Benefits: Medical Benefits: Reasonableness of Services

Chapman v. Twin City Fire Ins. Co. [11/05/10] 2010 MTWCC 30 Where the Court found that Petitioner exaggerated her condition, it concluded that the insurer was liable for Petitioner’s medical treatment up to the point where Petitioner’s primary healthcare provider also clearly indicated in her treatment notes that she no longer believed Petitioner’s condition to be genuine.
Hansen v. Liberty Northwest [05/09/05] 2005 MTWCC 27 The Court will not order an insurer to pay for an examination at the Mayo Clinic where the Mayo Clinic has indicated it cannot see the claimant at the time the examination was requested, no evidence was presented that the Mayo Clinic would ever be willing to see the claimant as a patient, and the physician referring the claimant to the Mayo Clinic did so only after the claimant requested the referral and without any medical justification other than the fact that the claimant’s pain had not improved.
Burton v. ARCO [12/20/02] 12/20/02 Claimant must show that medical services, devices or appliances are medically reasonable, not just that by his own report and limited usage they make him feel better.
Burton v. ARCO [12/20/02] 12/20/02 Request for a robotic massage chair denied where physician approving it has no experience with the chair, has never prescribed it, knows of no scientific basis to indicate it is therapeutic, and approved it only because the claimant said it made him feel better.

Emineth v. Travelers [3/08/02] 2002 MTWCC 15 Medical services must be reasonable at the time they are rendered.
Emineth v. Travelers [3/08/02] 2002 MTWCC 15 Where a condition that is treatable would interfere with other testing, and potentially render the other testing invalid or unreliable, the treatable condition should be treated before undertaking the additional testing.
Kaiser v. Sears [6/28/96] 1996 MTWCC 47 Where an IME panel found claimant's 1995 complaints of pain related to his 1981 electrocution injury, even though likely exacerbated by deconditioning, and recommended three physical therapy sessions, the Court finds treatment by claimant's family practitioner and one month's physical therapy related to the original injury and reasonable medical treatment. Additional physical therapy was found not reasonable where prescribed without examination of claimant or discussion with the physical therapist.