Judge Dismisses Penalty and Review Petitions and Terminates Claimant's WC Benefits
Successfully defended a penalty petition seeking more than $100,000 in unpaid medical bills. The claimant asserted that the parties entered into a Compromise and Release Agreement, which obligated the defendant to continue to pay ongoing medical treatment if the defendant chose not to proceed forward with payment of a Medicare Set-Aside proposal of $78,624.36. Pursuant to the terms of the agreement, if the amount of the Medicare Set-Aside was found by CMS to be greater than the proposed recommendation, the defendant retained the right to cancel funding of the annuity and to continue paying the claimant’s reasonable and necessary medical expenses related to the work injury. The claimant alleged that there was more than $100,000 in medical expenses not paid by the defendant after they retained their right to cancel funding of the annuity due to CMS finding an amount higher than the MSA proposal. Kacey presented medical evidence which supported that the medical treatment and ongoing treatment for the claimant were not associated with the accepted injury. Additionally, Kacey argued that the description of injury in the Compromise and Release Agreement limited the claimant’s claim and that the medical bills were related to the accepted injury. The Workers’ Compensation Judge dismissed the penalty and review petitions and granted termination of the claimant’s benefits.