Compromise Agreement Failed to Specify 'Related' Injuries
Under the terms of the agreement, Hayes accepted a lump sum payment for her injury and released Amore and Norguard from its obligation under the Workers' Compensation Act.
Before entering into the agreement, Amore and Norguard paid all the medical bills Hayes submitted. However, once she signed the agreement, Amore and Norguard stopped paying the medical bills that she incurred after the date of the agreement.
Hayes filed for a penalty petition, alleging that Amore and Norguard violated the agreement by not paying the bills.
At a hearing before the workers' compensation judge, Hayes contended that she underwent eight surgical procedures to her left arm and hand area, including a hand fusion, and all were related to the TFCC tear. The fusion, she testified, required her to use her whole arm when lifting items, which caused pain in her neck and shoulder. She further testified that chiropractic treatment relieved her pain and that a pain management specialist had administered pain block injections.
A doctor testified on behalf of Hayes that he had diagnosed her with wrist pain, myalgia, cervical inner signal dysfunction, cervicalgia and shoulder pain. He further testified that the treatments she'd received were related to the work injury and surgeries.
At the hearing, Hayes also admitted she hadn't filed a petition to add shoulder and neck injuries to the injury description in the agreement.
The judge determined that the treatment was for injuries causally related to the work injury and ruled in Hayes' favor, granting her a 25 percent penalty.
Amore and Norguard appealed to the Workers' Compensation Appeals Board, but the board upheld the judge's decision, noting that the coding for the particular bills and procedures was the same before and after the agreement.
Amore and Norguard then appealed to the Commonwealth Court, arguing that the judge had expanded the description of the injury.
Brobson noted that, under DePue, payment of medical bills does not constitute admission of liability, and then he looked to whether the definition of the agreement included the additional injuries.