Elite Care, RX, LLC v. Premier Comp. Sols., LLC, 2024 Pa. LEXIS 1040 (Pa. Super. July 17, 2024) (McCaffery, J.)
Elite Care, Rx, LLC v. Premier Comp Solutions, LLC, Supreme Court of Pennsylvania decided July 17, 2024.
OPINION IN SUPPORT OF REVERSAL
JUSTICE WECHT
The Superior Court below affirmed a decision allowing a lawsuit for fraud, civil conspiracy, and unjust enrichment to proceed against workers’ compensation insurance carriers that allegedly failed to reimburse providers for medications dispensed to injured workers. As I detail below, that holding plainly conflicts with the Workers’ Compensation Act’s exclusive remedy provision and was based upon a misunderstanding of the Act’s fee review provision. The Superior Court’s decision should be reversed.
IV. Discussion
The decision below plainly conflicts with the Workers’ Compensation Act’s exclusive remedy provision, which this Court has held “extends to [the] workers’ compensation insurance carrier, protecting the insurer to the full extent of the employer’s protection.” Because the employer/insurer’s obligation to pay the claimant’s medical expenses arises from the Workers’ Compensation Act in the first place, the workers’ compensation system is the exclusive forum for resolving both payment disputes and alleged mismanagement of workers’ compensation claims.
It is enough for our purposes today to say that nothing in the Act prevents the issue of a putative provider’s standing from being resolved in fee review. The Superior Court therefore erred in holding that the Act “does not provide for an administrative proceeding by or against putative providers or their billing agents in the Bureau.”
In sum, the decision below misinterpreted Subsection 306(f.1)(5) and created a state of affairs that plainly conflicts with the Act’s exclusive remedy provision. Elite Care’s sole remedy lies in the administrative realm. The lower courts therefore erred in allowing Elite Care’s civil suit to proceed.
I would reverse the Superior Court’s decision.
Justice Brobson joins this opinion in support of reversal.
