Whitmoyer v. Workers' Compensation App. Bd. (majority)Annotate this Case
The Pennsylvania Workers’ Compensation Act (“WCA”) 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. In January 1993, Craig 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].” Whitmoyer subsequently petitioned 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. 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. Selective continued to pay Whitmoyer’s work-related medical expenses in full (without taking credit under the TPSA) for approximately thirteen years, until September 2012. At that time, Selective filed a modification petition requesting an adjustment to the TPSA to reflect the medical expenses incurred since the parties entered the agreement. The WCJ found, per the parties’ stipulation, that Selective had paid $206,670.88 for Whitmoyer’s work injury as of February 2013.The WCJ ordered that Selective’s percentage credit be reduced to 26.09% of future medical expenses, up to Whitmoyer’s balance of recovery amount of $189,416.27. Whitmoyer appealed to the Workers’ Compensation Appeal Board (the “Board”), arguing that the TPSA was unenforceable because neither he nor his counsel had signed it. The Pennsylvania Supreme Court granted allowance of appeal to determine whether the Commonwealth Court erred in concluding that the term “instalments of compensation” in section 319 of the WCA encompassed both disability benefits and payment of medical expenses. Under the WCA, disability benefits were required to be paid “in periodical installments, as the wages of the employee were payable before the injury.” Medical expenses are not. 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. The Supreme Court reversed the Commonwealth Court and remanded for further proceedings.