Kellogg v. Phoenix Alternatives, Inc., No. WC17-6035 and No. WC17-6047 (W.C.C.A. September 14, 2017)
Employee appeals Compensation Judge’s finding that the Stipulation for Settlement closing out all claims, except for the low back, also closed out sacroiliac joint benefits. Employee also petitions to vacate prior Stipulation for Settlement.
The Employee suffered an admitted injury to his lumbar spine on November 26, 2008, principally consisting of a L4-5 disc herniation. He underwent a microdiscectomy and later a two level fusion from L4-S1. In 2012 the Employee filed a Claim Petition for permanent total disability benefits. A Stipulation for Settlement closed out all claims for the Employee’s work injury “with the sole exception of future medical treatment of the Employee’s back (lumbar) only,” for a lump sum payment of $80,000.00.
The Employee continued treating and was eventually recommended bilateral SI joint injections. These injections were denied based upon the treatment parameters, a formal hearing was requested and took place on December 1, 2016. At hearing, Employer and Insurer raised a defense based upon an interpretation of the Stipulation, contending that SI joints were previously closed out as they are not a part of the lumbar spine. In a Findings and Order served and filed on January 17, 2017, the Compensation Judge found that the Stipulation for Settlement closed out the Employee’s SI joint condition and the requested medical treatment was not payable. The Employee appeals that finding and petitions to vacate.
The W.C.C.A. affirmed the findings of the Compensation Judge. They concluded that the term in the Stipulation, closing out all medical benefits except those of the lumbar spine, was unambiguous. Further, the issues at hearing were properly expanded as the Employee agreed at hearing to the issues and did not object. The issues may be expanded based upon the agreement of the parties. Finally, the W.C.C.A. found that there were no grounds to petition to vacate as there was no mutual mistake of fact and there had been no substantial change in the Employee’s medical condition.