Benefits: Domiciliary Care

MONTANA SUPREME COURT DECISIONS

Powell v. State Fund [12/14/00] 2000 MT 31 The statutory cap on domiciliary care benefits provided in section 39-71-1107(3), MCA (1995) does not violate the equal protection provisions of the 14th Amendment of the US Constitution and Article II, section 4, of the Montana Constitution or the right to substantive due process within the 14th Amendment and Article II, section 17, of the Montana Constitution.

WORKERS' COMPENSATION COURT DECISIONS

Bustell v. Ins. Co. of PA [2/26/03] 2003 MTWCC 11 The rate of reimbursement for domiciliary care furnished by a non-family member is not limited to the rate paid by medicaid for care in a nursing home. § 39-71-1107(3), MCA (1999).

Cheetham v. Liberty NW [12/18/01] 2001 MTWCC 65 Section 39-71-1107(1)(a), MCA, on its face limits liability for domiciliary care benefits to periods after the insurer has notice or knowledge of the need for domiciliary care.

Cheetham v. Liberty NW [12/18/01] 2001 MTWCC 65The knowledge requirement in section 39-71-1107(1)(a), MCA, has no application where the insurer denies all liability for a claim.

Haas v. State Fund [9/1/00] 2000 MTWCC 54 Where claimant argued ongoing relationship with insurer was detrimental to him and warranted lump sum of domiciliary care benefits, the only relevance of evidence of investigation into him involved the effect of the investigation upon him, including what he knew or perceived and how he reacted. Court thus granted protective order, and denied motion to compel, relating to details of investigation where such details involved attorney work product and attorney/client communications.

Powell v. State Compensation Insurance Fund [2/4/99] 1999 MTWCC 10 Injured worker receiving 24-hour domiciliary care from his spouse challenged constitutionality of the limit on payments for 24-hour care by a family member established by section 39-71-1107(3), MCA (1995). He also sought to challenge the constitutionality of subsection (4) of the same statute, which governs domiciliary care by a family member necessary for a period of less than 24 hours a day. The WCC refused to consider a constitutional challenge to subsection (4) where claimant has no claim under that subsection. The Court found that subsection (3) does not violate federal or state guarantees of equal protection and substantive due process. Equal protection provisions do not prohibit different treatment of different groups or classes of people so long as all persons within a group or class are treated the same. The essence of substantive due process is similar as applied to this case; the statute must be reasonably related to a permissible legislative objective. Here, while the goal of cost containment alone may not save legislation which treats similarly situated people differently, there are cogent and logical reasons for limiting payments to family members providing 24-hour domiciliary care. Family members providing such care typically reside with the injured worker, meaning they generally continue their ordinary life activities during some of the day, and typically do not provide the trained, focused, professional care given by non-family members who are working away from their own home. These differences justify the statute.

Rausch v. State Compensation Ins. Fund [12/15/95] 1995 MTWCC 106 Where parties dispute proper rate of domiciliary care, claimant not entitled to discover information about rates paid by insurer statewide. Where claimant lives in Missoula-Frenchtown area, insurer ordered to use readily accessible computerized information to list claims in the Missoula-Frenchtown area in which it pays for domiciliary care, not identifying particular claimants, but noting: (1) the rate at which domiciliary care is paid; (2) whether the rate was fixed by agreement or court order; (3) the town or city where claimant resides; (4) the number of domiciliary care hours provided each day; (5) the nature of the claimant’s condition; (6) any special circumstances affecting the determination of the hourly rate.