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Philadelphia

106 Chesley Drive

Media, PA 19063

P: (610) 627-9100

F: (610) 627-9717 

Pittsburgh

6000 Brooktree Road

Suite 300

Wexford, PA 15090

P: (724) 940-2977

F: (724) 940-2970 

Delaware

Barley Mill House

3701 Kennett Pike

Suite 100

Greenville, DE 19807

P: (302) 308-6100

F: (302) 308-6106

Copyright© 2019 Carpenter, McCadden & Lane, LLP

Avoiding Pitfalls Involving the Heart and Lung Act

January 6, 2016

 

The Pennsylvania Heart and Lung Act, 53 PS § 637 pays eligible employees, generally Police Officer and Fire Fighters, their full salaries for any injury incurred in the performance of their duties.  These benefits are paid simultaneously with Workers’ Compensation Act benefits.  Performance of duties is a narrower standard than the Workers’ Compensation standard of arising in the course of employment.  Because of this, some injuries for Firefighters or Police Officers may be covered under the Workers’ Compensation Act, and not covered under the Heart and Lung Act. The Heart and Lung Act does not cover volunteer firefighters.  It only applies to municipal employees who are paid for their services in law enforcement or firefighting.  That includes Correction Officers, Sheriffs and Deputy Sheriffs.

 

When receiving both Heart & Lung Act and Workers’ Compensation benefits simultaneously, the Workers’ Compensation benefits have to be repaid to the Municipality that is paying Heart and Lung benefits.  In most circumstances, the Workers’ Compensation Insurance Carrier will pay the total disability benefits owed to Claimant directly to the Municipality.  Heart and Lung Act benefits are paid for any period of time the employee is unable to perform their work duties on a temporary basis.  Once a disability becomes permanent, Heart and Lung Act benefits stop.  Municipalities are not entitled to subrogation for Heart and Lung benefits they pay against any third party recovery an employee makes.

 

A workers’ compensation carrier has to be careful when administering these dual claims because rulings in the Heart and Lung Act case can act as collateral estoppel in the Workers’ Compensation claim.   A workers’ compensation carrier can be bound by decisions rendered by Civil Service Hearing Officers in Heart and Lung Act cases. For example, If Heart and Lung Act benefits are terminated because the Hearing Officer found the disability is now permanent, the workers’ compensation carrier for the Employer can be precluded from filing a Termination Petition to argue Claimant is fully recovered. Workers’ Compensation rulings also can bind the Employer in the Heart and Lung case.  However, each individual case involving the overlap between the Workers’ Comp Act and the Heart and Lung Act, hinges upon the facts and circumstances peculiar to each case. There are varying nuances which need to be closely examined and reviewed with counsel before making a claims handling decision.

 

The bottom line is if you are a Workers’ Compensation Carrier or TPA handling Municipal claims, there needs to be very close cooperation between you and the Municipality as to their decisions involving payment of, and administration of Heart and Lung Act claims.  Close communication between the Municipality and the workers’ compensation claims handler is an absolute necessity.

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