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The employer may need to cover compound creams



An employer may be on the hook for $ 4,827.56, plus interest, in costs for an analgesic compound distributed to an injured worker whose claim it approved and whose pharmacy order went without a request for review, a Pennsylvania judge decided Friday.

In 2017, a worker with a broken left ankle was prescribed a compound cream consisting of at least six elements and was instructed to apply the compound cream to the "affected area" two to four times a day, as needed, per treatment for it. accepted the employee's compensation claim, according to documents in Omni Pharmacy Services, LLC v Bureau of Workers & # 39; Compensation Fee Review Hearing Office (American Interstate Insurance Company), filed at the Commonwealth Court of Pennsylvania in Harrisburg.

Omni Pharmacy Services LLC distributed the 201

8 cream and submitted three invoices to the employer – Stitzer Crane Services Inc. – for a total of $ 6,081. The employer refused to pay all invoices and stated that it was not responsible for the processing.

Apoteket then filed applications for fee review, which resulted in decisions in favor of pharmacies, which led the employer to pay re-priced invoices in the amount of $ 4,827.56, plus interest with an interest rate of 10% annually calculated from the date on which the payment on each bill was due, according to documents.

The employer appealed, requested hearings to challenge the decisions and argued that "the bills have been denied on the issue of causation", among other allegations, according to documents. The pharmacy claimed that the employer "claimed his causal problem without presenting any evidence that the compound cream was not prescribed for the treatment of the plaintiff's work injury." Neither employers nor pharmacies presented evidence, according to documents.

An interrogator concluded that "there is a dispute … concerning the causal link between the prescribed compound cream and the accepted occupational injury" and provided the fee review provisions that led the employer to cover the cream, according to documents. [19659002]

The pharmacy appealed, claiming that the interrogation officer was wrong and claiming that the employer "has accepted responsibility for the plaintiff's work injury, but it did not seek review of the use of the compound creams as neither reasonable nor necessary to treat the plaintiff's work injury."

In turn, the employer claimed that the case law – Workers & # 39; First Pharmacy Services, LLC v Bureau of Workers & # 39; Compensation Fee Review Hearing Office – concerning a compound cream prescribed to an injured worker for an illness unrelated to a worker's injury was not accepted in court as part of the claim, according to documents.

The Pennsylvania court ruled on Friday that the previous case is not the same as the current one, where the employer accepted the claim and the cream was ordered as a result of the injury. The court wrote that the hearing officer's dismissal of the overdue payments suspended and restored the case "for a decision on the justification for determining the fee review." Catalog

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