Envista Forensics

Medicare And Marijuana: Preserving Settlements In the Face Of Evolving Laws

 Friday, September 3, 2021

 CLM Magazine

In an interesting case out of the Commonwealth Court of Pennsylvania, Lehigh Specialty Melting Inc. v. Workers Compensation Appeal Board, Lehigh appealed an order of the state’s Workers Compensation Appeal Board that would have caused the unwinding of an otherwise finalized workers’ compensation settlement agreement that included a Centers for Medicare and Medicaid Services (CMS)-approved Medicare Set-Aside (MSA) with an injured worker.

Essentially, the claimant had executed a settlement compromise and release (C&R) wherein the claimant agreed not only to a lump sum settlement, but also ‘to the potential establishment and funding of an MSA.’

As part of the C&R, the claimant also agreed to timely complete all paperwork necessary for Lehigh and its insurer/third-party administrator to apply for and secure an MSA allocation.

Post C&R, Lehigh had obtained an MSA that was approved by CMS. However, post-CMS approval, the claimant then refused to follow through with executing the paperwork necessary to finalize the MSA.

The claimant took the position that Lehigh would remain responsible for future work-related medical expenses without any reference to the establishment of an MSA. The claimant further alleged that the proposed MSA failed to consider all work-related medical treatment currently being provided to him.
LitigationWorkers' Compensation