Compromise Agreement Failed to Specify 'Related' Injuries
Failing to include medical treatments for related injuries in a compromise and release agreement will disqualify an injured worker from receiving payments for treatments allegedly causally related to the work injury, despite having received past payments for treatment of the condition, the Commonwealth Court has ruled.
On Jan. 24, a split three-judge Commonwealth Court panel ruled in Amore Restaurant v. Workers' Compensation Appeal Board that a workers' compensation judge erred by using previous payment of the injured worker's medical bills as persuasive evidence to grant the worker penalties. The court's decision, which was issued as an unreported memorandum, overruled the workers' compensation judge and the Workers' Compensation Board of Appeals, which had supported the judge's decision.
Writing the majority opinion, Judge P. Kevin Brobson said the court's 2013 ruling in DePue v. Workers' Compensation Appeal Board, which determined that previous payments did not indicate approval, was persuasive.
"Claimant elected to forgo the inclusion of any other potentially causally related injuries, whether currently known or not," Brobson said. "Thus, we believe that the [judge] and the board erred by basing their conclusions on the fact that employer here continuously paid the medical bills at issue up until the time of the agreement."
Judge Mary Hannah Leavitt joined Brobson's opinion; Judge Rochelle S. Friedman dissented.
According to Friedman, the case was distinguishable from DePue because the claimant was not seeking to add a new injury or to correct the described injury, but was only seeking to continue payments for treatment of an identified work injury.
"I was on the panel of DePue. I agreed with it then, and I agree with it now. However, this case is not controlled by DePue," Friedman said in a footnote. "The [judge] found that the medical bills, which were coded the same both before and after the agreement, were causally related to claimant's work injury. As such, I would affirm the board."
According to Brobson, in 2006, claimant Carla Hayes sustained a work-related aggravation of a left triangular cartilage complex tear.
Hayes, employer Amore Restaurant and Norguard Insurance Co. signed a compromise and release agreement in 2010.
The agreement, Brobson said, referred to the aggravation of the TFCC tear, and indicated that the agreement includes "any and all injuries incurred by claimant ... or arising therefrom, regardless of what terms are used to describe the injuries."