohibiting reimbursement, the act 
forecloses the possibility of disputed claims leading to 
defensive litigation.  Such litigation would only increase the 
likelihood of the entire statute being challenged on preemption 
grounds. 
23 
 
 
at home was a reasonable accommodation required by her employer.  
See id. at 461.  The defendants waived the argument that Federal 
preemption barred the plaintiff's claims, thereby limiting our 
discussion of the issue in that case.  See id. at 466 n.9. 
A provision of the act that was at issue in Barbuto 
expressly stated that the act did not "require[] any 
accommodation of any on-site medical use of marijuana in any 
place of employment."  St. 2012, c. 369, § 7 (D).  We concluded 
that by specifying that the act did not require "on-site" 
accommodation of medical marijuana use, this limitation 
"implicitly recognizes that the off-site medical use of 
marijuana might be a permissible 'accommodation.'"  Barbuto, 477 
Mass. at 464-465.  We emphasized that "accommodation" was a term 
of art under the handicapped discrimination laws, and the 
statute's drafting appeared to recognize the issue and the 
distinction between on-site and off-site accommodation.  Id.  
Here, by contrast, the reimbursement limitation language does 
not make any sort of similar implicit recognition.  Rather, the 
language broadly states that nothing in the act requires 
reimbursement to "any person for the expenses of the medical use 
of marijuana."  St. 2012, c. 369, § 7 (B). 
The more expansive limitation language in the reimbursement 
subsection comports with the different legal stakes at issue 
here.  As we recognized in Barbuto, "[t]he only person at risk 
24 
 
 
of Federal criminal prosecution for [the plaintiff's] possession 
of medical marijuana is the employee."  Barbuto, 477 Mass. at 
465.  On the other hand, while an employer's passive acceptance 
of off-site use of medical marijuana does not have potential 
criminal implications under Federal law, an insurer's compelled 
reimbursement of medical marijuana affirmatively entangles the 
insurer in the Commonwealth's medical marijuana scheme. 
We also recognized in Barbuto that there are specific cases 
where an employer may not reasonably be able to accommodate an 
employee's medical marijuana usage without violating Federal 
statutes or regulations.  See Barbuto, 477 Mass. at 467.  In 
such limited instances, the employer may be able to show that 
such accommodation would constitute an undue hardship.  See id. 
("an undue hardship might be shown if the employer can prove 
that the use of marijuana by an employee would violate an 
employer's contractual or statutory obligation, and thereby 
jeopardize its ability to perform its business").  We indicated 
that examples of such undue hardship may include transportation 
employers and Federal government contractors who are subject to 
certain Federal statutory and regulatory requirements 
restricting their ability to hire or maintain employees who use 
marijuana.  Id. at 467-468.  By contrast, concerns about 
possible legal exposure for insurance companies are likely to be 
present in every case, for the reasons discussed supra.  We thus 
25 
 
 
find Barbuto readily distinguishable. 
We also observed in Barbuto that declaring "an 
accommodation for medical marijuana to be per se unreasonable 
out of respect for Federal law would not be respectful of the 
recognition of Massachusetts voters, shared by the legislatures 
or voters in the vast majority of States, that marijuana has an 
accepted medical use for some patients suffering from 
debilitating medical conditions."  Id. at 465-466.  Here, 
however, our holding is entirely consistent with the will of 
Massachusetts voters.  The citizens of Massachusetts voted to 
approve a medical marijuana act that was designed to protect 
medical marijuana participants and avoid the risk of Federal 
intervention.  Our conclusion that insurers, who did not choose 
to participate, may not be compelled to reimburse medical 
marijuana expenses is entirely in accord with these purposes as 
well as the act's plain language. 
Our understanding of the reimbursement limitation provision 
is also consonant with the fact that most States have approached 
this issue in a similar manner.  As discussed, many States with 
medical marijuana schemes include language in their medical 
marijuana statutes protecting third-party insurers from being 
required to provide reimbursement to medical marijuana patients.  
See note 6, supra.  See also 8 L.K. Larson, Larson's Workers' 
Compensation Law § 94.06 (rev. ed. 2019) ("Acknowledging the 
26 
 
 
inconsistency between state and federal law, a number of states 
have adopted statutory provisions making it clear that an 
insurer or self-insurer may not be compelled to reimburse a 
patient for costs associated with the use of medical 
marijuana").  By excluding third-party insurers from being 
obligated to reimburse medical marijuana patients under the 
statute and limiting the protections of the act to those willing 
to assume the risk of exposure to Federal prosecution, these 
statutory provisions lessen the likelihood of Federal 
intervention and preemption. 
Finally, we reject any interpretation contending that the 
general language of the workers' compensation statute requiring 
reimbursement for reasonable and necessary medical expenses 
requires third-party reimbursement because medical marijuana use 
is legalized under the medical marijuana act.  Such an 
interpretation ignores the fact that marijuana was previously 
illegal under Massachusetts law, that it remains illegal under 
Federal law, and that the medical marijuana act itself expressly 
states that it does not require such reimbursement.  The medical 
marijuana act cannot state on its face that "[n]othing in this 
law requires [third-party reimbursement]" but then be 
interpreted to require reimbursement under other laws on the 
basis of the act's legalization of medical marijuana.  St. 2012, 
c. 369, § 7 (B).  If this were the case, then the express 
27 
 
 
language in the medical marijuana act would disguise the 
provision's actual meaning, parading as its opposite.  Ballot 
questions in particular must be readily understandable to 
voters, who are presumed to understand the plain meaning of an 
initiative when they vote to approve it.13  See Commonwealth v. 
Cruz, 459 Mass. 459, 470-471 (2011). 
In sum, based on the plain language of the reimbursement 
limitation provision contained within St. 2012, c. 369, § 7, as 
well as the context within which it was enacted, we conclude 
that health insurance providers may not be compelled to 
reimburse claimants for expenses for the medical use of 
                                                          
 
13 Moreover, the summary of the medical marijuana initiative 
petition prepared by the Attorney General and disseminated to 
voters explicitly stated that the "proposed law would . . . not 
require any health insurer or government entity to reimburse for 
the costs of the medical use of marijuana."  See Information for 
Voters:  2012 Ballot Questions, Question 3:  Law Proposed by 
Initiative Petition, Medical Use of Marijuana.  As summaries of 
initiative petitions are to be "written in plain English that a 
reasonable voter can readily comprehend," we will not assume 
that the summary was intended to relay to voters that insurers 
were, in fact, required to provide such reimbursements, contrary 
to the summary's plain language.  Hensley v. Attorney Gen., 474 
Mass. 651, 664 (2016).  See Barbuto v. Advantage Sales & Mktg., 
LLC, 477 Mass. 456, 469 & n.11 (2017) ("the closest equivalent 
to legislative history [for laws enacted through an initiative 
petition] . . . is the Information for Voters guide," which 
includes Attorney General's summary). 
28 
 
 
marijuana.14,15 
b.  Scope of reimbursement limitation provision.  The 
claimant separately argues that, regardless of how we interpret 
the reimbursement limitation provision, it does not implicate 
workers' compensation insurers.  By its terms, the provision 
applies to "any health insurance provider, or any government 
agency or authority."  St. 2012, c. 369, § 7 (B).  The claimant 
contends that a workers' compensation insurer may not be 
considered a "health insurance provider" under the statute.  We 
conclude that the statute applies to those providing insurance 
for medical marijuana payments, including workers' compensation 
insurers.  We also conclude that the trust fund involved in the 
                                                          
 
14 Because we conclude that the Massachusetts medical 
marijuana act explicitly alleviates insurers from the burden of 
reimbursing for medical marijuana expenses, we do not need to 
reach Central Mutual's alternative argument that the 
Massachusetts medical marijuana scheme is preempted by Federal 
law.  Accordingly, we need not consider whether an insurer's 
reimbursement of medical marijuana expenses would, in fact, 
constitute a violation of the CSA.  Nonetheless, the fear of 
criminal exposure was clearly a motivating factor in the 
drafting of the reimbursement limitation language found in the 
act. 
 
15 We also observe that marijuana remains a controlled 
substance in Massachusetts.  See G. L. c. 94C, § 31 (listing 
"marihuana" as class D substance).  Although recreational 
marijuana possession and use was legalized in 2016, the 
Commonwealth places limits on possession and regulates its 
commercial sale.  See G. L. c. 94G, § 7 (a) (1), (2).  See also 
Commonwealth v. Long, 482 Mass. 804, 811 (2019).  Possession and 
distribution outside of these limits may still subject an 
individual to penalties under Massachusetts law.  See G. L. 
c. 94C, § 34. 
29 
 
 
instant case fits within the definition of a government agency 
or authority. 
Workers' compensation constitutes a "system of insurance" 
intended to "replace in part the wages lost by workers or their 
dependents as a result of injuries suffered in connection with 
their work."  Letteney's Case, 429 Mass. 280, 282 (1999).  
Pursuant to this statutory scheme, "[e]mployees give up their 
right to sue their employers in tort in return for a right to 
compensation for job-related injuries, whether or not the 
employer was at fault."  Id. at 284.  We have frequently made 
reference to the fact that workers' compensation is a form of 
insurance.  See, e.g., Benoit v. Boston, 477 Mass. 117, 125–126 
(2017) ("Such payments are in the nature of insurance benefits 
received pursuant to a policy taken out by the employer for the 
employee's benefit"); Letteney's Case, supra.  Further, a 
significant aspect of the workers' compensation insurance 
scheme, and the one precisely at issue here, is the provision of 
medical expenses and associated health care payments.  See Neff 
v. Commissioner of the Dep't of Indus. Accs., 421 Mass. 70, 75 
(1995).  Thus, entities who provide workers' compensation 
insurance are plainly providing health insurance benefits. 
This conclusion also comports with the design of the act to 
avoid the risk of Federal intervention.  Whether a medical 
marijuana patient seeks reimbursement under the workers' 
30 
 
 
compensation statute for injuries suffered in the course of his 
or her employment, or seeks reimbursement from his or her 
private health insurance provider, the underlying conduct at 
issue is the same:  a medical marijuana patient is requesting 
that the entity provide payments for the patient's purchase of 
marijuana.  In either case, requiring the insurer to reimburse 
these expenses would compel the insurer's involvement in the 
medical marijuana market.  Given that the act was drafted to 
avoid Federal prosecution and that, in accordance with this 
purpose, the reimbursement limitation provision shields third 
parties from potential Federal criminal exposure, it would make 
little sense to protect insurance companies in one scenario and 
not the other. 
This conclusion is also in keeping with the general purpose 
of workers' compensation insurance.  Workers' compensation was 
designed to eliminate "piecemeal tort litigation and tort claims 
by individual workers, which are time-consuming, expensive, and 
afford no guarantee of compensation."  Estate of Moulton v. 
Puopolo, 467 Mass. 478, 483 (2014).  It serves to protect 
workers, ensuring prompt administration of benefits while also 
allowing employers to "gain predictability and cost 
containment."  Id.  However, requiring workers' compensation 
insurers to reimburse medical marijuana expenses would threaten 
to undermine the protection, predictability, and timeliness 
31 
 
 
contemplated by the workers' compensation scheme.  Insurers who 
fear criminal exposure under existing Federal law would not 
voluntarily agree to reimburse a claimant for medical marijuana 
expenses in the first instance, as the insurer in this case 
vigorously argued.  The resulting delays in settlement and 
potential litigation in every single case where a claimant seeks 
benefits that include reimbursement for medical marijuana would 
be entirely contrary to the underlying purpose of the workers' 
compensation scheme.  The reimbursement limitation provision 
ensures that the medical marijuana act does not result in such 
widespread litigation and maintains the stability of the 
workers' compensation scheme. 
Finally, we also recognize that workers' compensation 
insurers may seek reimbursement from the trust fund for up to 
seventy-five percent of payments made to employees who have been 
previously injured.  See G. L. c. 152, § 37, second par.  
Indeed, in the instant case Central Mutual has represented that 
it intends to seek reimbursement from the trust fund if ordered 
to pay for Wright's medical marijuana expenses.  The trust fund 
is administered by the Massachusetts treasury.  See G. L. 
c. 152, § 65.  Thus, as a government entity, the trust fund is 
directly implicated by the language of the reimbursement 
limitation provision, which includes within its scope "any 
government agency or authority."  See St. 2012, c. 369, § 7 (B).  
32 
 
 
Such reimbursement of medical marijuana expenses violates the 
express language of the statute. 
In sum, neither Central Mutual nor the trust fund can be 
ordered to reimburse Wright for his medical marijuana expenses, 
as the medical marijuana act does not provide for such third-
party reimbursements. 
3.  Conclusion.  We conclude that the reimbursement 
limitation provision contained within St. 2012, c. 369, § 7, 
prevents a health insurance provider or government agency from 
being ordered to reimburse a claimant for medical marijuana 
expenses.  Accordingly, the claimant's medical marijuana 
expenses are not compensable.  The decision of the reviewing 
board is affirmed. 
 
 
 
 
 
 
So ordered.