When a case is resolved by Compromise & Release (C&R) it is not unusual for the agreement to include open future medical treatments for the accepted injuries to be paid by the employer. It is important when this type of agreement is intended, that specific language is used in describing the injuries or conditions to be covered in the future. Language that is ambiguous or not carefully crafted can create unnecessary and costly litigation when a disagreement arises concerning what treatment is or is not covered. This was the problem faced by the parties in Haslam v. WCAB (London Grove Communication), No. 1655 C.D. 2016, filed: September 1, 2017.
The work injury involved a shattered right ankle, tibia and fibula and a left calcaneus fracture as well as neck and back injuries. Several years later, the parties settled the wage loss portion of the claim and left future medical treatments open to be paid by the employer/carrier per a C&R Agreement which described the accepted injuries as "various injuries and bodily parts including but not necessarily limited to fractured right and left feet." After the C&R Agreement was approved by a Workers' Compensation Judge (WCJ), litigation commenced over the employer's responsibility to pay for compounded medication used in the treatment of the injured worker's RSD/CRPS condition. The employer contended that these conditions were not within the accepted injuries under the C&R Agreement.
Eventually the Pennsylvania Commonwealth Court addressed the issue. The Court instructed that the proper vehicle to determine whether the employer was responsible for the medical expenses under the terms of the C&R Agreement was a petition for review of medical treatment rather than a petition for review of Utilization Review Determination, which is limited to issues of reasonableness and necessity. The Court agreed with the Workers' Compensation Appeal Board that a C&R Agreement approved by a WCJ is final and conclusive and cannot be amended unless certain conditions such as fraud or duress are established which was not claimed in this case.
However, this did not end the Court's analysis of the case. The Agreement provided that the employer would pay for all reasonable and necessary medical expense related to the employee's fractured feet. The Court explained that there was an obvious connection between the injury and the pain that was being treated. Therefore the treatment was within the scope of the compensable conditions described in the C&R Agreement. The Court explained that for the employer to avoid responsibility for the expenses of treating the injured workers' feet it would have to prove an injury/condition distinct from the accepted injury, which it did not do.
Comment: The lesson to learn from this decision is to use careful and precise language that specifically describes the future medical treatment obligations that are being left open in the C&R Agreement. Use of precise language concerning the injury description and medical treatment obligations during settlement negotiations may force the issue to be addressed sooner rather than later and that may prevent subsequent litigation.
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