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Employer is responsible for all medical expenses related to the acknowledged injury in a C&R agreement.

September 1st, 2017

In Haslam v. WCAB, 2017 WL 3798517, (Pa. Cmwlth. Ct., 9/1/17), the Commonwealth Court reversed the WCAB which had concluded that Employer was NOT required to pay for treatment of claimant’s RRS/CRPS condition after claimant entered into a Compromise and Release (“C&R”) Agreement which described Claimant’s injury on a standardized Labor & Industry form as “[v]arious injuries and bodily parts including but not necessarily limited to fractured right and left feet.”  Employer did not dispute the reasonableness or necessity of the treatment for Claimant’s RSD/CRPS condition.  Instead, Employer filed a Utilization Review (“UR”) Petition arguing that it should not be responsible for the treatment because it only accepted liability for “fractured right and left feet.”

The court first noted that the purpose of the UR process is only to determine if medical treatment is reasonable and necessary.  It is not to be used to determine the causation of the injury or condition, or to litigate the question of whether a particular injury or condition is within the scope of an injury acknowledged in a C&R agreement.  The proper method to address the scope of an acknowledged injury in a C&R agreement would have been to file a petition for review.

The court acknowledged that once a valid C&R agreement is approved it is final, conclusive, and binding.  An approved C&R agreement may only be set aside upon a clear showing of fraud, deception, duress, mutual mistake, or unilateral mistake caused by “fault of the opposing party.  Otherwise, the C&R agreement may not be amended.

The court found that under the terms of the C&R agreement, Employer agreed to pay for all reasonable and necessary medical expenses related to the acknowledged injury, i.e., Claimant’s fractured feet.  The court also held that where conditions are obviously related to the original work related injury, the burden shifts to the employer to establish that the conditions are not related.  An “obvious” connection “involves a nexus that is so clear that an untrained lay person would not have a problem making the connection between” the new symptoms and the compensated injury.  Here, employer accepted responsibility for Claimant’s fractured feet.

Claimant’s RSD/CRPS arises from pain in those feet.  The court found an obvious connection between Claimant’s fractured feet and his RSD/CRPS.  Employer failed to provide any proof that the RSD/CRPS was not related.  It merely argued that it should not be responsible because RSD/CRPS was not specifically acknowledged in the C&R agreement.  Thus, the court held that the WCAB erred in concluding that Employer was not responsible for medical expenses related to Claimant’s RSD/CRPS.

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