A claimant who settles his claim by final and binding C&R Agreement cannot later petition to expand the nature of the work injury, arguing that the employer is precluded from denying causation by voluntarily making a medical bill payment.

The claimant settled his indemnity claim by Compromise and Release Agreement (C&R). The C&R that was approved by the Workers’ Compensation Judge described the injuries as "[a]ny and all injuries . . . including but not limited to the accepted injuries of a severe closed head injury with seizure disorder and short term memory loss." The C&R also stated that the employer would pay for all reasonable and related medical bills. After a decision was issued by the judge approving the settlement, the claimant filed a penalty petition, alleging that the employer refused to pay for medical bills related to the work injury. The claimant additionally filed a petition to review, in which he alleged the description of his work injury was incorrect and sought to add a left shoulder injury.

The judge denied the claimant's petitions. She concluded that the review petition was barred by res judicata since the claimant was aware of the left shoulder injury at the time of the settlement and had agreed not to include it in the approved C&R. The Appeal Board affirmed.

On appeal to the Commonwealth Court, the claimant argued that the C&R should be corrected to add the left shoulder injury. He claimed the left shoulder injury was erroneously omitted in the final draft of the agreement and that, because the employer paid medical bills for the left shoulder injury, they were aware it was causally related to the work incident. The claimant further argued that under the Doctrines of Promissory and Equitable Estoppel, the employer should be precluded from refusing to pay the medical bills for the left shoulder.

The Commonwealth Court rejected the claimant's arguments and dismissed the appeal. The court pointed out that, before the C&R was signed, employer's counsel rejected a proposed addendum to the agreement prepared by claimant's counsel, which included a left shoulder fracture as part of the work injury. The final version of the C&R omitted the injuries that the claimant sought to include in the proposed addendum to the C&R. The court further noted that the claimant did not expressly reserve his right to add a new injury in the C&R. The court additionally held that the Doctrines of Promissory Equitable Estoppel did not apply simply because the employer made a voluntary payment of medical bills for treatment of the left shoulder. The employer's payments did not constitute an admission of liability for an injury.           

Case Law Alerts, 3rd Quarter 2013