Allegheny Beverage Corp. v. Workmen's Compensation Appeal Board

646 A.2d 762, 166 Pa. Commw. 646, 1994 Pa. Commw. LEXIS 475
Commonwealth Court of Pennsylvania·Decided August 18, 1994·No. 1688 C.D. 1990·Published·Cited by 9 cases

Opinions

[649] KELLEY, Judge.

Before the court is an appeal by Allegheny Beverage Corporation (employer), and employer’s workers’ compensation carrier, Pennsylvania Manufacturers’ Association Insurance Company (PMA), from an order of the Workmen’s Compensation-Appeal Board.1 The issue in this case involves the proper allocation of a third party structured settlement in order to satisfy employer’s subrogation lien for past compensation paid where there is no money available at the time of settlement for this purpose, and a determination of employer’s credits and liabilities for the future.

I. Traditional Subrogation

The disposition of this appeal requires the proper application of the reimbursement for past compensations and allocations of attorney’s fees as required by section 319 of the Workers’ Compensation Act (Act)2 to the structured settlement recoveries from the third party settlement. The pertinent language of section 319 is:

Where the compensable injury is caused in whole or in part by the act or omission of a third party, the employer shall be subrogated to the right of the employe, his personal representative, his estate or his dependents, against such third party to the extent of the compensation payable under this article by the employer; reasonable attorney’s fees and other proper disbursements incurred in obtaining a recovery or in effecting a compromise settlement shall be prorated between the employer and employe, his personal representative, his estate or his dependents. The employer shall pay that proportion of the attorney’s fees and other proper disbursements that the amount of compensation paid or payable at the time of recovery or settlement bears to the total recovery or settlement. Any recovery against such third person in excess of the compensation theretofore paid by the employer shall be paid forthwith to the employe, his [650] personal representative, his estate or his dependents, and shall be treated as an advance payment by the employer on account of any future instalments of compensation. (Emphasis added.)

This section specifically requires the employer and claimant to share pro rata the attorney’s fees and costs involved to establish the recovery in the third-party claim.

In a “traditional” subrogation case, where the claimant receives a lump sum settlement from a third party, to comply with section 319, the claimant must first reimburse employer for past compensation paid to satisfy the employer’s subrogation lien. The amount of the lien for past compensation paid is reduced proportionately by the attorney’s fees and costs incurred in obtaining the settlement.

For example, assume that an employer has already paid past compensation of $50,000 at the time that the claimant receives a third party settlement of $150,000, and that the claimant pays his attorney 40% of the settlement or $60,000. The employer is entitled to an immediate reimbursement of $50,000 for past compensation paid, reduced by the proportionate share of attorney’s fees or $20,000 (40% of $50,000). Therefore, claimant must pay $30,000 to satisfy his reimbursement to the employer for past compensation paid. This leaves $100,000 as a credit against future compensation. (Note that the $20,000 reduction benefits claimant as the employer’s sharing of its proportion of attorney’s fees with respect to the subrogation lien, since claimant already paid the entire attorney’s fee upon obtaining the third party settlement or judgment.)

The next step is to calculate a grace period based on the remaining settlement money during which employer’s responsibility for making weekly benefit payments is suspended. We do this by simply dividing the amount of the settlement money remaining by the weekly rate of compensation. In our example, assuming a weekly rate of compensation of $200, we divide $100,000 by $200 to obtain a grace period of 500 weeks. At the end of 500 weeks, assuming claimant’s [651] condition has not changed, employer’s responsibility for making weekly compensation payments will resume.

Although employer’s responsibility for paying weekly benefits during the grace period is suspended, in order to comply with section 319 the employer must pay its pro rata share of attorney’s fees for the compensation suspended as it benefits from the settlement. The most equitable way to do this is to have the employer pay its proportionate share of attorney’s fees each time it receives a credit. Therefore, in our example the employer would pay 40% of $200, or $80, each week during the 500 week grace period. This way if the employer’s responsibility for making payments should end during the grace period because of the claimant’s death or the end of his disability, then the employer will already have paid its pro rata share of the attorney’s fees with respect to the amount of benefit which it has received.

An illustration of the traditional subrogation method can be found in Pendleton v. Workmen’s Compensation Appeal Board (Congoleum Corp.), 155 Pa.Commonwealth Ct. 440, 625 A.2d 187 (1993). The calculations in Pendleton are performed in a slightly different manner but yield the same result. In Pendleton, the subrogation lien is divided by the gross recovery to give the percentage of the gross attorney’s fees which should be deducted from the subrogation lien. The grace period is computed in the same manner. The rest of the attorney’s fees not attributable to the subrogation lien are then divided by the grace period to give the weekly payment which employer must make for its pro rata share of the fees.

We will examine why the traditional subrogation .method would be inappropriate to apply in the present case after reviewing the facts of this case.

II. Factual History

Ronald B. Wolfe (claimant) suffered a work-related injury on December 19, 1981, when he slipped and fell in an icy parking lot while making a delivery for employer. Claimant sustained a serious injury to his left knee and received work[652] ers’ compensation benefits of $262.00 per week from PMA pursuant to a notice of compensation payable.3

In November of 1988, claimant filed a third party complaint in trespass against Weis Markets (Weis), the owner of the property on which he had been injured. After negotiations, claimant and Weis agreed to a structured settlement under which claimant would receive payments over a number of years rather than in one lump sum. The details of the settlement are as follows:

Up-front payment $110,000

Monthly payments of $1,250 for life with 20 years guaranteed $300,000 guaranteed

Balloon payments:

May 20, 1990-$10,000

May 20, 1995-$20,000

May 20, 2000-$30,000

May 20, 2005-$40,000

May 20, 2010-$50,000 $150,000 guaranteed

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Allegheny Beverage Corp. v. Workmen's Compensation Appeal Board, 646 A.2d 762, 166 Pa. Commw. 646, 1994 Pa. Commw. LEXIS 475 (Pa. Ct. App. 1994).

646 A.2d 762 (Allegheny Beverage Corp. v. Workmen's Compensation Appeal Board) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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