Protecting Your Right to Medical Coverage

If you are keeping the medical expenses open when you settle your case, look closely at the language. Sometimes injured workers will settle a workers' compensation case while keeping the insurance companies' responsibility to medical bills open.

In DePue v. WCAB , 61 A.3d 1062 (Pa. Cmwlth. 2012), the injured worker entered into a compromise and release agreement which described the injury as "closed head injury with seizure disorder and short-term memory loss." After the compromise and release agreement was approved, the injured worker filed a penalty petition alleging that the employer failed to pay for medical bills for a shoulder injury and then filed a review petition to add a left shoulder injury to the description of injury.

The Commonwealth Court ruled that the injured worker cannot do so. In connection with the resolution of the case, the injured worker is bound by the description of injury contained in the compromise and release agreement. The parties can, by agreement, say that the agreement is without prejudice to the right of the claimant to add additional injuries at some future point. Absent that language, the injured worker is going to be bound by the description of injury contained in the compromise and release agreement.

Bottom line: If you are keeping medical expenses open in the settlement of your workers' compensation case, pay careful attention to the description of injury contained in the agreement.

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