The Workers’ Compensation Act provides benefits for an injured worker no matter who is negligent (if anyone) in causing an injury. The Workers’ Compensation Act also prohibits an injured worker from suing their employer for negligence. However, in some cases, there is a third party other than the Employer who was at fault or negligent in causing the injury.
In those cases, the injured workers could receive Workers’ Compensation Benefits and still sue the negligent third party. However, any recovery from the third party is subject to subrogation. That means the Employer/Workers’ Compensation carrier is entitled to be paid back out of that third-party recovery for all medical and wage loss benefits they have paid to the injured worker. In the event the third-party recovery exceeded the amount of the lien (the amount of wage loss benefits and medical benefits paid to that date), the Employer/Workers’ Compensation carrier is to get a credit against future benefits. For years, that has been interpreted to mean both wage loss and medical benefits.
On June 19, 2018, the PA Supreme Court rendered a decision in Whitmoyer v WCAB (Mountain County Meats) No. 52 MAP 2017. In this Decision, the Court interpreted the Subrogation language of the Act and clarified that the Employer/Workers’ Compensation carrier is entitled to future credit only against future wage loss benefits and not against future medical benefits. This appears to mean that the Employer/Workers’ Compensation carrier is responsible to pay 100% of all ongoing work-related medical bills and not simply a reduce percentage of the bills.
If you are continuing to receive Workers’ Compensation Benefits for lost wages and/or medical care after receiving a large third-party settlement, you may be affected by this decision. Please feel free to contact me for a review of your case and an examination of whether you may be entitled to full payment of future medical bills and even a possible adjustment to the amount of your ongoing partial wage loss benefits.
The advice offered above is general in nature and may not be applicable to every case. Consultation with an attorney is highly recommended. Reliance on this advice does not represent the formation of an attorney-client relationship in the absence of a fee agreement with Mr. Hillsberg.