Louisiana’s Workers’ Compensation fund exists to pay employees injured at work. Payment can be used for medical care and lost wages. When parties sign a settlement agreement on payment terms, an employee may assume payment is imminent. In a recent case from Rapides Parish, an employee discovered some conditions in a settlement may delay payment.
Mary Ortega sustained an injury while employed by Cantu Services. Ortega filed a Disputed Claim for Compensation, and the parties entered a settlement agreement. The parties settled for $120,000. $56,049 of the total was allocated to a Medicare set-aside agreement (MSA) to cover future medical expenses related to the work injury. The MSA was filed with the Centers for Medicare and Medicaid Services (CMS) for approval. The parties agreed that if CMS did not approve the full amount in the MSA, the employer would adjust the amount paid in monetary benefits, so Ortega would still receive $120,000. Several months after signing the agreement, Ortega had not received any payments. She filed a motion to enforce the settlement agreement plus a request for fees and penalties before the Office of Workers’ Compensation.
The Workers’ Compensation Judge (WCJ) denied Ortega’s request because payment under the settlement agreement was conditioned on first getting approval from the MSA. Pending approval suspended the statutory requirement of payment within thirty days. Ortega appealed to the Louisiana Third Circuit Court of Appeal.