Court Opinion

ID: 9765659
Source: CourtListenerOpinion
Date Created: 2023-08-29 04:12:18.828747+00
Date Added: 2024-06-11T07:30:12.551563
License: Public Domain

NEWMAN, Justice,
dissenting.
I respectfully dissent. On September 6, 1990 Employer filed a Petition for modification and subrogation pursuant to Section 319 of the Worker’s Compensation Act (the Act),1 alleging that Claimant obtained funds from Suburban General Hospital and thus Employer was entitled to a future credit against medical expenses in the amount of these funds. (Findings of Fact, 12/15/93, No. 14). The en banc Commonwealth Court determined that Employer was not entitled to a future credit because there was no statutory authority to allow the Employer to seek recoupment or subrogation from the Claimant. I agree.
Employer requested relief pursuant to Section 319 of the Act, and this section, by its plain terms, simply does not provide for the subrogation that Employer seeks. Instead, Section 319 of the Act entitles an employer to subrogation or modification where a work injury is caused by a third party or where the employer or an insurance company has paid additional benefits on the basis that the injury is not compensable under the Act. See 77 P.S. § 671. Employer avers neither scenario. I believe that we are constrained to review this matter based upon the rights to subrogation set forth in the Act. Because the Employer is not entitled to subrogation or recoupment pursuant to Section 319, I agree with the Commonwealth Court that Employer is not entitled to the future credit. The Majority’s decision to ignore Section 319 and to award Employer the $30,000.00 future credit based upon the equitable doctrine set forth in Section 20 of the Restatement of Restitution is misplaced for many reasons.
*282First, it does not appear that this Court has previously adopted the Restatement of Restitution § 20 (Section 20) (The cases cited by the Majority do not reference this Section). I hesitate to do so here because the facts before us do not fit this Section. Section 20 provides for restitution only where a person mistakenly has paid an “excessive amount” of money because of an “erroneous belief’ that “the sum paid was necessary to discharge a duty.” Here, when Employer issued a check for $140,000.00, it did not pay an “excessive amount” of money to Claimant and did not pay an amount in excess of that necessary to discharge Employer’s statutory duty to pay medical expenses under the Act. The medical bills owed to the hospital, which Employer was required to pay, were more than $175,000.00. Claimant incurred the majority of these bills in 1984 and in 1986; however, they remained outstanding through February 1989, when Employer finally issued a check payable to Claimant and to the hospital in the amount of $140,000.00. (Employer subtracted Claimant’s attorneys’ fees from this amount).2
During the time when the hospital bills remained unpaid, Suburban General Hospital apparently filed an action in the Court of Common Pleas of Montgomery County against Claimant for the payment of these bills. (Findings of Fact, 12/15/93, Nos. 10, 11). The hospital’s action against the Claimant appears to have originated because the bills were outstanding during the time in which the Employer exercised its rights to contest the employee’s claim for a work related injury. In March 1989, the hospital agreed to accept $110,000 in payment of the bill and dismissed its action against Claimant. The Claimant also released any claims against the hospital. Id. The $30,000.00 at issue here reflects Claimant’s negotiation of a mutual release and indemnification agreement *283with the hospital in an apparent settlement of a dispute between the hospital and the Claimant and does not act to discharge the Employer of the duty to pay the amount of medical bills under the statute. See, e.g., 77 P.S. § 531 (statutory provisions for the payment of reasonable medical expenses). Accordingly, Section 20 is not applicable to the facts of this case.
Second, I agree with the Commonwealth Court that the facts presented to us do not entitle Employer to restitution. The Commonwealth Court determined that the equities presented did not support restitution to Employer because Employer did not pay more than its fair share. In particular, the Commonwealth Court found that:
Employer does not maintain that ... the $30,000 overpayment should be returned to Suburban (the hospital). Instead, Employer seeks a windfall or a reduction in the amount that it was statutorily required and ordered to pay.
701 A.2d at 642 (emphasis added). I find no error in the holding of the en banc Commonwealth Court and accordingly I would affirm their decision.
Third, the Claimant was not “unjustly enriched” vis-a-vis the Employer because at no time did Employer pay more than it was statutorily required to pay. Section 306(f.l) of the Act, 77 P.S. § 531. Unjust enrichment occurs when a person has and retains money or benefits, which in justice and equity belong to another. Blacks Law Dictionary 1535 (6th Ed 1990). The $30,000.00 may indeed have originally “belonged” to the hospital because it is the creditor who rendered the service; however, the Employer has not shown that the $30,000.00 belongs to it. While allowing Claimant to keep the $30,000.00 may serve as a windfall to him, Employer equally receives a windfall from the $30,000.00 future credit. Employer never paid the full amount of the medical bill, and never paid an amount more than the reasonably incurred medical expenses. In a situation like here, where we must necessarily grant a windfall to either the employer or the employee, I believe that the equities of the Act tip in favor of allowing the Claimant to *284retain the $80,000.00. As set forth in Harper & Collins v. W.C.A.B. (Brown), 543 Pa. 484, 672 A.2d 1319, 1321 (1996), “Borderline interpretations of the Act are to be construed in the injured party’s favor.”
For these reasons, I respectfully dissent.
Justice CAPPY joins this Dissenting Opinion.

. 77 P.S. § 1 et seq.

. Pursuant to Section 306(f.l) of the Act, 77 P.S. § 531, an employer is obligated to pay all reasonable medical bills incurred by an injured employee. Here, the hospital’s charge for its medical services to Claimant was $175,546.32, from which $35,109.27 was deducted for Claimant's counsel fees and the remaining $140,437.05 paid by check made payable to Claimant and the hospital. According to the Board's order. Employer was statutorily responsible for payment of the full $175,546.32.