39-71-1101, MCA

Gamble v. Sears, 2007 MT 131, 337 Mont. 354, 160 P.2d 537 Viewing this statutory authorization rule in isolation, one might perhaps conclude that the failure to obtain authorization to change treating physicians should result in a loss of coverage for the treatment obtained. However, § 39-71-1101(2), MCA, cannot be viewed in isolation as it must be viewed as part of a whole statutory scheme and construed so as to forward the purpose of that scheme. It must also be construed in a way that avoids absurd results. Where the claimant did not know until after surgery that her neck fracture was related to her industrial accident, she must be excused from complying with the pre-authorization statute as a matter of law.
Gamble v. Sears, 2007 MT 131, 337 Mont. 354, 160 P.2d 537 Given the underlying policy of the WCA (§ 39-71-105, MCA), the employer/insurer’s contention that any failure to comply with the authorization rule eliminates entitlement to medical benefits mandated under the WCA must be rejected. Categorical imposition of this penalty based solely on a mere failure to obtain authorization could lead to absurd outcomes wherein an injured worker is deprived of coverage to which he is entitled. Such a consequence is not only unjust, but it conflicts with the WCA’s underlying purposes of ensuring medical benefits for work-related injuries without regard to fault.
Gamble v. Sears, 2007 MT 131, 337 Mont. 354, 160 P.2d 537 The procedural authorization rule of § 39-71-1101(2), MCA, allows the insurer an opportunity to choose a treating physician if the claimant no longer prefers the doctor he or she initially chose; it does not operate as an escape mechanism by which the insurer can avoid all liability for the cost of undisputedly necessary treatment arising from a work-related injury.
Hart v. Hartford Ins. Co. of the Midwest [04/07/10] 2010 MTWCC 8 Undisputedly necessary medical treatment arising from a work-related injury is compensable irrespective of prior authorization.  Where some medical bills have no corresponding medical records which would allow the court to assess the necessity of medical treatment and Petitioner’s behavior includes drug seeking and misrepresentations to physicians, it is impossible for the Court to decipher what bills remain unpaid that would fall into the category of undisputedly necessary.
Montana State Fund v. Pardis [05/10/06] 2006 MTWCC 21 Although an IME doctor strongly recommended that a patient, whose treating physician is a chiropractor, see a medical doctor to “monitor [the patient’s] progress,” the insurer cannot compel the patient to change treating physicians. Monitoring progress does not equate to the type of specialized evaluation or treatment contemplated by § 39-71-1101(3), MCA.
[1997] Young v. Liberty Northwest Ins. Corp. [8/25/00] 2000 MTWCC 51Under sections 39-71-1101, MCA (1997), claimant is not entitled to demand treatment by an orthopedic surgeon who is not a member of the insurer's designated preferred provider organization (PPO).
[1997] Parmer v. State Fund [6/9/00] 2000 MTWCC 33 Under section 39-71-1101 and -1103, MCA (1997), claimant's right to select an initial treating physician pursuant to subsection (1) was subject to the provisions of (3), which in turn provided that a non-MCO (managed care organization) physician cannot provide treatment, unless authorized by the insurer, if the injury results in total wage loss or an impairment rating. Here, the claimant experienced a wage loss and was referred to the MCO and the MCO physician became his treating physician, per (4). Thereafter, except for emergency treatment, the insurer was responsible for treatment by a chiropractor only if the insurer authorized those treatments. WCC would still review denial of chiropractic treatment, but found claimant had not proven that he sought chiropractic care through the MCO or that such care was superior to services available through the MCO.