C.M. Whitmoyer v. WCAB (Mountain Country Meats)
614 C.D. 2015
| Pa. Commw. Ct. | Dec 1, 2016Background
- In 1993 Whitmoyer suffered a work-related amputation; parties commuted his specific-loss indemnity to a lump sum in 1994, leaving employer (via insurer Selective) liable only for related medical expenses.
- In 1999 Claimant recovered $300,000 from third parties; after reimbursing employer’s accrued lien, $189,416.27 remained and the third‑party settlement stated that balance would be a “fund for credit against future workers’ compensation payable,” subject to pro rata litigation-cost adjustments.
- Claimant’s counsel sent letters with the lien payment asserting no credit should apply to future medical bills because Section 319’s phrase “future instalments of compensation” refers only to periodic indemnity benefits.
- Employer/Selective paid the Claimant’s medical bills for ~13 years and in 2012 petitioned to modify the settlement to apply the balance of recovery as a credit against future medical expenses (adjusting the claimant’s share of litigation costs accordingly).
- The WCJ and the Workers’ Compensation Appeal Board concluded Section 319’s reference to “compensation” includes medical expenses and granted the modification; the Commonwealth Court majority affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does “future instalments of compensation” in Section 319 include medical expenses? | Whitmoyer: “instalments” implies periodic indemnity (wage‑replacement) payments only; medical expenses are paid “as and when needed” and thus not instalments. | Employer/Selective: Section 319’s subrogation purpose (prevent double recovery; reimburse innocent employer) extends to all compensation components including medical. | Held: Includes medical expenses; Section 319 covers medical and indemnity payments. |
| Did parties form a binding agreement that no credit would apply to future medical bills? | Whitmoyer: His counsel’s letters plus Selective’s acceptance of lien payment and later medical payments show agreement. | Employer/Selective: Letters were requests by counsel to a representative lacking authority; the signed third‑party agreement controls and contemplates future credit. | Held: No binding agreement; WCJ crediting insurer rep testimony defeated meeting‑of‑minds. |
| Did Employer waive or release subrogation rights against future medical expenses? | Whitmoyer: Long silence and payments for 13 years amounted to waiver. | Employer/Selective: Waiver must be clear and supported by consideration; acceptance of an amount already owed does not effect waiver. | Held: No clear, supported waiver; accepted check was payment of an accrued lien, not consideration for release. |
| Is Employer equitably estopped from asserting a credit for future medical expenses? | Whitmoyer: He relied on insurer’s conduct and would suffer hardship if credit applied now. | Employer/Selective: No inducement or justifiable reliance shown; equitable exceptions to statutory subrogation are disfavored absent bad faith. | Held: Estoppel argument waived/unsupported; subrogation is statutory and generally absolute absent deliberate bad faith. |
Key Cases Cited
- Dasconio v. Workmen’s Compensation Appeal Board (Aeronca, Inc.), 559 A.2d 92 (Pa. Cmwlth. 1989) (held payments of medical expenses are "compensation" subject to subrogation and future‑credit application)
- Deak v. Workmen’s Compensation Appeal Board (USX Corp.), 653 A.2d 52 (Pa. Cmwlth. 1994) (reaffirmed that "compensation" in §319 includes medical expenses)
- Giant Eagle, Inc. v. Workers’ Compensation Appeal Board (Givner), 39 A.3d 287 (Pa. 2012) (explained "compensation" can have different meanings in different statutory contexts; courts must analyze context)
- Thompson v. Workers’ Compensation Appeal Board (USF&G Co.), 781 A.2d 1146 (Pa. 2001) (statutory subrogation under §319 is automatic and admits no equitable exceptions except in cases of employer bad faith)
- Fortwangler v. Workers’ Compensation Appeal Board (Quest Diagnostics), 113 A.3d 28 (Pa. Cmwlth. 2015) (explained past vs. future aspects of employer subrogation rights and calculation considerations)
- Haley to Use of Martin v. Matthews, 158 A. 645 (Pa. Super. 1932) (early authority recognizing employer’s subrogation to reimbursement of sums paid, including medical and hospital expenses)
- Zacour v. Workers’ Compensation Appeal Board (Mark Ann Industries), 824 A.2d 336 (Pa. Cmwlth. 2003) (addressed allocation/percentage methods when claimant retains indemnity but employer remains liable for medicals)