An evenly divided Pennsylvania Supreme Court Tuesday affirmed a lower appellate court decision allowing a workers compensation medical billing dispute to continue being litigated in civil court, but dissenting justices said the decision violated workers comp exclusive remedy.
The state high court found the Pennsylvania Superior Court correctly determined the case of Elite Care Rx LLC vs. Premier Comp Solutions LLC should play out in trial court as opposed to the workers comp system.
The case concerns a dispute between billing agency Elite Care Rx and several workers comp insurers over prescription reimbursements that Elite Care says it is still owed.
Elite Care sought to have the case litigated in civil court because it contains claims of unjust enrichment, fraud and civil conspiracy, while the defendants contended the matter belonged before the Pennsylvania Bureau of Workers’ Compensation. The Superior Court sided with the plaintiff.
The state Supreme Court affirmed the Superior Court in a one-sentence order but did not release a full opinion.
Two justices wrote lengthy dissents arguing that the Superior Court got it wrong.
The lower court’s decision “plainly conflicts with the Workers’ Compensation Act’s exclusive remedy provision and was based upon a misunderstanding of the Act’s fee review provision,” Justice David Wecht wrote, adding that Elite Care’s “sole remedy lies in the administrative realm.”