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Optimax v. W.C.A.B (Yacono), 806 A.2. 994 (Pa.Cmwlth. 2002)

I. PERTINENT CASE FACTS: This case involved a defense Termination Petition wherein the defendant argued that the claimant had fully recovered from a November 13, 1999 work injury. The defendant's supersedeas request was denied by the WCJ. Thereafter, the parties entered into a Stipulation of Facts agreeing that the claimant had fully recovered from the past work injury, and thus, that the claimant's benefits should be terminated. The WCJ approved the parties' Stipulation of Facts in a final Order granting the Termination Petition and incorporating the Stipulation of Facts in its entirety. The WCJ's decision listed the evidence of record, including medical deposition testimony from experts for both parties.

After receiving the WCJ termination order, the defendant filed an Application for Supersedeas Fund Reimbursement with the Supersedeas Fund. This supersedeas reimbursement for $32,389.81 was requested pursuant to Section 443(a) of the Pennsylvania Workers' Compensation Act. The defendant/employer submitted proof of payment surrounding past medical and indemnity benefits paid after the defense petition was filed. The Bureau of Workers' Compensation thereafter filed an Answer denying the defendant's entitlement to supersedeas fund reimbursement. The Bureau argued that no final WCJ "determination" existed pursuant to Section 443(a) of the Act. The newly-assigned WCJ denied the defendant/employer's Supersedeas Fund Application, and the WCJ's decision was affirmed by the Workers' Compensation Appeal Board.

II. CASE HOLDING: The Commonwealth Court held that the defendant/employer was entitled to supersedeas fund reimbursement in this case based on the defendant/employer establishing the four criteria listed below.

  1. Supersedeas must be requested through the filing of a defense petition;
  2. A supersedeas request must be denied by the WCJ;
  3. Compensation and/or medical benefits must be paid following the Supersedeas Denial Order;
  4. It must be determined in a WCJ's final decision that compensation was not payable, and such a determination must be based on legally-sufficient and prima facie evidence of record.

The main issue surrounding the Commonwealth Court decision was whether the WCJ's underlying decision adopting the parties' Stipulation of Facts constitutes a final "determination" pursuant to Section 443(a) of the Act. The Commonwealth Court rationalized that the parties entered into a viable agreement that was based on unequivocal medical evidence of record. Because the parties' Stipulation was supported by the evidence of record, which is independent of the parties' Stipulation, the Court rationalized that it is in the interests of judicial economy and public policy to minimize needless litigation and encourage settlement of legal disputes.

III. PRACTICAL HANDLING ADVICE: In cases where a defense petition is pending that is supported by legally sufficient evidence of record and the parties agree to enter into a Compromise and Release Agreement, it is recommended that a Stipulation of Facts granting the defense petition be negotiated as part of the overall settlement. Such a Stipulation when incorporated in a final decision, allows the defendant/insurance carrier to seek supersedeas fund reimbursement after the appeal period surrounding the WCJ's decision expires. As noted by the Commonwealth Court in this case, such a Stipulation of Facts is sufficient to warrant supersedeas fund reimbursement if the Stipulation is supported by legally-sufficient evidence. Even if the Judge expressly notes that his/her final decision is based on a parties' Stipulation of Facts ,it is incumbent upon the Supersedeas Fund to grant reimbursement pursuant to this case.