Causation: Injury


Ford v. Sentry Casualty Company, 2012 MT 156 Because of changes the 1995 Legislature made to §§ 39-71-119 and -407, MCA, the Montana Supreme Court overruled that statement in Boyd v. Zurich Am. Ins. Co., ¶ 22, that “claimants are not required to prove causation through medical expertise or opinion.”  Since 1995, Claimants must establish injury and causation by objective medical findings.

Fellenberg v. Transportation Ins. Co., 2005 MT 90 Causation is an essential element to an entitlement to benefits and the claimant has the burden of proving a causal connection by a preponderance of the evidence.

Guymon v. Montana State Fund [06/28/16] 2016 MTWCC 7 Where this Court concluded that the medical opinion the claimant offered to establish causation was based on misinformation, the claimant failed to meet his burden of proof that an accident caused his left-shoulder condition as required by § 39-71-119, MCA.

McNamara v. MHA Workers' Compensation Reciprocal [05/25/16] 2016 MTWCC 5 The medical condition for which compensation is sought must be caused by the industrial accident.  Where claimant’s treating physician testified that her need for a total knee replacement was a foregone conclusion prior to her industrial injury, and that she would have required the surgery regardless of her injury, claimant failed to prove her surgery was compensable.

Warburton v. Liberty Northwest Ins. Corp. [01/07/16] 2016 MTWCC 1 Although Petitioner tripped over a clothing rack at work and fell backwards, landing on the floor, and the medical evidence indicated that Petitioner has problems with her head, neck, and shoulders, the medical opinions which connected these problems to her industrial accident were based on inaccurate and incomplete medical histories Petitioner provided her doctors and she therefore failed to satisfy her burden of proving that her industrial accident caused her injury.

Gaudette v. Montana State Fund [03/19/13] 2013 MTWCC 7 Petitioner did not prove that her condition was causally related to her industrial injury where reports of her sensitivity to odors predated her industrial injury, no contemporary medical records supported her account of a reaction to an aerosol office cleaner, one medical provider opined that her reactions were actually anxiety attacks, an industrial hygienist found no contaminants in the workplace, and medical providers who supported Petitioner’s contentions offered no evidence in support of their opinions beyond Petitioner’s subjective reports.  Moreover, other medical experts opined that Petitioner’s condition had a psychological origin, and some of Petitioner’s symptoms could be readily explained as side effects of medications she took.  Petitioner further failed to follow treatment recommendations, refused to disclose part of her medical history to some providers, and refused to undergo a recommended diagnostic procedure. While some evidence supported Petitioner’s claim, it is significantly weaker than the evidence to the contrary.

McLeish v. Rochdale Ins. Co. [07/18/11] 2011 MTWCC 18 Where Petitioner suffered an “undetermined medical event” which caused him to fall on a flat surface, his injury occurred in the course of his employment but did not arise out of his employment under § 39-71-407(1), MCA, as his employment was not one of the contributing causes which placed him in harm’s way.
Stewart v. Liberty Northwest Ins. Corp. [09/14/04] 2007 MTWCC 41 “Causation is an essential element to an entitlement to benefits and the claimant has the burden of proving a causal connection by a preponderance of the evidence. Grenz v. Fire and Cas. of Conn., 250 Mont 373, 380, 820 P.2d 742, citing Brown v. Ament, 231 Mont. 158, 163, 752 P.2d 171, 174 (1988). Although a treating physician’s opinion is generally accorded greater weight, the opinion is not conclusive. Where virtually no evidence that a causal connection between Petitioner’s surgeries and the purported damage to her knee exists, and her treating physician’s ultimate opinion that there is a causal relationship is belied by the entire remaining balance of his testimony acknowledging that he has no idea how the surgeries and knee damage are related, Petitioner has not met her burden of proof.
Johnson v. MHA Workers' Comp Trust [05/22/07] 2007 MTWCC 17 Taking the evidence as a whole – the objective findings that an injury occurred, the fact that Petitioner’s type of injury can be caused by lifting, the absence of any symptoms before the date of injury, and the immediate onset of symptoms at the time of the incident – the Court concludes it is more probable than not that Petitioner’s October 4, 2005, injury occurred from activities arising out of and in the course of her employment at Community Medical Center.
Heckel v. UEF and LaFever [03/07/07] 2007 MTWCC 11 Where the medical evidence does not support a conclusion that Petitioner’s arm injury occurred as a result of an altercation in which he ejected a trespasser from the apartment building where he was employed, Petitioner cannot meet his burden of proof and the Court need not reach whether the ejection was within the course and scope of Petitioner’s employment.

Liberty Northwest Insurance Company v. Michael Stolz [11/9/99] 1999 MTWCC 71 While the insurer's counsel's questioning tried to make it appear that claimant's pain resulted from one incident, a complete reading of claimant's testimony shows that while there may have been one day on which claimant began experiencing pain, it was not associated with a specific event or incident. Physician's testimony suggests it is more probable that lifting over several days led to the condition, making it an occupational disease.

Hamlin v. State Fund [12/29/95] 1995 MTWCC 113 Section 39-71-407(5), MCA (1993) relieves the insurer of liability for claimant’s knee condition following non-work related fall where he had reached MMI after knee surgery following industrial accident and the Court finds, as a matter of fact, that claimant did not suffer from instability of his knee following his first surgery and that his non-work related fall was not caused by a pre-existing work-related knee condition.