Maintenance Care

Benefits: Medical Benefits: Maintenance Care

MONTANA SUPREME COURT DECISIONS

Wieglenda v. State Compensation Insurance Fund/Department of Labor and Industry, No. 97-045 (1997) (Unpublished opinion) In an unpublished, nonciteable opinion, Supreme Court affirmed WCC determination that section 39-71-704(1)(f), MCA (1993) did not deny equal protection or due process by providing that insurer was not required to furnish maintenance care, in this case chiropractic care, to injured worker.

MONTANA WORKERS' COMPENSATION COURT DECISIONS

Hiett v. MSGIA [10/11/06] 2006 MTWCC 33 The Montana Supreme Court’s holding in Hiett v. Missoula County Pub. Sch., 2003 MT 213, 317 Mont. 95, 75 P.3d 341, has not abrogated the exclusion of maintenance care as found within § 39-71-704, MCA.

Montana State Fund v. Pardis [05/10/06] 2006 MTWCC 21 Where no IME was performed on four chiropractic patients until after the treating physician opined that the patients were at MMI, in spite of statistical evidence which demonstrated that the four patients each received a number of treatments well in excess of the statistical average, the Court cannot conclude that a high number of treatments taken alone – without an IME or other direct evidence that a patient has reached MMI and is therefore receiving palliative or maintenance treatments – is sufficient to deny the insurer’s liability for payment.

Montana State Fund v. Pardis [05/10/06] 2006 MTWCC 21 This Court affirmed a Department of Labor and Industry hearing officer who, in a case in which four chiropractic patients received a number of treatments far in excess of the statewide statistical average of treatments, concluded that the only factual means to establish that any particular patient is receiving maintenance care would be through examination of that patient by another qualified health care professional.

Messitte v. Liberty Mutual Fire Ins. [8/30/01] 2001 MTWCC 51 Claimant suffering from muscle ailment beginning with lifting heavy items during waitressing work ten years prior was entitled to continued medical services from her treating physician, and prescribed medicines, but not to massage and health club membership. The physician's recommendations for massage and health club membership must be judged under the language of section 39-72-704, MCA (1989), allowing "other treatment approved by the department." ARM 24.29.2003 and .2004 set out the Department's standards in implementation of the statute. Under treating physician's testimony, the massage and exercise would constitute maintenance which is not compensable under the regulations.

Wieglenda v. State Compensation Insurance Fund [10/23/96] 1996 MTWCC 67Section 39-71-704(1), MCA (1993), and other statutory and regulatory provisions, do not deny equal protection or due process by providing that an insurer is not required to furnish maintenance care. (Note: WCC was affirmed by the Supreme Court in an unpublished, nonciteable opinion, Wieglenda v. State Compensation Insurance Fund/Department of Labor and Industry, No. 97-045 (1997).)