Worker's refusal to sign Medicare consent form violates agreement
Case name: Lenahan v. Bell Hearing Aid Centers, Inc., 28 PAWCLR 116 (Pa. W.C.A.B. 2013).
Ruling: The Pennsylvania Workers' Compensation Appeal Board reversed the workers' compensation judge's decision and held that the compromise and release agreement entered by the parties should be set aside. The board also reversed the WCJ's decision awarding the worker penalties.
What it means: In Pennsylvania, a worker's refusal to sign a necessary consent form for the submission of a Medicare set-aside account, where the set-aside account is part of the terms of a compromise and release agreement, is a violation of the compromise and release agreement. Under such circumstances, the agreement should be set aside.
Summary: The board reversed the WCJ and held that the compromise and release agreement entered by the parties should be set aside. Under the agreement, the employer would make a lump-sum payment to the worker of $50,000 in indemnity benefits and fund a Medicare set-aside account. When the worker refused to sign a Medicare consent form, the employer withheld payment. Completion of the consent form was mandatory for the Center for Medicare and Medicaid Services to review and approve the Medicare set-aside account. The board found the worker's continued refusal to sign the consent violated the spirit, if not the plain language, of the agreement as well as the Medicare Secondary Payer Act. The signed consent form was also in the worker's best interest, as the worker's continued refusal to cooperate could place her medical benefits in jeopardy.
The board also held that the WCJ erred in awarding the worker penalties. The worker's refusal to sign the consent form called into question the validity of the agreement, thus relieving the employer of its obligation to make the lump-sum payment.
Read more at the WorkersComp Forum homepage.
October 14, 2013
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