Holmes v. Solon Automated Services

752 S.E.2d 179, 231 N.C. App. 44, 2013 WL 6236750, 2013 N.C. App. LEXIS 1238
CourtCourt of Appeals of North Carolina
DecidedDecember 3, 2013
DocketNo. COA13-325
StatusPublished

This text of 752 S.E.2d 179 (Holmes v. Solon Automated Services) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Holmes v. Solon Automated Services, 752 S.E.2d 179, 231 N.C. App. 44, 2013 WL 6236750, 2013 N.C. App. LEXIS 1238 (N.C. Ct. App. 2013).

Opinion

STROUD, Judge.

Plaintiff appeals an opinion and award of the North Carolina Industrial Commission denying “Plaintiff’s request that the Commission enforce the provisions of the Mediated Settlement Agreement which [45]*45relate to the funding by Defendants of a Medicare Set-Aside Account[.]” For the following reasons, we affirm in part and reverse in part.

I. Background

On 21 November 2012, the North Carolina Industrial Commission issued an opinion and award in this matter. The basic facts of the situation are uncontested. Washington D. Holmes was an employee of defendant Solon Automated Services who sustained a compensable injury on 16 May 1990, for which he received workers’ compensation benefits. On 26 August 2010, Mr. Holmes and defendants engaged in a voluntary mediation, and they “entered into an agreement to settle” Mr. Holmes’ claim. This “agreement was memorialized in an Industrial Commission Form MSC8 Mediated Settlement Agreement (“Agreement”) which was signed by all parties.”

In the Agreement, in consideration of the payments to be made by defendants, Mr. Holmes “waived the right to any further benefits under the Act” arising from his 16 May 1990 injury. Defendants agreed to pay the following:

a. $250,000.00;
b. Mediator’s fees;
c. “[A]ll authorized medical expenses to the date of the mediation[;]”
d. Funding of “a Medicare Set-Aside Allocation (‘MSA’) in the amount of $186,032.51, with ‘$19,582.37 seed money for the Medicare Set Aside for the benefit of Washington Holmes’ and payments of ‘9,247.23 annually beginning on September 15, 2011, payable 18 years only if Washington Holmes is living.’ ”

The defendants were to purchase an annuity to make the annual payments. “The portion of the Mediated Settlement Agreement relating to the Medicare Set Aside further provides, ‘Non-surgical medical bills will be paid to date of CMS approval.’ ” The Agreement also provided that “ ‘The Employee understands and agrees that the monies in the Medicare Set-Aside Account will be used for the sole purpose of paying future medical expenses related to his injury which would otherwise be paid for by Medicare.’ ” The seed money and annual payments “with which Defendants were to fund the Medicare Set-Aside Account [were] derived from a Medicare Set-Aside Summary prepared by Gould & Lamb” and “the factors used in the calculation of the Medicare Set-Aside include [d [46]*46Mr. Holmes’] life expectancy, which Gould & Lamb calculated to be 19 years, and his anticipated medical care, physical therapy and medication costs.”

After the mediation, counsel for the parties “began drafting a settlement agreement^]” but Mr. Holmes “died unexpectedly of pneumonia on October 24, 2010[,]” before the settlement agreement was completed.1 Plaintiff, Mr. Holmes’ widow, was substituted as plaintiff in this action. On 15 December 2010, defendants paid the $250,000.00 required by the Agreement to plaintiff “pursuant to an Administrative Order entered by Executive Secretary Tracey H. Weaver[.]” But defendants refused to pay any sums under the Agreement regarding the Medicare Set-Aside Account, stating:

On December 30, 2010, Plaintiff filed an Industrial Commission Form 33 Request for hearing seeking payment of the Medicare Set-Aside funds set forth in the Mediated Settlement Agreement. Defendants contend they are not obligated to pay the seed money or the annual payments to a Medicare Set-Aside Account as set forth in the Mediated Settlement Agreement.

The Commission denied “Plaintiff’s request that the Commission enforce the provisions of the Mediated Settlement Agreement which relate to the funding by Defendants of a Medicare Set-Aside Account[.]” The Commission based its determination upon the following rationale:

9. Pursuant to the Medicare Secondary Payer Act, the burden of future medical expenses arising from a workers’ compensation case may not be shifted to Medicare. For this reason, the Act requires that Medicare’s interest be considered in workers’ compensation settlements which take into account future medical expenses.
10. As in the instant case, protecting Medicare’s interest may be accomplished through the establishment of a Medicare Set-Aside Account. Medicare will not pay for any expenses related to the workers’ compensation injury until the monies contained in the Medicare Set-Aside Account are exhausted. To this end, the Settlement [47]*47Agreement drafted by the parties in this case provides, “The Employee understands and agrees that the monies in the Medicare Set-Aside Account will be used for the sole purpose of paying future medical expenses related to his injury which would otherwise be paid for by Medicare.”
12. Based upon the preponderance of the evidence in view of the entire record, the Full Commission finds that the parties’ purpose in agreeing to establish a Medicare Set-Aside Account was to comply with the mandate of the Medicare Secondary Payer Act to protect Medicare from bearing the burden of future medical expenses arising from this workers’ compensation case. This purpose was to be accomplished through the funding by Defendants of the Medicare Set-Aside Account with monies which were to be used by Deceased-Employee for “the sole purpose of paying future medical expenses related to his injury which would otherwise be paid for by Medicare.”
13. The Full Commission further finds that an implied condition in the agreement to establish a Medicare Set-Aside Account was that Deceased-Employee be living, and, in effect, capable of incurring future medical expenses, at the time the Medicare Set-Aside Account was established through the deposit of the seed money. As medical bills could be incurred during Decedent-Employee’s lifetime, his death prior to the establishment of the Medicare Set-Aside Account frustrated the parties’ purpose in agreeing to establish the Account, namely, to protect Medicare from bearing the burden of future medical expenses arising from this workers’ compensation case.
14. Specifically with regard to the annual payments to be made by Defendants to the Medicare Set-Aside Account set forth in the Settlement Proposal, the Full Commission finds, that, not only was the purpose of these payments frustrated by Decedent-Employee’s death as set forth above, but also, the contingency of Decedent-Employee being alive as of the due date of the annual payment has not been satisfied as Decedent-Employee died on October 24, 2010, before the first annual payment came due.
[48]*4815. For the foregoing reasons, the Full Commission finds that Defendants are not required to pay the seed funds or the annual payments to a Medicare Set-Aside as detailed in the Mediated Settlement Agreement.

The Commission concluded,

1. Compromise settlement agreements, including mediated settlement agreements [in Workers’ Compensation cases], are governed by general principles of contract law.[] Roberts v. Century Contractors, Inc., 162 N.C. App. 688, 592 S.E.2d 215 (2004) (quoting Lemly v. Colvald Oil Co., 157 N.C. App.

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Bluebook (online)
752 S.E.2d 179, 231 N.C. App. 44, 2013 WL 6236750, 2013 N.C. App. LEXIS 1238, Counsel Stack Legal Research, https://law.counselstack.com/opinion/holmes-v-solon-automated-services-ncctapp-2013.