Workers’ Compensation Appeal Board Enforces Terms of Original Settlement Giving Defendant the Sole O


In Scheaffer v. Workers’ Comp. Appeal Bd. Std. Steel, 2017 Pa. Commw. Unpub. LEXIS 103 (February 14, 2017), Mark Scheaffer (Scheaffer) appealed the Order of the Workers’ Compensation Judge (WCJ) approving closure of the medical portion of the case by funding of a Medicare Set-aside. Scheaffer argued that the parties had not reached an agreement to close medical benefits with an MSA and that an order should not have been issued before he had an opportunity to object and provide testimony.

The Workers’ Compensation Appeal Board looked to the record and found the terms of the original Compromise and Release to be clear. As a term of the original settlement, the parties expressly agreed that, once CMS approved an MSA, the Employer, at its sole discretion, could fund the approved MSA or choose to leave medical benefits open. The Employer had decided to fund the CMS-approved MSA and submitted documentation of the same to the WCJ, who issued the Order confirming that the medical portion of the case was closed by the funding of the Medicare Set-aside.

The Workers’ Compensation Appeal Board upheld the Order because, as an express term of the original settlement, Scheaffer had agreed that the Employer had the sole option to close medical benefits by funding a CMS-approved MSA.

#MSA #MedicareSetaside #CMS #CMSapproval

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