Whitmoyer v. Workers' Compensation Appeal Board

150 A.3d 1003, 2016 Pa. Commw. LEXIS 518
CourtCommonwealth Court of Pennsylvania
DecidedDecember 1, 2016
DocketNo. 614 C.D. 2015
StatusPublished
Cited by4 cases

This text of 150 A.3d 1003 (Whitmoyer v. Workers' Compensation Appeal Board) is published on Counsel Stack Legal Research, covering Commonwealth 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' Compensation Appeal Board, 150 A.3d 1003, 2016 Pa. Commw. LEXIS 518 (Pa. Ct. App. 2016).

Opinions

OPINION BY

JUDGE SIMPSON

In this factually complex workers’ compensation appeal involving an employer’s subrogation rights, we are asked whether those rights extend beyond indemnity payments and also reach payments toward medical bills. Although this issue has already been decided, new arguments are raised in reliance on recent Supreme Court decisions.

Craig Whitmoyer (Claimant) argues the workers’ compensation authorities erred in granting Mountain Country Meats’ (Employer) petition to modify a compensation agreement reached after a third-party negligence claim was resolved. The parties refer to the compensation agreement at issue as a “third-party settlement agreement.” The modification reflected additional medical expenses Employer paid for Claimant’s 1993 work injury. The third-party settlement agreement contemplated that, after payment of the employer’s accrued (past) workers’ compensation lien, the $189,416.27 balance of the claimant’s third-party negligence recovery would constitute a fund for credit against “future workers’ compensation payable.”1 The primary issue is whether the term “compensation” in Section 319 of the Workers’ Compensation Act2 (Act) (relating to sub-rogation of employer to rights of employee against third persons) encompasses medical expenses in addition to indemnity benefits. Concluding that it does, we affirm.

I. Background

We summarize the pertinent facts found by the Workers’ Compensation Judge (WCJ) and the procedural history as follows. In January 1993, Claimant sustained a work-related amputation of his right arm at the distal forearm. WCJ’s Op., 10/17/13, Finding of Fact (F.F.) No. 1; Reproduced Record (R.R.) at 65a.

Several agreements followed, the third of which is the most important now. First, in April 1993, Employer3 entered into a supplemental agreement that “confined [Claimant’s work injury] to the specific loss of the amputation of the right upper extremity at the distal forearm.” F.F. No. 2; R.R. at 66a. The supplemental agree[1006]*1006ment stated the defined injury entitled Claimant “to a 20 week healing period and 370 weeks of specific loss benefits [at $237.50 per week after 5/22/93].” F.F. No. 2; R.R. at 66a. The supplemental agreement also stated: “The 20 week healing period expires on 5/21/93. Compensation was paid from 1/2/93 thru [sic] 5/21/93 for 20 weeks at a rate of $158.33 per week for a total of $3,166.60, which includes both the waiting period and the healing period.” R.R. at 66a.

Second, as memorialized in a December 16, 1994, stipulation of facts signed by Claimant and Employer, Claimant commuted the weekly payments agreed on by the parties in the supplemental agreement into a lump sum payment of $69,994.64 for his specific loss. R.R. at 69a-70a. The stipulation also stated: “[Employer] remains responsible for all reasonable, necessary, and related medical expenses and/or treatment for [Claimant’s] work injuries.” R.R. at 70a. At this point, Employer’s only ongoing liability for payments under the Act was for Claimant’s medical bills.

Third, about five years later, in April 1999, Claimant and Employer entered into the controlling agreement, the “third-party settlement agreement,” reflecting Claimant’s recovery of $300,000 from Hollymatic Corporation and Dantro Associates. F.F. No. 3; R.R. at 64a. As to past-paid benefits, the third-party settlement agreement indicates Employer was entitled to a sub-rogation lien of $110,583.73, minus $28,955.86 for Employer’s pro rata share of the third-party litigation costs, for a net lien recovery of $81,627.87. R.R. at 64a.

What remains at issue here is the rest of Claimant’s recovery from the third-party tortfeasor. The balance of the recovery in the negligence claim was $189,416.27. The third-party settlement agreement stated the “BALANCE of RECOVERY shall constitute [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. (Emphasis added.) Thus, Employer would be liable to Claimant for 37% of future medical expenses up to the balance of recovery, representing Employer’s share of the litigation costs incurred by Claimant in his negligence action. F.F. No. 3. The emphasized language quoted above is the basis for the current contest.

The parties further stipulated: (1) the third-party settlement agreement contains accurate figures and calculations; (2) Claimant reimbursed Selective $81,627.87, the amount of Employer’s net lien according to the third party settlement agreement; (3) as of February 2013, Selective paid $206,670.88 in medical benefits for Claimant’s work injury; and, (4) Claimant did not pay any amount toward these bills.

About a month later, in a May 26, 1999 letter that included a check for the $81,627.87 accrued (past) lien amount, Claimant’s counsel advised Selective “it is [Claimant’s] position that no credit can be applied to future medical bills. Instead, under Section 319 such credit only applies to ‘future installments of compensation’ ” and “[f]uture medical expenses [do] not constitute ‘installments of compensation.’ ” R.R. at 63a; see also F.F. No. 5.

At this point, the only on-going liability of the Employer under the third-party settlement agreement was to pay Claimant a portion of related medical bills (representing a payment toward litigation costs), until the balance of recovery fund was exhausted.

As stipulated by the parties, Employer paid all the medical bills for several years, while the Claimant did not pay any of his related medical bills. In September 2012, Employer filed its modification petition, [1007]*1007which is currently before us. Hearings ensued before the WCJ.

Employer submitted the deposition testimony of Jodi Bell, a current supervisor for Selective, who, during 1998 and 1999 was a claims representative who worked on Claimant’s case. F.F. No. 6(a). The WCJ made the following additional findings based on Bell’s testimony:

b. Ms. Bell became aware of a $300,000 settlement.
c. Ms. Bell received the [1999 Supplemental] Agreement, signed it and filed it with the Bureau of Workers’ Compensation.
d. She received the $81,627.87 lien reimbursement check and Claimant’s counsel’s May 26,1999 letter.
e. Ms. Bell did. not have authority to agree to the interpretation of the future installments of compensation as outlined in the May 26,1999 letter.
f. Ms. Bell did not respond to the May 26,1999 letter.

F.F. Nos. 6(b)-(f). The WCJ found Bell’s uncontradicted deposition testimony credible. F.F. No. 7. Claimant did not present any evidence other than the May 26, 1999 letter, F.F. No. 9.

In addition, the WCJ determined the parties agreed that, as of February 2013, Selective paid $206,670.88 in medical bills for Claimant’s work injury. F.F. No. 4(c). Claimant did not reimburse Employer or Selective from the balance of recovery fund for any medical expenses paid for Claimant’s work injury. F.F. No. 4(d).

Based on his findings and conclusions, the WCJ modified the third-party settlement agreement.

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Cite This Page — Counsel Stack

Bluebook (online)
150 A.3d 1003, 2016 Pa. Commw. LEXIS 518, Counsel Stack Legal Research, https://law.counselstack.com/opinion/whitmoyer-v-workers-compensation-appeal-board-pacommwct-2016.