In Wiehoff, the WCCA affirmed the rejection of a proposed Stipulation for Settlement which closed out future medical benefits that were judicially determined to be reasonable and necessary in a prior proceeding.
Having sustained an admitted cervical strain, the employee settled her workers’ compensation claim on a full, final and complete basis closing all workers’ compensation benefits with the exception of ongoing medical benefits.
Subsequently, the employee proceeded to a hearing regarding a denied fusion procedure. At that hearing, the Compensation Judge awarded the requested fusion procedure to the employee. That judicial determination was appealed and later affirmed by the WCCA.
Subsequently, the employee retained new representation. After a year of negotiation the parties submitted a Stipulation for Settlement and proposed Award closing out past, present and future medical treatment for a lump sum payment of $110,000. The Compensation Judge held telephone conference with the parties and issued an Order Denying Stipulation Approval. She reasoned, in part, that the Stipulation would unfairly shift work-related medical costs from the liable employer and insurer resulting in an “unfair and unreasonable” outcome.
The WCCA noted that Compensation Judges do have wide discretion to approve or disapprove of Stipulations for Settlement under Hengemuhle. The WCCA noted that the previous hearing provided sufficient facts to support the Compensation Judge’s valid concerns regarding cost shifting. In addition, these facts supported the compensation judge’s conclusion that closure of future medical benefits would not be in conformity with the Workers’ Compensation Act.
Ultimately, medical benefits which have been judicially determined to be reasonable and necessary may be impossible to close. However, it still may be in the Compensation Judge’s discretion to approve such a settlement.