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BE CAREFUL WHEN SETTLING YOUR CASE!

In Pennsylvania, workers’ compensation cases are settled by entering into a compromise and release agreement.  The parties then must go to a hearing in which the workers’ compensation judge determines whether the injured worker understands the significance of the agreement.

 In Hong v. WCAB, 51 A.3d 905 (Pa. Cmwlth. 2012), the injured worker entered into a lump sum settlement.  The agreement did not say whether unpaid medical bills would be paid in addition to the lump sum.  After the settlement, the injured worker learned that one physician had an outstanding bill in excess of $37,000.00 which the employer refused to pay. 

The Commonwealth Court stated that to set aside a compromise and release agreement, the party trying to set it aside must show fraud, deception, duress, or mutual mistake.  The court found that none of these factors was present.  The court found that had claimant wanted to ensure payment of past medical bills in addition to the lump sum, his counsel could have included appropriate language in the agreement.  That the claimant had counsel was an important factor for the court.

Bottom line:  Make sure you understand the Compromise and Release Agreement, including and provisions concerning the payment of medical expenses.

PROTECTING YOUR RIGHT TO MEDICAL COVERAGE

If you are keeping the medical expenses open when you settle your case, look closely at the language.  Sometimes injured workers will settle a workers’ compensation case while keeping the insurance companies’ responsibility to medical bills open. 

In DePue v. WCAB, 61 A.3d 1062 (Pa. Cmwlth. 2012), the injured worker entered into a compromise and release agreement which described the injury as “closed head injury with seizure disorder and short-term memory loss.”  After the compromise and release agreement was approved, the injured worker filed a penalty petition alleging that the employer failed to pay for medical bills for a shoulder injury and then filed a review petition to add a left shoulder injury to the description of injury.

The Commonwealth Court ruled that the injured worker cannot do so.  In connection with the resolution of the case, the injured worker is bound by the description of injury contained in the compromise and release agreement.  The parties can, by agreement, say that the agreement is without prejudice to the right of the claimant to add additional injuries at some future point.  Absent that language, the injured worker is going to be bound by the description of injury contained in the compromise and release agreement.

Bottom line:  If you are keeping medical expenses open in the settlement of your workers’ compensation case, pay careful attention to the description of injury contained in the agreement.

TAKING MONEY FROM YOUR POCKET

Under Pennsylvania Law, an employer is entitled to a credit equal to 50% of any old age benefits against workers’ compensation benefits the employee receives.  If the employee was collecting old age benefits before the work injury occurred, the employer is not entitled to a credit.  This credit does not apply to social security disability benefits.

For example, if an employee receives $2,200.00 per month in workers’ compensation benefits and $1,100.00 per month in social security retirement benefits (old age benefits), the insurance company would be obligated to pay only $1,650.00 monthly. ($2,200-$1,100/2=$1,650.00)

In Caputo v. WCAB, an injured worker challenged this position, arguing that it was a violation of the Pennsylvania Constitution. The Court rejected the employee’s challenge. 

Bottom line:  Employers are entitled to reduce payments of workers’ compensation benefits by 50% of social security retirement benefits the injured worker receives.

American Lawyer Media and Martindale Hubble have selected Pennsylvania Attorney Gregory J. Boles as a “2013 Top Rated Attorney.”  Mr. Boles, partner with the Pennsylvania workers’ compensation law firm, Fenner & Boles LLC, will be listed in the November 25, 2013 edition of the Legal Intelligencer, Pennsylvania’s premier legal publication.  Attorneys recognized as “Top Rated Lawyers” have achieved significant leadership status and are highly regarded by their peers for both their legal ability and high ethical standards.

Mr. Boles’ practice is exclusively devoted to the representation of the disabled in workers’ compensation, social security disability, pension and insurance contract litigation.  He has also been chosen as a Pennsylvania SuperLawyer every year since 2007.  Each year, no more than five percent of the lawyers in the state are selected by the research team at Super Lawyers to receive this honor.

Gregory Boles is a graduate of Georgetown University and Villanova Law School. Before opening his own practice in 2000, Greg was a partner in Willig, Williams & Davidson, where his practice was devoted exclusively to the representation of injured workers.

He is the author of "Consumer's Guide to Pennsylvania Workers' Compensation" and "Caregiver's Guide to Pennsylvania Workers' Compensation Billing."  Greg has written extensively on Pennsylvania workers' compensation and has lectured before attorneys, labor unions and advocacy groups for the disabled.

Diane Fenner graduated from the University of Pennsylvania Law School. She received her Bachelor of Arts degree with honors from Barnard College, and also has a Ph.D. in psychology from Columbia University. Diane has been practicing law since 1983.