Summary
In Simpson v. Workmen's Compensation Appeal Board, 48 Pa. Commw. 51, 408 A.2d 1186 (1979), this Court did not allow a claimant to collect simultaneous recovery because the employer in Simpson had paid for the claimant's insurance benefits and was consequently entitled to a credit.
Summary of this case from Glassman v. W.C.A.BOpinion
December 17, 1979.
Workmen's compensation — Blue Cross and Blue Shield benefits — Subrogation — Credit against workmen's compensation award — Collective bargaining agreement.
1. An employer is entitled to credit against a workmen's compensation award for amounts paid the injured employe for the same injury by Blue Cross and Blue Shield and for which no subrogation interest has been asserted when to allow such credit would not require the employe to deplete benefits which could have been used for other purposes, particularly when the Blue Cross and Blue Shield coverage was also provided by the employer, and the fact that such coverage was categorized as a benefit under a collective bargaining agreement is immaterial. [53]
Submitted on briefs, October 3, 1979, to Judges CRUMLISH, JR., WILKINSON, JR. and MENCER, sitting as a panel of three.
Appeal, No. 963 C.D. 1978, from the Order of the Workmen's Compensation Appeal Board in case of William J. Simpson v. Township of Marple, No. A-73692.
Petition with the Department of Labor and Industry for workmen's compensation benefits. Petition granted. Benefits awarded. Employer appealed to the Workmen's Compensation Appeal Board. Award affirmed as modified. Credit for medical expenses paid by others granted employer. Petitioner appealed to the Commonwealth Court of Pennsylvania. Held: Affirmed.
Michael A. Paul, with him Richard, Brian, DiSanti Hamilton, for appellant.
Thomas R. Bond, with him LaBrum and Doak, for appellee.
In this workmen's compensation appeal, the sole issue is whether the Township of Marple (employer) is entitled to a credit against compensation payable to William J. Simpson (petitioner) for his medical and hospital expenses, which were paid by Blue Cross and Blue Shield (BC BS), and for which no subrogation interest has been asserted. The Workmen's Compensation Appeal Board (Board) granted the credit, and petitioner appeals to this court. We affirm.
The Board otherwise ruled that petitioner had suffered a compensable injury and was entitled to compensation.
Petitioner argues that, since the BC BS payments were a benefit provided under the collective bargaining agreement, employer should not be allowed to use those payments as a credit towards meeting its workmen's compensation obligations. We have recently determined, however, that whether or not such payments may be credited against an employer's workmen's compensation obligations "depends not upon whether the payments are categorized as a benefit of a collective bargaining agreement, but rather whether the payments were made as wages for work performed or in relief of the employee's incapacity to labor." Steinle v. Workmen's Compensation Appeal Board, 38 Pa. Commw. 241, 246, 393 A.2d 503, 506 (1978). The criterion, then, for allowing a credit is whether the claimant would be required to "deplete benefits . . . which could have been used for other purposes." Workmen's Compensation Appeal Board v. Olivetti Corp. of America, 26 Pa. Commw. 464, 470, 364 A.2d 735, 738 (1976). Here, petitioner was not required to deplete benefits that would have been otherwise due him or which could have been used for other purposes. Thus, employer is entitled to the credit. See Steinle, supra, and Olivetti, supra.
Petitioner argues, however, that public policy permits simultaneous recovery by him from both employer and a private health insurance plan for the injuries sustained. See General Tire Rubber Co. v. Workmen's Compensation Appeal Board, 16 Pa. Commw. 473, 332 A.2d 867 (1975). General Tire, however, can be easily distinguished by the fact that here petitioner failed to provide any evidence that his bills were paid by a private insurance plan for which he paid premiums. Furthermore, the Board found as a fact that BC BS coverage was provided by the employer, a finding which was supported by the record. A further distinguishing factor is that, in General Tire, the group health benefits received by claimant were for viral bronchitis and intercostal neuritis which did not result from an injury in the course of his employment.
Accordingly, we enter the following
ORDER
AND NOW, this 17th day of December, 1979, the order of the Workmen's Compensation Appeal Board, dated April 20, 1978, is hereby affirmed. Accordingly, it is ordered that judgment be entered in favor of William J. Simpson and against the Township of Marple and its insurance carrier, Pennsylvania National Insurance Company, in the amount of $60 per week for the period from March 6, 1972 to and including June 12, 1972, together with interest at the rate of 6 percent per annum on deferred payments of compensation from the date due to the date paid, all within the terms and limits of The Pennsylvania Workmen's Compensation Act. The Township and/or its insurance carrier is further directed to reimburse claimant for drugs, in the amount of $300.18, and for services by Dr. Schwartz, in the amount of $31. The Township and/or its insurance carrier shall pay directly to claimant's attorney 20 percent of all compensation and interest thereon payable to claimant out of the claimant's compensation and interest and shall pay the balance of the compensation and interest directly to claimant.