Benefits: Termination of Benefits

Short v. J.H. Kelly Holdings, [09/24/09] 2009 MTWCC 33 The Court must employ a fact-driven analysis in determining a petitioner’s appropriate labor market for purposes of developing alternative job analyses pursuant to § 39-71-609, MCA. In this case the Court considered a number of factors to conclude that Shoreline, Washington, is the appropriate labor market including: (1) the petitioner permanently resided in Shoreline, Washington, from 1998 through the time of his injury in 2005; (2) the petitioner accepted millwright jobs throughout the Pacific Northwest, but returned to Shoreline as his residential base between 2003 and the time of his injury; (3) the petitioner worked in Montana only on a temporary basis, returned to Shoreline after his injury and testified that he would have stayed there for his recovery had he been able to locate a treating physician in the area; and (3) the petitioner moved from Shoreline to Clark Fork, Idaho, because he knew other millwrights living there and envisioned working as a millwright again after recovering from his injury.

Porter v. Liberty [10/19/07] 2007 MTWCC 42 Although Respondent’s claims adjuster testified that he informed Petitioner by letter that his benefits were being terminated, no copy of the letter was found in Petitioner’s claim file. The claims adjuster conceded that no journal entry or any documentation in the claim file supported his assertion that Petitioner had been informed that his benefits were being terminated. Petitioner testified that he was never informed that his benefits were being terminated. The Court finds that Petitioner was not informed that his benefits were being terminated, nor was Petitioner provided a rationale for their termination.
Purkey v. AIG and Liberty Mut. Fire Ins. Co. [01/13/05] 2005 MTWCC 2 Even if an insurer fails to comply with the requirements of section 39-71-609, MCA (2003), when terminating temporary total disability benefits, its liability for such benefits ends upon a claimant's actual return to work since section 39-71-701(7), MCA (2003), expressly prohibits a claimant from receiving both wages and temporary total disability benefits unless the insurer expressly agrees.
Purkey v. AIG and Liberty Mut. Fire Ins. Co. [01/13/05] 2005 MTWCC 2 To terminate temporary total disability benefits and convert them to permanent partial disability benefits, an insurer must comply with section 39-71-609, MCA (2003), which requires a physician's determination that the claimant has reached maximum medical improvement, specification of his or her physical restrictions, and approval of his or her return to work based on a job analysis prepared by a vocational consultant, and further requires the insurer to furnish the claimant with a copy of the physician's determination. The job analysis requirement is satisfied where the evidence shows that even though the physician did not approve a time-of-injury job analysis in writing, both the physician and the claimant understood that the physician was approving a return to work in the time-of-injury job and the physician had previously reviewed the job analysis and was aware of the job requirements.
Daulton v. MHA Workers' Comp. Trust [7/09/01] 2001 MTWCC 37 Under 1997 and 1999 law, § 39-71-701 and -609, MCA, once claimant has been found to be at MMI the insurer may terminate claimant's temporary total disability benefits upon 14 days notice. If the claimant has also been released to return to any sort of employment, the insurer may immediately terminate temporary total disability benefits.
Ness v. Anaconda Minerals Co. [2/3/95] 1995 MTWCC 10 Based on the holding of Ness v. Anaconda Minerals Co., 257 Mont. 335, 849 P.2d 1021 (1993) (Ness I), claimant is entitled only to extension of temporary total disability benefits through the date the insurer satisfied the fourth element of Coles v. Seven Eleven Stores, 217 Mont. 343, 704 P.2d 1048 (1985), providing him notice of a physician’s report determining his ability to work. Note: this decision was affirmed by the Montana Supreme Court in Ness v. Anaconda Minerals Co., 279 Mont. 472, 929 P.2d 205 (1996) (Ness II).