A report zeroing in on medical marijuana’s status in the workers compensation arena show that although the majority of the country has laws that allow for medical use of cannabis – 36 states to date — it’s a mixed bag on whether a payer must reimburse for the drug.

According to a study published in the American Journal of Industrial Medicine by six separate comp-affiliated research organizations, only six states of the medical cannabis access states expressly allow workers compensation insurance reimbursement: Connecticut, Minnesota, New Hampshire, New Jersey, New Mexico and New York.

The study was conducted by the several offices within the National Institute for Occupational Safety and Health, the International Association of Accident Boards and Commissions, the Workers’ Compensation Research Institute, and the National Council on Compensation Insurance. The issue has been a leading topic in workers comp circles, as stakeholders aim to understand better which states allow for access and reimbursement for what the federal government still considers an illegal drug.

The study, which relied on state laws and various precedential court rulings, points out that the drug is “generally considered a treatment of last resort” and that various medical guidelines in these states “require the physician to provide evidence that non‐cannabis treatment approaches have been ineffective for work‐related health condition.”

In addition to identifying states that grant access to medical marijuana reimbursements, researchers identified 14 states that provide that reimbursement by any insurer, described as “health or property‐casualty insurer like a workers compensation insurer” is not required by law. They include Arizona, Arkansas, California, Colorado, Delaware, Illinois, Louisiana, Michigan, Montana, Nevada, Oregon, Pennsylvania, Utah and Vermont. According to the report, the other states and Washington, D.C. “lack a discernable position” on cannabis and reimbursement status: Alaska, Maryland, Mississippi, Missouri, Oklahoma, Rhode Island, South Dakota, Virginia and West Virginia.

Six states expressly prohibit reimbursement: Florida, Maine, Massachusetts, Ohio and Washington.

Researchers however predict a shifting landscape, writing that “cannabis treatment for work‐related health conditions that are unresponsive to conventional medical treatments may increase as more workers petition state courts and administrative agencies for cannabis (workers compensation insurance) reimbursement.”