Whitmoyer v. Workers' Comp. Appeal Bd.

186 A.3d 947
CourtSupreme Court of Pennsylvania
DecidedJune 19, 2018
DocketNo. 52 MAP 2017
StatusPublished
Cited by8 cases

This text of 186 A.3d 947 (Whitmoyer v. Workers' Comp. Appeal Bd.) is published on Counsel Stack Legal Research, covering Supreme Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Whitmoyer v. Workers' Comp. Appeal Bd., 186 A.3d 947 (Pa. 2018).

Opinion

SAYLOR, C.J., BAER, TODD, DONOHUE, DOUGHERTY, WECHT, MUNDY, JJ.

OPINION

JUSTICE DONOHUE

The Pennsylvania Workers' Compensation Act ("WCA")1 makes an employer liable for paying the disability benefits and medical expenses of an employee who sustains an injury in the course of his or her employment. See 77 P.S. §§ 431 (disability), 531 (medical). This liability attaches without regard to the employer's negligence. See id ; see also Heckendorn v. Consolidated Rail Corp. , 502 Pa. 101, 465 A.2d 609, 613 (1983). Under section 319 of the WCA, however, employers (or their insurance carriers) are "subrogated to the right of the employe" and therefore entitled to reimbursement for certain expenses where a third party caused the employee's injury. 77 P.S. § 671. The instant matter addresses a specific question about the scope of this reimbursement.

Section 319 of the WCA provides, in pertinent part:

Where the compensable injury is caused in whole or in part by the act or omission *949of 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 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.

77 P.S. § 671 (internal footnote omitted) (emphasis added). We granted allowance of appeal to determine whether the Commonwealth Court erred in concluding that the term "instalments of compensation" in section 319 encompasses both disability benefits and payment of medical expenses.2

We recognize that the word "compensation," as used elsewhere in the WCA (including elsewhere in section 319), refers variously to one or both of these types of benefits. See Giant Eagle, Inc. v. W.C.A.B. (Givner) , 614 Pa. 606, 39 A.3d 287, 294 (2012) (plurality). "Instalments of compensation," however, is a more specific term. As discussed herein, we find that it means what it says: compensation that is paid in installments. Under the WCA, disability benefits are required to be paid in this manner, namely, "in periodical installments, as the wages of the employe were payable before the injury." See 77 P.S. § 601. Medical expenses are not. See 77 P.S. § 531. Accordingly, when a workers' compensation claimant recovers proceeds from a third-party settlement (following repayment of compensation paid to date) as prescribed by section 319, the employer (or insurance carrier) is limited to drawing down against that recovery only to the extent that future disability benefits are payable to the claimant. Accordingly, and as explained herein, we reverse the decision of the Commonwealth Court.

In January 1993, Craig Whitmoyer ("Whitmoyer") suffered a work-related injury that resulted in the amputation of part of his arm. Starting at that time, his employer, Mountain Country Meats ("MCM"), or MCM's insurance carrier, Selective Insurance ("Selective"), paid all of Whitmoyer's medical expenses related to this injury. A few months later, the parties reached an agreement related to Whitmoyer's disability benefits-he was entitled "to a 20 week healing period and 370 weeks of specific loss benefits [at $237.50 per week after May 22, 1993]." Judge's Exhibit 3 (Supplemental Agreement for Compensation for Disability or Permanent Injury, 4/29/1993) (providing that "weekly wages must be computed in accordance with Section 309 of the [WCA]").3 Whitmoyer subsequently *950petitioned for a commutation of these weekly payments. In December 1994, the Workers' Compensation Judge ("WCJ") granted his petition and directed MCM or Selective to pay Whitmoyer a lump sum payment of $69,994.64. While this commutation resolved his entitlement to disability benefits entirely, MCM remained responsible for Whitmoyer's ongoing medical bills. Judge's Exhibit 4 (Commutation Decision and Stipulation of Facts, 12/27/1994).

Several years later, Whitmoyer obtained a $300,000 settlement from third parties related to his injury and, in April 1999, he entered a third-party settlement agreement (the "TPSA") with Selective providing that as to past-paid compensation, Selective was entitled to a net subrogation lien of $81,627.87. See Selective's Exhibit 7 (TPSA).4 The net subrogation lien represents the difference between Selective's total accrued subrogation lien ($110,583.73) and Selective's pro rata share of the third-party litigation expenses ($28,955.86). Id. Thus, under the terms of the TPSA, Whitmoyer's "balance of recovery" was $189,416.27. Id. This term is defined on the form as a "fund for credit against future workers' compensation payable, subject to reimbursement to claimant of expenses of recovery at the rate of 37% on credit used." Id.

In communicating with Selective about the TPSA, Whitmoyer's counsel sent two letters to Jodi Bell ("Bell"), Selective's claims adjuster. In the first letter, dated March 8, 1999, counsel forwarded the TPSA, noted that "the lien of [Selective] can be satisfied in full with payment of $81,627.87" pursuant to section 319, and asked "that [Selective] remain responsible for payment of future medical expenses incurred by Mr. Whitmoyer." Selective's Exhibit 6 (March Letter from Donald F. Smith, Jr.). In the second letter, dated May 26, 1999, counsel enclosed a check for $81,627.13 and advised Selective of Whitmoyer's position that "no credit can be applied to future medical bills" because "under Section 319 such credit only applies to 'future installments of compensation'," which does not encompass "future medical expenses." Selective's Exhibit 8 (May Letter from Donald Smith, Jr.).

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Bluebook (online)
186 A.3d 947, Counsel Stack Legal Research, https://law.counselstack.com/opinion/whitmoyer-v-workers-comp-appeal-bd-pa-2018.