Burden of Proof - Aggravations

Proof: Burden of Proof: Aggravations

MONTANA SUPREME COURT DECISIONS

Kuntz v. Nationwide Mutual Fire Ins. Co., 1998 MT 5 Under Belton v. Carlson Transport, 202 Mont. 384, 658 P.2d 405 (1983), the insurer at the time of a second injury is at risk for the injury if the previous injury covered by another insurer has reached maximum healing, maximum recovery, or a medically stable condition; complete recovery from the previous injury is not necessary for the second insurer to be responsible. The burden of proof is on the insurer at the time of the second injury. A limitation not at issue in Belton, but clearly set forth therein, is that the second injury must be an aggravation of a pre-existing injury. If the new incident is an exacerbation, or temporary alteration in symptoms, but not an aggravation, or material or permanent alteration, the second insurer does not become liable for the condition following recovery from the exacerbation. If the claimant does not prove the latter incident caused a permanent detriment, the burden of proof does not shift to the second insurer. As noted in prior cases, e.g., Chaney v. U.S. Fidelity & Guar., 276 Mont. 513, 917 P.2d 912 (1996) and Walker v. United Parcel Service, 262 Mont. 450, 865 P.2d 1113 (1993), the claimant continues to bear the initial burden of establishing that he suffered a compensable injury from an industrial accident.

Briney v. Pacific Employers Insurance Co., 283 Mont. 346, 942 P.2d 81 (1997) Once the claimant has proven a work-related injury and produced evidence that the injury is a cause of a present disability, an insurer who alleges that subsequent events are the actual cause of the claimant’s current disability has the burden of proving that allegation, which is in the nature of an affirmative defense, by a preponderance of the evidence.

MONTANA WORKERS' COMPENSATION COURT DECISIONS

Barnhart v. Liberty Northwest Ins. Corp. [09/13/16] 2016 MTWCC 12 The claimant’s burden to establish an accident, an injury or aggravation of a pre-existing condition, and a causal connection between the accident and the injury or aggravation is “more probable than not.”

Engle v. Hartford Underwriters Ins. Co. [12/31/13] 2013 MTWCC 27 Where the insurer elicited medical opinions that Petitioner’s elbow condition was caused by a childhood injury and that her current condition would have developed regardless of any later incident, the Court held that it did not meet its burden of proving that Petitioner suffered a permanent aggravation subsequent to the occupational disease claim for which the insurer had accepted liability.

Moore v. State Compensation Ins. Fund [04/17/95] 1995 MTWCC 29 Where claimant seeks continued medical benefits denied by an insurer, she must prove by a preponderance of the evidence that a causal connection exists between her injury and her current condition. However, if the insurer contends that injuries subsequent to the industrial accident permanently damaged her condition and relieve it of liability for continued medical treatment, it has the burden of proof. See, Lee v. Group Cable TCI of Montana, 245 Mont. 292; Walker v. United Parcel Service, 262 Mont. 450 (1993).

Moore v. State Compensation Ins. Fund [04/17/95] 1995 MTWCC 29 Where insurer is unable to point to any specific injury occurring when claimant’s house cleaning aggravated her back condition, it has not proven a subsequent non work-related injury relieving it from liability for ongoing medical care under section 39-71-407, MCA (1991).