Case Law Alerts
A C&R Agreement cannot be used to set aside a fee review determination.
According to the Commonwealth Court, paragraph 10 of the C&R Agreement—stating that the employer would pay reasonable, necessary and related medical expenses incurred before the hearing date—obligated the employer to pay for the medications dispensed by the pharmacy since the expense had already been incurred. The court further noted that a valid C&R Agreement is binding upon the parties, but that in this case the pharmacy was not a party to the agreement. Consequently, the court held that a C&R Agreement to which a provider is not a party cannot be used to deprive that provider of the fee review procedures or to excuse the employer from paying the provider. To do so would violate the Act and due process.
Case Law Alerts, 4th Quarter, October 2018
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