Workers' Compensation

The claimant settled his workers’ compensation claim by a Compromise and Release Agreement (C&R). After the Workers’ Compensation Judge issued a decision approving the settlement, he issued an amended order, specifying that the employer was to continue to pay medical expenses for the work injury until the funding of a workers’ compensation Medicare Set-Aside arrangement (MSA) approved by the Center for Medicare and Medicaid Services (CMS). In the C&R Agreement, the claimant agreed to cooperate with the employer’s effort to obtain an MSA. However, later, the claimant refused to sign the structured settlement papers needed to finalize the MSA. The claimant took the position that he wanted to be reimbursed for his past usage of medical marijuana and did not want to agree to the MSA without some provision for the funding of his future use of medical marijuana.

The employer filed petitions seeking to have the prior approved C&R Agreement enforced. The judge granted a review petition filed by the employer, and in the order indicated that if the employer wanted to end its obligation to pay for the claimant’s medical benefits, it was to obtain a new MSA quote and forward the paperwork to the claimant for signature. The claimant was given 14 days to sign the paperwork. If the claimant signed, the employer and insurer would be relieved of all future medical expenses liability. If the claimant refused to sign, the judge said the employer may send the claimant a check for the value of the MSA and that its obligation to pay for medical expenses related to the work injury would be extinguished.

The claimant appealed to the Appeal Board, which reversed. The Board said that the judge had no authority to require the claimant to execute MSA documents. The employer then appealed to the Commonwealth Court.

The court reversed the Board and affirmed the judge’s decision. The court noted noted that the C&R said that the claimant agreed to timely complete all paperwork necessary for the employer and its insurer/third party administrator to exercise its option to apply for and secure an MSA. According to the court, the only reason the claimant was refusing to cooperate was because the MSA and/or the employer would not pay for his use of medical marijuana, which became legal two years after the C&R was approved. The court rejected the claimant’s argument that there was no meeting of the minds relative to the C&R Agreement and said that the only means to negate a C&R is to establish fraud, deception, duress, mutual mistake or unilateral mistake, which did not exist. Finally, the court held that in light of the judge’s inability to require the claimant to sign MSA paperwork, they found no error in the judge’s decision to enforce the settlement agreement, rather than set it aside. 
 

_{What’s Hot in Workers’ Comp is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2021 Marshall Dennehey Warner Coleman & Goggin, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.}