|
No.
95-485
IN
THE SUPREME COURT OF THE STATE OF MONTANA
1995
MICHAEL
E. HEISLER,
Petitioner and Appellant,
v.
HINES MOTOR COMPANY,
Employer,
STATE
COMPENSATION INSURANCE FUND
Insurer/Defendant and Respondent.
APPEAL
FROM: Workers' Compensation Court
For the State of Montana
The Honorable Michael McCarter, Judge presiding.
COUNSEL OF RECORD:
For
Appellant:
Lawrence
A. Anderson, Great Falls, Montana
For
Respondent:
Norman
Clyde Peterson, Assistant Attorney General, Agency Legal
Services Bureau, Helena, Montana
Heard:
January 16, 1997
Submitted: January 17, 1997
Decided: April 24, 1997
Filed:
__________________________________________
Clerk
Justice William E. Hunt, Sr. delivered the Opinion of the Court.
Appellant Michael E. Heisler (Heisler) appeals the decision of the Workersþ
Compensation Court denying his motion for summary judgment on the issue
of whether he was constitutionally entitled to change his treating physician
without the prior approval of the State Compensation Insurance Fund (State
Fund). We reverse and remand.
ISSUE
The dispositive
issue presented on appeal is whether the Workersþ Compensation
Court erred in denying Heislerþs motion for summary judgment on
the question of
whether he was constitutionally entitled to change his treating physician
without the prior approval of the State Fund.
FACTS
The facts in this
case are not in dispute. On June 28, 1993, Heisler was injured
in a work-related auto accident while employed by Hines Motor Supply Company
of
Great Falls. Hines Motor Supply Company was insured by the State Fund
for purposes of workersþ compensation. Immediately after the accident,
Heisler sought treatment at the emergency room at Columbus Hospital. Heisler
also went to a convenient care clinic on July 10, 12, and 14, 1993, for
treatment of his injury. On July 12, 1993, Heisler submitted a claim for
compensation to the State Fund in which he named a Dr. Richard A. Nelson
as his treating physician.
The State Fund
believed that Heislerþs initial visits to a given doctor at the
convenient care clinic constituted a choice of treating physician. The
State Fund therefore contended that Heisler was attempting to change his
existing choice of treating physician from the initial doctor to Dr. Nelson.
Under ARM 24.29.1511, an injured claimant cannot change treating physicians
without the prior approval of the State Fund. Since Heisler had not obtained
its prior approval, the State Fund refused to pay any of the charges Heisler
incurred from his visits to Dr. Nelson. Heisler then instituted this suit
to compel payment of Dr. Nelsonþs expenses.
In the Workersþ Compensation Court, and now on appeal, Heisler contended
that
he was statutorily entitled to full freedom to choose his own physician
pursuant to 33-22-111, MCA (1991). He further contended that this statute
must take precedence over the conflicting administrative rule, thereby
allowing him to change his treating physician without the State Fundþs
approval. For its part, the State Fund contended that the administrative
rule was clear and unequivocal and, pursuant to its terms, the Fund had
no duty to pay for treatment from an unauthorized treating physician.
Based on his interpretation
of the apparent conflict of laws, Heisler moved for
summary judgment. The Workersþ Compensation Court denied the motion,
concluding that 33-22-111, MCA (1991), did not conflict with ARM 24.29.1511
and, further, did not apply in Heislerþs case. Heisler then moved
that a final judgment be entered on that basis. The Workersþ Compensation
Court granted the motion and entered a final judgment. Heisler appeals
the denial of his motion for summary judgment.
STANDARD OF
REVIEW
This Court's standard
of review of a grant or denial of summary judgment is the
same as that used by the trial court in ruling upon the motion for summary
judgment.
Malek v. Hankins (1996), 275 Mont. 97, 98, 911 P.2d 1127, 1128 (citing
Motarie v.
Northern Montana Joint Refuse Disposal Dist. (1995), 274 Mont. 239, 907
P.2d 154). Summary judgment is proper only when there is no genuine issue
of material fact and the moving party is entitled to judgment as a matter
of law. Rule 56(c), M.R.Civ.P.; Malek, 911 P.2d at 1128.
DISCUSSION
Before addressing
the merits of the case, we must dispose of certain collateralmatters.
First, the State Fund takes exception to Heislerþs citation to excerpts
from certain depositions in his brief. Relying on Johnson v. Killingsworth
(1995), 271 Mont. 1, 894 P.2d 272, the State Fund contends that, in appealing
this case, the parties must limit themselves to the "uncontested
facts" contained in the pretrial order, which included no reference
to the depositions in question. Johnson does not stand for the proposition
advanced, however.
In Johnson, this
Court declined to consider certain evidence offered on appeal
which was not contained in the District Court record. In so doing, this
Court stated that "[i]t is axiomatic that this Court will not consider
evidence not contained in the record on appeal. Moreover, a partyþs
reference to evidence does not incorporate that evidence into the record."
Johnson, 894 P.2d at 273 (citations omitted). Johnson does not address
whether this Courtþs consideration of the facts in a given case
must be limited to the scope of the pretrial order; it merely states that
this Court will not consider evidence which is not part of the record.
In the case at bar, the depositions referenced are part of the record
transmitted from the Workersþ Compensation Court on appeal.
The State Fund
presents no relevant authority to support its argument that this
Courtþs review of the facts presented in the trial court must be
limited to the uncontested facts in a pretrial order. A pretrial order
serves to "prevent surprise, simplify the issues, and permit counsel
to prepare their case for trial on the basis of the pretrial order."
King v. Zimmerman (1994), 266 Mont. 54, 66, 878 P.2d 895, 903 (citing
Zimmerman v. Robertson (1993), 259 Mont. 105, 111, 854 P.2d 338, 342).
It lists such facts as are uncontested, and if a party admits to a fact
by allowing its inclusion as uncontested in a pretrial order, the party
will not be allowed to raise that particular factual issue on appeal.
Whitehawk v. Clark (1989), 238 Mont. 14, 19, 776 P.2d 484, 487 (citing
Morse v. Cremer (1982), 200 Mont. 71, 647 P.2d 358). The pretrial order,
however, includes only such facts as are uncontested; it does not preclude
a party from attempting to prove additional facts which remain in dispute.
Nor does the pretrial order in and of itself limit the scope of this Courtþs
review. On appeal, this Court may consider any evidence which is part
of the record, Johnson, 894 P.2d at 273, even if it was not included in
a pretrial order. Accordingly, if the depositions in question will facilitate
our review we will consider them, just as we are free to consider the
entirety of the record presented on appeal.
Second, the State
Fund argues that this Court should decline to review the
Workersþ Compensation Courtþs decision in this case because
the matter is moot. This suit was filed to recover certain expenses incurred
by Dr. Nelson, which the State Fund refused to pay because Heisler had
not obtained the Fundþs prior approval before switching treating
physicians. The State Fund notes that it has since authorized Dr. Nelson
to be Heislerþs treating physician and paid all the medical bills
at issue. It therefore contends that the issue presented is moot.
As the State Fund correctly notes, an issue is moot when it no longer
presents a
justiciable controversy, due to the occurrence of a given event or the
passage of time. Montana Tavern Association v. State Department of Revenue
(1986), 224 Mont. 258, 262, 729 P.2d 1310, 1313-14 (citations omitted).
However, an issue will not be considered moot if it is "capable of
repetition, yet evading review." School Dist. No. 4 v. Board of Personnel
Appeals (1985), 214 Mont. 361, 364, 692 P.2d 1261, 1263. In order to prove
that a given situation is capable of repetition, yet evading review, a
party must show:
(1) the challenged
action was in its duration too short to be fully litigated
prior to the cessation or expiration of the action; and
(2) there was a reasonable expectation the same complaining party would
be subjected to the same action again.
School Dist. No.
4, 692 P.2d at 1263 (citing Sosna v. Iowa (1975), 419 U.S. 393, 95
S.Ct. 553, 42 L.Ed.2d 532).
We agree with
the Workersþ Compensation Courtþs conclusion that the issue
raised in this case is not moot because the actions of the State Fund
are capable of repetition, yet evading review. We note that the State
Fund has not abandoned its contention that ARM 24.29.1511 gave it the
absolute right to pre-approve a claimantþs change of treating physician.
Therefore, should Heisler again change his treating physician without
the prior approval of the State Fund, the Fund could again refuse to pay
the expenses incurred. The action complained of is capable of repetition.
Moreover, the dispute would probably continue to evade review, because
the State Fund could avoid resolution of the underlying problem by simply
paying the disputed expenses after a suit was instituted, just as it did
in this case. Therefore, the State Fund's voluntary discontinuance of
the action complained of was insufficient to render the issue moot. Because
the action which prompted institution of this suit is capable of repetition,
yet evading review, the State Fundþs payment of the disputed charges
will not serve to moot the issue presented. Having determined that the
issue in the case is not moot, we will review the substantive question
presented.
Did the Workersþ
Compensation Court err in denying Heislerþs motion for
summary judgment on the question of whether he was constitutionally entitled
to change his treating physician without the prior approval of the State
Fund?
This appeal stems
from an apparent conflict of laws which existed as of the date
of Heislerþs injury. In this case, as in all workersþ compensation
cases, it is the law in effect on the date of the claimantþs injury
which must be applied. Kraft v. Flathead
Valley Labor & Contractors (1990), 243 Mont. 363, 367, 792 P.2d 1094,
1096 (citing Young Motor Company v. Division of Workers' Comp. (1985),
219 Mont. 1, 710 P.2d 58).
When Heisler was
injured, 33-22-111, MCA (1991), provided in pertinent part:
[a]ll policies of disability insurance, including individual, group, and
blanket policies, and all policies insuring the payment of compensation
under the workersþ compensation act shall provide that the insured
has full
freedom of choice in the selection of any licensed physician . . . .
(Emphasis added.) However, ARM 24.29.1511, which although enabled in 1993
retroactively applied to Heislerþs claim, provided in pertinent
part:
Selection of physician for claims arising before July 1, 1993. Although
33-22-111, MCA, provides freedom of choice in selection of a physician,
workersþ compensation and occupational disease case law also recognizes
that a worker must select a single physician who is responsible for the
overall medical management of the workersþ condition. That physician
is
known as the treating physician. . . . A worker must obtain prior
authorization before changing treating physician.
ARM 24.29.1511 (1993), enabled by 39-71-203, MCA (1993) (emphasis added).
Therefore, Heisler
was confronted by two apparently irreconcilable provisions of law: one
which apparently granted him an absolute right to choose his own physician,
the other which prohibited him from changing physicians without the prior
approval of the State Fund.
While the Workersþ
Compensation Court acknowledged the apparent conflict
between 33-22-111, MCA (1991), and ARM 24.29.1511 (1993), it concluded
that these provisions did not in fact conflict. The Workersþ Compensation
Court cited 33-1-102(5), MCA (1991), which stated "[t]his code
[Title 33, Insurance and Insurance Companies] does not apply to workersþ
compensation insurance programs provided for in Title 39, chapter 71,
parts 21 and 23, and related sections." Under the plain language
of 33-1-102(5), MCA (1991), provisions in the insurance code (including
33-22-111, MCA (1991) which granted individuals full freedom of choice
of physicians) did not apply to cases brought under workersþ compensation
Plan 1 (Title 39, chapter 71, part 21, which set forth the law regarding
self-insurers) or workersþ compensation Plan 3 (Title 39, chapter
71, part 23, which set forth the law regarding the State Fund).
Since Heisler
was covered by the State Fund under Plan 3, the Workersþ Compensation
Court concluded that 33-22-111, MCA (1991), did not grant to him the
right to choose his own physician.
On appeal, Heisler
first argues that the Workersþ Compensation Court misinterpreted
the relevant statutes. Upon review, we conclude that it did not. Section
33-22-111, MCA (1991), the statute which provided freedom to choose a
physician, was included in Title 33, the Insurance and Insurance Companies
code. Section 33-1-102(5), MCA (1991), stated that the provisions of Title
33 did not apply to workers' compensation cases involving coverage provided
by the State Fund. Heisler admittedly was covered by the State Fund. Therefore,
the right to freely choose a physician was not extended to him or to others
whose coverage was provided either by the State Fund or a self-insured
company. Section 33-1-102(5), MCA (1991). This construction of the relevant
statutory provisions was correct; indeed, it was the only interpretation
possible given the plain language of the applicable statutes.
Heisler next argues
that this interpretation of the statutes created an untenable equal
protection problem. Heisler argues that the Workersþ Compensation
Courtþs
interpretation meant that the right to full freedom of choice of a physician
was granted to certain injured workers who were covered by workersþ
compensation, specifically those covered by Plan 2, private insurers (Title
39, chapter 71, part 22). At the same time, injured workers who happened
to be covered by Plan 1 or Plan 3 were not accorded this right. Heisler
argues that this differentiation between similarly situated individuals
violated his right to equal protection of the law.
Initially, the
State responds by arguing that this Court should not address this issue
because it was not raised in the trial court. The State notes this Courtþs
long-standing policy against addressing on appeal any issues which were
not raised below. See Grenz v. Fire and Casualty of Connecticut (1996),
924 P.2d 264, 267, 53 St.Rep. 898, 900 (citing Rasmussen v. Lee (1996),
276 Mont. 84, 916 P.2d 98; Fandrich v. Capital Ford Lincoln Mercury (1995),
272 Mont. 425, 901 P.2d 112). Since Heisler did not allege an equal-protection
violation in his petition, the State argues that this Court should decline
to hear his equal-protection allegation on appeal.
A review of the
record, however, reveals that the equal protection issue was raised
before the Workersþ Compensation Court. In responding to Heislerþs
original petition, the State addressed the possible applicability of the
equal protection clause of the Montana Constitution. Heisler then in turn
addressed this issue in his reply. Since the issue of equal protection
was argued in the Workersþ Compensation Court, it is not raised
here for the first time on appeal.
Equal protection
of the laws requires that all persons be treated alike under like
circumstances. Billings Associated Plumbing, Heating and Cooling Contractors
v. State Board of Plumbers (1979), 184 Mont. 249, 253, 602 P.2d 597, 600
(citing U.S.Const., Amend. XIV, section 1; Mont.Const., Art. II, section
4; Montana Land Title Assn. v. First American Title (1975), 167 Mont.
471, 539 P.2d 711). In reviewing equal protection challenges to workersþ
compensation statutes, this Court has said:
the right to receive
Workersþ Compensation benefits is not a fundamental
right which would trigger a strict scrutiny analysis of equal protection.
Nor
does this [workersþ compensation] statute infringe upon the rights
of a
suspect class. When a right determined to be less than fundamental is
infringed upon by classification, the test applied by this Court is the
rational
relationship test. That is, does a legitimate governmental objective bear
some identifiable rational relationship to a discriminatory classification.
Stratemeyer v.
Lincoln County (1993), 259 Mont. 147, 151, 855 P.2d 506, 509 (quoting
Cottrill v. Cottrill Sodding Service (1987), 229 Mont. 40, 42, 744 P.2d
895, 897).
In order to pass
the "rational-relationship" or "rational-basis" test,
a challenged legislative enactment "must implicate legitimate goals,
and the means chosen by the legislature must bear a rational relationship
to those goals." Lyng v. Automobile Workers (1988), 485 U.S. 360,
375, 108 S.Ct. 1184, 1194, 99 L.Ed.2d 380 (Justice Marshall, dissenting).
In addition, legislative
enactments are presumed to be constitutional. Vainio v.
Brookshire (1993), 258 Mont. 273, 277, 852 P.2d 596, 599; City of Helena
v. Krautter (1993), 258 Mont. 361, 364, 852 P.2d 636, 639. The party challenging
the legislative enactment bears the burden of proving its unconstitutionality
beyond a reasonable doubt. Vainio, 852 P.2d at 599 (citing Romero v. J
& J Tire (1989), 238 Mont. 146, 149, 777 P.2d 292, 294). If any doubt
exists, it must be resolved in favor of the legislative enactment. GBN,
Inc. v. Montana Department of Revenue (1991), 249 Mont. 261, 265, 815
P.2d 595, 597 (citing Harper v. Greely (1988), 234 Mont. 259, 269, 763
P.2d 650, 656).
Heisler argues
that 33-22-111, MCA (1991), and ARM 24.29.1511 (1993), taken
together, discriminate against certain injured workers (specifically,
those covered by Plan 1 or Plan 3 insurers). He therefore contends that
persons under like circumstances (i.e., injured workers) are not treated
alike (because some are given full freedom of choice of physicians and
others are not). Heisler further argues that this discrimination should
not be allowed because it is not rationally related to a legitimate governmental
interest. See Stratemeyer, 855 P.2d at 509. The State responds by conceding
that Plan 2 injured workers are treated differently
than Plan 1 and Plan 3 injured workers, in that Plan 2 workers are afforded
the right to freely choose or change their treating physician but Plan
1 and Plan 3 workers are not.
Nevertheless,
the State presents three arguments in support of its contention that such
differentiation is proper and constitutional.
A. Case law
from other jurisdictions.
First, the State
argues that other state courts have addressed the issue of equal
protection in the area of workersþ compensation and upheld statutes
which have an effect similar to that of the Montana administrative rule
mandating pre-approval of a change in treating physician. In support of
this argument, the State discusses Burrgess v. Industrial Commission (Ill.App.1
Dist.1988), 523 N.E.2d 1029; Rivers v. Oregon Accident Insurance Fund
(Or.App.1980), 610 P.2d 288; and Chiropractors for Justice v. State of
Alaska (Alaska 1995), 895 P.2d 962. But neither Burrgess nor Rivers are
strictly on point to the narrow issue presented in this case, and Chiropractors
for Justice is distinguishable.
Burrgess involved
a challenge to an Illinois statute which mandated that an injured
worker obtain his or her employerþs consent before switching to
a third treating
physician. The statute, however, gave the injured worker two elective
physician choices before the requirement of employer consent was triggered.
Burrgess, 523 N.E.2d at 1033. While the Illinois Court of Appeals in Burrgess
cursorily noted and dismissed the claimantþs equal protection challenge,
nothing in the case or in the challenged statute (Ill.Rev.Stat.1985, ch.48,
par.138.8(a)) indicated that the statute in question only applied to some
injured workers but not to others. Therefore, Burrgess sheds no light
on the question of whether a statutory scheme which does differentiate
between similarly situated injured workers may violate a claimantþs
right to equal protection of the law.
Similarly, neither
Rivers nor Chiropractors for Justice involve statutes which
differentiate between classes of injured workers on the basis of the insurance
plan by which the worker is covered. In Rivers, the Oregon Court of Appeals
reviewed a
provision which allowed injured workers to choose their own physicians
within the state of Oregon, but allowed the insurer to choose the physician
if the injured worker received treatment outside the state of Oregon.
Rivers, 610 P.2d at 289. The Oregon court determined that such a requirement
did not violate the claimantþs right to equal protection, because
it was rationally related to the legitimate governmental objective of
ensuring that the Oregon Workersþ Compensation Board would have
the legal authority to subpoena or otherwise compel the cooperation of
the doctors whose services it investigated. Rivers, 610 P.2d at 290. In
Rivers, the Oregon court reviewed an equal protection question quite different
than the one faced by this Court today, and it justified the challenged
provision on a rational basis which cannot apply in the case at bar. Rivers
is therefore not on point.
In Chiropractors
for Justice, the Alaska Supreme Court reviewed a statutory
provision which required an injured worker to receive approval before
exceeding the
maximum number of allowable compensable medical treatments. But in this
Alaska case, a group of health-care providers (specifically, chiropractors),
and not an injured worker, asserted that the statute violated its right
to equal protection of the law. In determining that the provision in question
did not violate the chiropractorsþ right to equal protection, the
Alaska court noted that the provision was rationally related to the legitimate
government aim "to reduce costs by curbing perceived abuses [of the
workers' compensation system] through procedural safeguards. . . [and
to] ensure that employers are liable only for reasonable and necessary
medical costs." Chiropractors for Justice, 895 P.2d at 971. The State
argues that Chiropractors for Justice is persuasive authority because
the means (limitations on treatment) and the ultimate state goal (cost
control) which were sanctioned in that case are identical to the means
and state goal challenged in the case at bar. For reasons set forth in
part "C," below, we determine that the goal advanced by the
Alaska statute is not identical to the goal advanced by the Montana
statute and, therefore, Chiropractors for Justice can and must be distinguished.
B. Effect of
the challenged provision.
The State next
argues that 33-22-111, MCA (1991), and ARM 24.29.1511
(1993), taken together, did not violate Heisler's constitutional right
to equal protection because the effect of the statute and regulation is
not to prevent the injured worker from being treated by the physician
of his or her choice but, rather, merely to limit the circumstances under
which the State Fund must pay for such treatment. The State therefore
argues that Heisler in fact retains his right to "full freedom of
choice of physicians," but, should he choose to exercise that right
in violation of ARM 24.29.1511(1993), the State Fund will not bear the
cost. Such an argument in disingenuous at best.
Few, if any, injured
workers are willing or able to bear the entire cost of treating
their work-related injuries in exchange for the privilege of choosing
their own physicians.
When the State
makes the payment of treatment costs contingent on its approval of the
treating physician, it effectively removes the injured claimantþs
right to freely choose the physician of his or her choice. The State cannot
seriously argue otherwise, given that, as noted below, it cites the cost
control achieved by limiting physician choice as the sole rational basis
justifying the policy requiring physician preapproval.
C. Equal protection
challenge.
Lastly, and most significantly, the State argues that the admitted differentiation
between injured workers caused by 33-22-111, MCA (1991), and ARM 24.29.1511
(1993), should pass constitutional muster because such disparate treatment
is rationally related to the legitimate governmental goal of controlling
workersþ compensation costs.
The State contends
that [r]equiring as part of the [workersþ compensation] program
that claimants in Heisler's class obtain prior authorization before permitting
a change in doctors is a rational means of addressing the legitimate objective
of
ensuring that all primary medical care is both reasonable and necessary.
In turn, ensuring that medical treatments meet the Stateþs criteria
for "reasonable and necessary" serves to control and minimize
the cost of a workable workersþ compensation program. The State
argues that such a goal justifies treating Plan 1 and Plan 3 claimants
differently from Plan 2 claimants.
In support of
its contention that cost control justifies disparate treatment, the State
cites Stratemeyer, where this Court reviewed a statutory provision which
refused
workersþ compensation benefits to a claimant suffering from a mental
injury. This Court determined that the challenged provision did not violate
the claimantþs right to equal protection of the law, in part because
we determined that the differentiation between mental and physical injuries
was rationally related to the legitimate governmental objective of controlling
workersþ compensation costs. Stratemeyer, 855 P.2d at 511.
Relying on Stratemeyer
and Chiropractors for Justice, the State urges this Court to
determine that the challenged statute and administrative rule do not violate
the claimant's right to equal protection of the law and must be upheld.
After review, we conclude that neither Stratemeyer nor Chiropractors for
Justice
should control the result in this case. While both cases cite cost-control
as a legitimate reason for disparate treatment of injured workers, in
neither case was cost-control the only justification for the challenged
provisions. In contrast, the only justification given for treating certain
injured workers differently than others in the case at bar is the possibility
that such discrimination will assist the State in controlling workers'
compensation costs. Heisler argues that cost-control alone cannot justify
discrimination.
We agree. On this
basis, both Stratemeyer and Chiropractors for Justice must be
distinguished. Cost-control alone cannot justify disparate treatment which
violates an individual's right to equal protection of the law. Discrimination,
that is, offering services to some while excluding others for any arbitrary
reason, will always result in lower costs. We do not, however, allow discrimination
merely for the sake of fiscal health. As the Alaska court noted in Chiropractors
for Justice,
the asserted goal of lowering insurance premiums can have no independent
force in the stateþs attempt to meet its burden under the equal
protection
clause. Although reducing costs to taxpayers or consumers is a legitimate
government goal in one sense, savings will always be achieved by excluding
a class of persons from benefits they would otherwise receive. Such
economizing is justifiable only when effected through independently
legitimate distinctions. Chiropractors for Justice, 895 P.2d at 971 (quoting
Alaska Pacific Assurance Co. v. Brown (Alaska 1984), 687 P.2d 264, 272)
(emphasis added).
In finding the
respective challenged provisions constitutional, this Court in Stratemeyer
and the Alaska court in Chiropractors for Justice both determined that
"independently legitimate distinctions" existed, beyond an arbitrary
exclusion of some claimants, and that these "independently legitimate
distinctions" justified disparate treatment.
In Chiropractors
for Justice, the Alaska court determined that the requirement that
treatment sessions numbering beyond the statutorily allowed maximum be
pre-approved did not violate health-care providersþ right to equal
protection. The court noted that such a requirement [was] not designed
to reduce costs by depriving a certain class of persons, e.g. chiropractors,
of benefits they would otherwise receive. Rather, they are designed to
reduce costs by curbing perceived abuses through procedural safeguards.
Chiropractors may be paid for frequent treatments
by adhering to the regulation and demonstrating that the treatments are
reasonable and necessary. The purpose here was to ensure that employers
are liable only for reasonable and necessary medical costs.
Chiropractors for Justice, 895 P.2d at 971.
In the case at
bar, the precise effect of the Montana statute and administrative rule
is "to reduce costs by depriving a certain class of persons of benefits
they would
otherwise receive." The regulation does not serve to ensure that
the medical costs
incurred are reasonable and necessary, because the relevant factor in
cost control is thereasonableness of the medical services provided, not
the identity of the provider. Limiting physician-choice does not address
the reasonableness or necessity of a given treatment; it reduces costs
solely by prohibiting Plan 1 or Plan 3 claimants from exercising a privilege
granted to Plan 2 claimants.
In Stratemeyer,
this Court acknowledged that control of workersþ compensation
costs was a legitimate government interest, to which the exclusion of
mental-injury claims was rationally related. However, mental-injury claims
were not arbitrarily excluded simply because their exclusion reduced costs.
This Court also noted that compensating injury claims which did not include
a physical component would be problematic, in that it would be very difficult
to prove or disprove that the injury complained of was causally related
to the employment situation. Stratemeyer, 855 P.2d at 511 (citing Erhart
v. Great Western Sugar Company (1976), 169 Mont. 375, 379, 546 P.2d 1055,
1057). Therefore, the policy against allowing mental- or stress-injury
claims was rationally related to the legitimate governmental interest
of maintaining a workable workersþ compensation system.
Furthermore, we
note that Stratemeyer factually differed significantly from the case
at bar. Stratemeyer distinguished between mental and physical injuries
and held that only the latter were compensable under workersþ compensation.
In the case at bar, identically injured workers receive disparate treatment
based solely on which workersþ compensation plan insures them--a
matter beyond the control of the average worker. This case is therefore
more analogous to Cottrill, where one injured worker was treated differently
than another, identically injured worker would be, based solely on where
the claimant lived. In Cottrill, this Court found such a distinction to
be arbitrary and noted that "[a] classification that is patently
arbitrary and bears no rational relationship to a legitimate governmental
interest offends equal protection of the laws." Cottrill, 744 P.2d
at 897
(quoting Tipco Corp., Inc. v. City of Billings (1982), 197 Mont. 339,
346, 642 P.2d
1074, 1078). Similarly, in this case, differentiating between injured
workers based solely on which insurance plan covers them is an arbitrary
distinction, not rationally related to the goal of controlling workersþ
compensation costs.
In sum, we conclude
that the policy of discriminating between injured workers
based solely on which insurance plan covers them is not rationally related
to a legitimate government objective. Having decided this case on the
issue of equal protection, we need not address Heisler's second argument
that the statute in question violates his constitutional right to privacy.
The decision of the Workers' Compensation Court is reversed and this matter
is remanded to the Workers' Compensation Court for further proceedings
consistent with this opinion.
/S/ WILLIAM E. HUNT, SR.
We Concur:
/S/ J. A. TURNAGE
/S/ JIM REGNIER
/S/ JAMES C. NELSON
/S/ W. WILLIAM LEAPHART
/S/ TERRY N. TRIEWEILER
Justice Karla M. Gray, concurring
and dissenting.
I concur in the Court's statutory analysis and in the result it reaches
on the equal
protection issue, although I would reach that result under a different
analysis. In
addition, I disagree with the overly broad conclusion on which the Court
bases its equal protection holding.
I agree with the
Court that Stratemeyer is distinguishable from the present case and
that it does not support the State Fund's position here. I cannot agree,
however, with the Court's sweeping conclusion that cost alone can never
justify a classification or distinction in the workers' compensation arena.
That conclusion, while not stated as such, results from the Court's agreement
with Heisler's argument "that cost-control alone cannot justify discrimination"
and the Court's statement that "[c]ost-control alone cannot justify
disparate treatment which violates an individual's right to equal protection
of the law."
This latter statement
by the Court is circuitous at best. It suggests that disparate
treatment can actually violate equal protection prior to a determination
of whether the disparate treatment is rationally related to a legitimate
governmental objective or interest.
This is simply
not the case and the Court puts the cart before the horse in so stating.
In any event, however, it is my view that the Court's sweeping conclusion
is
incorrect and ill-advised. The entire workers' compensation system is
premised on an economic compromise determined to be in the best interests
of all concerned: employees gave up the right to sue employers in tort
for work-related injuries in exchange for a guaranteed compensation system;
employers avoided the potential of unlimited tort liabilities in exchange
for required "no fault" compensation payments to injured workers.
Indeed, the stated
public policy objective of the Workers' Compensation Act is to provide
wage-loss benefits to injured workers "at a reasonable cost to the
employer." Section 39-71-105(1), MCA. Medical benefits, also to be
provided without regard to fault, are based on "reasonableness"
and "cost-effectiveness." Sections 39-71-105(1) and 39-71-704(a)
and (b), MCA. Thus, to an extraordinary extent, the entire system is grounded
in "cost control" of various kinds. The Court's conclusion that
cost control can never justify disparate treatment eviscerates the purpose
and provisions of the Act.
Moreover, resolution
of the present case does not require a sweeping conclusion
of the type made by the Court. Here, the State Fund's position is that
operating an
economical Plan Three system is a valid, legitimate governmental objective
to which
requiring prior authorization before changing treating physicians is reasonably
related; stated differently, the State Fund contends that the prior authorization
rule is a rational means of addressing the legitimate objective of ensuring
that all primary medical care is both reasonable and necessary. The problem
with that position is that the State Fund articulates no nexus between
the prior authorization rule and the economic operation of Plan Three
or the "reasonable and necessary medical care" objective. That
is, the State Fund makes no showing of how the prior authorization rule
actually achieves any cost control or cost reduction goals and I can conceive
of none. Thus, while it is my view that cost control in its broadest sense--which
may include a variety of considerations directed to maintaining, overall,
a viable workers' compensation system to the ultimate benefit of both
employees and employers--can constitute a legitimate governmental objective
in the workers' compensation arena, I would conclude that no case has
been made here that the prior authorization rule is rationally related
to that objective. On that basis, I join the Court in holding that the
prior authorization rule denies Heisler's right to equal protection of
the laws.
/S/ KARLA M. GRAY
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