39-71-2907, MCA
MONTANA
SUPREME COURT DECISIONS |
Stewart v. Liberty Northwest Ins. Corp. [04/23/13] 2013 MT 107 The penalty provided under § 39-71-2907, MCA, was not intended to eliminate an insurer’s assertion of a legitimate defense to liability. Reliance on a prior decision of the WCC creates a reasonable basis for denying liability, precluding a penalty award. |
[1993]
Marcott
v. Louisiana Pacific Corp., 297 Mont. 197 (1996)
Holton v. F. H. Stoltze Land & Lumber Co., 637 P.2d 10
(1981) requires that an insurer begin paying an impairment award if
uncontroverted medical evidence indicates claimant’s entitlement,
but does not require the employer to pay benefits where a reasonable
dispute as to compensability of the injury exists, even if some doctors
have opined the claimant’s condition is work-related. |
[1993]
Marcott
v. Louisiana Pacific Corp., 297 Mont. 197 (1996)
An insurer has a duty to make at least a minimal investigation of
a claim’s validity in light of the relevant statutes; absent
such an investigation, denial of a claim for benefits is unreasonable.
The insurer, however, has no duty to make claimant’s case for
him by discounting his initial statements to his employers and doctors
and soliciting additional information different from that first provided.
|
[1993]
Marcott
v. Louisiana Pacific Corp., 297 Mont. 197 (1996)
Where the compensability of a leg injury occurring while simply walking
had not been so clearly decided as to negate the employer’s
ability to reasonably raise the compensability issue, substantial
evidence supported the Workers’ Compensation Court’s finding
that the employer did not unreasonably deny benefits, though the injury
was compensable under the law. |
[1983]
Galetti
v. Montana Power Company, 2000 MT 234, 301 Mont. 314, 8 P.2d
812. Self-insured employer
accepted liability for claimant's 1983 back injury, but denied liability
for 1994 flare-up. Although the employer accepted liability at the
commencement of the hearing, trial proceeded on claims for attorneys
fees and penalty. WCC found the self-insured employer's denial of
the claim for medical benefits unreasonable where the adjuster had
persisted in maintaining claimant's flare-up was not compensable despite
medical information and legal precedent to the contrary in his files.
Further evidence of unreasonable conduct claim came through evidence
the employer ignored several requests by claimant for a copy of his
entire file, failing even to provide a copy of the doctors' response
to the self-insured employer's inquiries. The Supreme Court found
the twenty percent penalty under section 39-71-2907, MCA (1983) applied
to the entire amount of workers compensation benefits due claimant
from the self-insured employer's workers' compensation plan, even
though employee had received some compensation for medical expenses
from the same employer's self-insured medical benefits plan. |
[1993] Ingebretson v. Louisiana-Pacific Corp., 272 Mont. 294 (1995) (No. 94-622) Although there is no penalty provision in the Occupational Disease Act, section 39-72-402(1), MCA (1993) of that Act provides that “practice and procedure prescribed in the Workers’ Compensation Act applies to all proceedings under this chapter,” allowing the Workers’ Compensation Court to award penalty in an appropriate occupational disease case on the authority of section 39-71-2907, MCA (1993), the penalty provision of the Workers’ Compensation Act. |
WORKERS'
COMPENSATION COURT DECISIONS |
Koch v. Employers Ins. Group [05/19/14] 2014 MTWCC 14 Once Petitioner’s claim was adjudged compensable, Respondent became liable for it. After Respondent refused to authorize treatment and terminated liability without clear justification, the Court found its actions unreasonable and held Petitioner to be entitled to a penalty. |
Baeth v. Liberty NW Ins. Corp. [05/05/14] 2014 MTWCC 10 Where Respondent relied on the opinions of three physicians who did not see evidence of Petitioner’s exposure to asbestos and who opined that her pulmonary condition was either emphysema or COPD brought on by years of smoking, Respondent was not without a reasonable basis to deny liability. |
Engle v. Hartford Underwriters Ins. Co. [12/31/13] 2013 MTWCC 27 The Court found Respondent unreasonably adjusted Petitioner’s claim where the claims adjuster deemed a fall Petitioner suffered after her occupational disease claim to be a new injury without reviewing any medical records or seeking additional medical opinions. While the adjuster determined that the subsequent fall severed liability and accelerated Petitioner’s condition, nothing in the medical records supports that theory. Moreover, when Petitioner disputed the adjuster’s conclusions, the adjuster did not investigate further, did not reinstate Petitioner’s benefits, and did not conduct additional investigation after she received a medical opinion disputing the adjuster’s theory of liability. |
Peters v. American Zurich Ins. Co. [07/31/13] 2013 MTWCC 16 No grounds exist to order an “automatic” penalty under § 39-71-2907, MCA, nor may the Court award a penalty merely because a matter requires the time and resources of the Court or the opposing party. |
Dostal v. Uninsured Employers' Fund [12/04/12] 2012 MTWCC 45 Where the evidence demonstrated that Petitioner was ineligible for the treatment authorization she sought, the Court held that Respondent could not be found to have unreasonably denied treatment which Petitioner would never have been able to receive. |
Dostal v. Uninsured Employers' Fund [12/04/12] 2012 MTWCC 45 Where the Court found no delay, denial, or termination of benefits caused by a dispute between the parties over photocopy charges, the Court held that it was immaterial whether Respondent acted unreasonably regarding the photocopy charge dispute. |
Dostal v. Uninsured Employers' Fund [11/15/12] 2012 MTWCC 42 Since the UEF was included in the definition of “insurer” in § 39-71-116(10), MCA (1991), it is therefore treated as such for purposes of § 39-71-2907, MCA, and can be ordered to pay a penalty if this Court determines it unreasonably delays or refuses to pay benefits. |
Stewart v. Liberty Northwest Ins. Corp. [04/11/12] 2012 MTWCC 11 An insurer’s reliance on an earlier ruling of this Court forms a reasonable basis to deny liability. The insurer had a reasonable defense to liability after this Court concluded that Petitioner failed to prove a causal connection between her injury and her pain; however, the insurer continued to pay for the disputed medication under a reservation of rights. The insurer’s actions were reasonable, and a penalty under these facts is inappropriate. |
Baker v. Fireman's Fund Ins. Co. [03/22/12] 2012 MTWCC 9 The insurer agreed to pay certain medical bills in the settlement agreement, yet those bills remained unpaid for months after the agreement was reached despite repeated requests to pay them. The inexplicable delay was unreasonable, and Petitioner is entitled to a penalty on the value of the medical bills pursuant to § 39-71-2907, MCA. |
Pearson v. MIGA [01/09/12] 2012 MTWCC 1 The Montana Insurance Guaranty Association is not an “insurer” as defined in § 39-71-116, MCA, and within the meaning of the WCA, which provides that attorney fees and penalties can only be awarded in cases involving insurers. Since it is not an insurer, MIGA is not subject to the penalty and attorney fee statutes of the WCA. |
Brown v. Hartford Ins. Co. [12/16/09] 2009 MTWCC 38 The Court concluded that Petitioner was entitled to the statutory penalty due to the unreasonable actions of an insurer in denying liability where the insurer presented no evidence that Petitioner was not suffering from an occupational disease, but argued solely that its adjuster’s “confusion” as Petitioner’s diagnoses denying her claim. The Court noted that the first claims adjuster reviewed Petitioner’s medical records and noted that her condition was not work-related when the medical notes explicitly stated that it was, and that the file sat for four months with no adjuster assigned to it. The Court further noted that both medical providers recorded objective medical findings to support their diagnoses, and the second claims adjuster sat on the file for seven months without seeking clarification regarding her “confusion” about the diagnoses, and later continued to deny liability and again failed to seek clarification after the physician again examined Petitioner and found her to be suffering from an occupational disease. |
Long v. New Hampshire Ins. Co. [04/10/09] 2009 MTWCC 14 Respondent’s actions in denying liability were unreasonable where a claims adjuster authorized Petitioner to receive ongoing TTD benefits after Petitioner returned to work at his alternate employment, and when another claims adjuster took over the claim, rather than reevaluating the previous adjuster’s authorization, she simply denied that the authorization existed, and threatened Petitioner with garnishment of his wages to recoup the alleged overpayment. Additionally, the claims adjuster attempted to dissuade Petitioner’s counsel from obtaining a complete copy of his claims file by answering her inquiries in a misleading fashion. Furthermore, the claims adjuster acknowledged that for a period of time, the previous adjuster’s notes were not accessible by anyone in Montana, in violation of § 39-71-103(3), MCA. |
Briese v. Ace American Ins. Co. [02/20/09] 2009 MTWCC 5 A Lockhart lien is a payment which a claimant makes to his attorney out of his medical benefits and therefore, a penalty may attach to a Lockhart lien pursuant to § 39-71-2907, MCA, because a penalty may be imposed on the “full amount of benefits due a claimant during the period of delay or refusal to pay.” |
Narum v. Liberty Northwest Ins. Corp. [06/04/08] 2008 MTWCC 30 In a case which was settled with medical benefits left open, Respondent stopped paying for ongoing medical treatment without notifying Petitioner, denied authorization for hip replacement surgery even though the possibility of this surgery was specifically identified in the settlement agreement, and provided no persuasive explanation that could justify stopping payment of Petitioner’s medical treatment. The Court concludes Respondent’s actions are unreasonable and Petitioner is entitled to a penalty award. |
Porter
v. Liberty [10/19/07] 2007 MTWCC 42
Where the claims adjuster admitted during his deposition that he was
aware that Petitioner’s treating physician had withdrawn his
finding that Petitioner was at MMI, and further admitted that the
withdrawal meant that Respondent would have to reinstate benefits,
Respondent nonetheless took no action and did not reinstate Petitioner’s
TTD benefits. The Court concluded this was an unreasonable refusal
to pay benefits and that Petitioner was therefore entitled to a 20%
increase of the full amount of benefits due, pursuant to § 39-71-2907,
MCA. |
Vanbouchaute
v. Montana State Fund [08/23/07] 2007 MTWCC 37 Unlike
attorney fees and costs, an adjudication of compensability is not
a prerequisite for a penalty. |
Mack
v. Transportation Ins. Co. [05/22/07] 2007 MTWCC 16
Where the difference between two physicians’ impairment ratings
was substantial and the Court found both physicians to be credible
witnesses, Respondent’s conduct in paying the lower impairment
rating was not unreasonable. |
Popenoe
v. Liberty Northwest [12/01/06] 2006 MTWCC 37 Penalty against
insurer assessed where Court failed to appreciate how Respondent could
favorably distinguish the facts in this case from the similar fact
patterns of two Montana Supreme Court rulings regarding a case where
a worker was injured on his employer's premises prior to the start
of his shift. |
[1989]
Doubek
v. CNA Ins. Co. [11/10/04] 2004 MTWCC 76 An
insurer acts unreasonably and is liable for a penalty, § 39-71-2907,
MCA (1989), with respect to denied medical benefits where the treating
physician finds a causal relationship between the medical condition
treated and the industrial injury or occupational disease and where
the physician expressing a contrary opinion was hired by the insurer,
was provided with only selected records regarding the claimant's treatment,
is less qualified than the treating physician, and relies on a medical
test of questionable quality and value. |
[1993]
Nielson
v. State Fund [2/20/04] 2004 MTWCC 12 Where
arguments of insurer in opposition to claimant's request for impairment
award of fifty percent were not unreasonable, claimant is not entitled
to a penalty. § 39-71-2907, MCA (1993). However, if the 42% has not
been paid, claimant is entitled to a penalty on that portion. |
[2001]
Mosca
v. American Home Assurance [2/13/04] 2004 MTWCC 6
Where within thirty days
the claimant reported his belief that his herniated disk was job related
and the only medical opinions in evidence were that his condition
was in fact job related, liability was reasonably clear and it was
unreasonable for the insurer to deny the claim and take the case to
trial. A twenty percent penalty is therefore awarded under section
39-71-2907, MCA (2001). |
[2001]
Pekus
v. UEF [4/25/03] 2003 MTWCC 33, rev'd in part, 2012 MTWCC 42The UEF is not an insurer
under section 39-71-2907, MCA (2001), and is not subject to a penalty. |
[2001]
Hernandez
v. ACE USA [4/24/03] 2003 MTWCC 32 A permanently totally disabled
claimant receiving biweekly benefits is not entitled to a penalty
where awarded a lump sum even though the insurer's denial of the lump-sum
request was unreasonable. The lump sum was not due until approved
either by the Department of Labor and Industry or the Workers' Compensation
Court, therefore there was no delay in benefits. Thompson
v. CIGNA, 2000 MT 306, ¶¶ 24-25,
302 Mont. 399, 14 P.3d 1222. |
[1983]
Galetti
v. MPC [12/05/01] 2001 MTWCC 60 In a Subsequent Injury Fund
case, an insurer or self-insured which fails to provide the notice
required by section 39-71-908, MCA (1983), and denies a claim for
further benefits, is liable for a penalty where the claim is subsequently
submitted to the Subsequent Injury Fund and accepted by it. |
[1985]
Stephenson
v. CIGNA [3/29/01] 2001 MTWCC 12 No penalty where the claim
for permanent total disability is based upon pain and the insurer
reasonably questioned the claimant's credibility as to his pain complaints. |
[1991]
Shepard
v. Borden, Inc. [5/23/00] 2000 MTWCC 28 Although claimant
found PTD, insurer did not act unreasonably where it kept claimant
on TTD, without threatening to cut him off, pending resolution; diligently
explored finding claimant productive employment; and relied on doctor's
opinion claimant "can probably return to work in some capacity
once he gets a better handle on his pain complaints." |
[1997]
Patrick
v. State Fund [4/4/00] 2000 MTWCC 20 Penalty awarded where
insurer unreasonably limited rehabilitation evaluation to the gathering
of information to support the insurer's prior conclusion claimant
suffered no wage loss. Facts suggesting unreasonable delay and denial
of rehab benefits included adjuster's hiring of private investigator
based only a computer generated "fraud flag," which in turn
was based only on claimant's failure to return to work within a predicted
period of time, and did not consider claimant's serious preexisting
condition upon which work injury was imposed; adjuster's apparent
communication to investigator, without any support, that there was
no objective evidence of injury and treating physician was "making
matters worse"; referral for neuropsychological evaluation without
basis; provision of report unfavorable to claimant, but not report
favorable to claimant, to expert; and general tendency to ignore evidence
favorable to claimant while seeking opinions to support adjuster's
conclusion. (After decision, parties settled and presented a Stipulated
Judgment to the Court, which then issued its Order Nunc Pro Tunc
For Entry of Judgement and Dismissal with Prejudice,
Patrick v. State Compensation Insurance Fund,
2000 MTWCC 20A.) |
[1981]
Thompson
v. CIGNA [8/17/99] 1999 MTWCC 51 [aff'd in 2000
MT 306] PTD claimant receiving benefits on a biweekly benefits
wanted lump sum settlement. His attorney was in negotiations with
a claims adjuster who did not have final authority to approve settlement.
An out-of-state bureaucratic maze caused lengthy delay and put the
adjuster in the position of having to attempt to change agreed settlement
terms. Penalty not awarded because claimant was receiving biweekly
benefits and was not entitled to a lump sum settlement as a matter
of law, meaning there was no unreasonable delay of benefits due claimant. |
[1991]
Pattee
v. Twin City Fire Ins. Co. [2/9/99] 1999 MTWCC 14 Where insurer
agreed to send settlement checks within one week, and adjuster knew
claimant was already emotionally distraught over delays in receiving
benefits, the insurer's failure to get settlement checks to claimant's
attorney until two weeks after due date constituted unreasonable delay.
Twenty-percent penalty imposed on $20,000 insurer check insurer was
to pay jointly to claimant and her attorney and $13,250 check insurer
was to pay to claimant's attorney where money to attorney was still
benefits, not attorneys fees ordered by the Court. |
[1983]
Galetti
v. Montana Power Company [2/4/99] 1999 MTWCC 11. Self-insured
employer accepted liability for claimant's 1983 back injury, but denied
liability for 1994 flare-up. Although the employer accepted liability
at the commencement of the hearing, trial proceeded on claims for
attorneys fees and penalty. WCC found the self-insured employer's
denial of the claim for medical benefits unreasonable where the adjuster
had persisted in maintaining claimant's flare-up was not compensable
despite medical information and legal precedent to the contrary in
his files. Further evidence of unreasonable conduct claim came through
evidence the employer ignored several requests by claimant for a copy
of his entire file, failing even to provide a copy of the doctors'
response to the self-insured employer's inquiries. A penalty was imposed
on the amount of medical benefits claimant paid out of pocket, but
not on the amount paid by the employer's self-insured health plan.
[Note: the WCC was reversed
on its conclusion penalty was not appropriate on amounts paid by the
employer's health plan; see Galetti
v. Montana Power Company, 2000 MT 234, ¶ 26-32.] |
[1991]
S.L.H.
v. State Fund [1/14/99] 1999 MTWCC 6 Penalty was awarded with
respect to (1) a 10% award for physical restrictions, (2) one half
of a 20% wage loss award; and (3) the amounts due for an MRI and EMG
the insurer had refused to cover. Penalty was not awarded with regard
to (1) insurer's assertion of a subrogation interest in a third-party
recovery, which assertion was dropped and was not, in any event, relating
to benefits due; (2) claimant's request for further impairment award;
and (3) a prescription the insurer had denied. |
[1995]
Leastman
v. Liberty Mutual Fire Ins. Co. [1/6/99] 1999 MTWCC 2 After
claimant refused to adhere to insurer's rehabilitation provider's
advice, insurer refused any rehabilitation benefits. Coupled with
the rehabilitation provider's inadequate job of evaluating claimant's
realistic job prospects with and without retraining, the delay and
denial of benefits caused by this position was unreasonable, giving
rise to a penalty and attorneys fees. |
[1991]
Pittsley
v. State Fund [11/19/98] 1998 MTWCC 84 Where a claimant seeks
penalty and attorneys fees following a grant of summary judgment turning
interpretation of statutes, regulations, and case law, the question
is whether the legal position taken by the insurer was unreasonable.
In this case, important legal precedent was found by the Court's own
research. It is difficult to find an insurer's legal position unreasonable
when a claimant's attorney does not cite legal precedent to support
his or her position. Attorneys fees and penalty denied. |
[1993]
Huffman
v. Twin City Fire Ins. Co. [11/16/98] 1998 MTWCC 83 Claimant's
physical restrictions post-injury established his entitlement to PPD
benefits for lost lifting capacity; the insurer's refusal to pay these
benefits was unreasonable and smacks of punishing claimant for failing
to agree to settle all of his claims. Penalty is awarded on what was
due claimant for physical restrictions, but not awarded on other benefits
ordered where the insurer's denial of those benefits was reasonable
given the status of the facts and applicable law. |
[1995]
McGillis
v. State Fund [11/2/98] 1998 MTWCC 79 Attorney fees and penalty
were awarded only with respect to the 10% wage loss (PPD benefits)
which the insurer conceded at trial and should have conceded earlier
based on the evidence. |
[1997]
Ronemus
v. Business Ins. Co. [7/28/98] 1998 MTWCC 59 Although Court
found claimant credible and was not persuaded by insurer's witnesses
on issues of occurrence of accident and reporting, insurer's conduct
in resisting claim was not unreasonable where a legitimate credibility
issue existed. |
[1995]
Wall
v. National Union Fire Ins. Co. [2/24/98] 1998 MTWCC 11 Penalty
and attorneys fees are warranted based on the insurer's unreasonable
denial of the claim, reflected in its failure to ascertain the IME
physician's qualifications for the condition at issue, continued reliance
on the IME physician's opinions despite information suggesting the
treating physician was more qualified, denial of an OD claim in its
entirety despite the IME physician's opinion 50% of the condition
was occupational, and disregard for some facts and for the opinions
of the nurse manager and treating physician. |
[1991]
O'Brien
v. State Fund [2/10/98] 1998 MTWCC 6 Where section 39-71-2907,
MCA, refers to unreasonable delay in payment of "benefits,"
insurer's conduct in causing delay in release of third-party settlement
proceeds does not give rise to a statutory penalty. However, sanctions
under section 39-71-2914, MCA (1991), a statutory version of Rule
11, are available in workers' compensation proceedings. Claimant may
be entitled to sanctions where State Fund's assertion of "equittable
subrogation" in claimant's recovery in a third-party malpractice
case, maintained in its response to petition, but abruptly dropped
prior to trial, raises a prima facie issue as to whether the assertion
was well founded and in good faith. Because the facts on that issue
are insufficiently developed, a briefing schedule and hearing on sanctions
was set. |
[1995]
Ardesson
v. Legion Ins. [1/15/98] 1998 MTWCC 2 The penalty provision
is available to a claimant from the moment the insurer's delay in
payment becomes unreasonable. See, Mintyala
v. State Fund, 276 Mont. 521,
525, 917 P.2d 442, 445 (1996); Handlos
v. Cyprus Indus. Minerals,
243 Mont. 314, 317, 794 P.2d 702, 704 (1990). |
[1995]
Ardesson
v. Legion Ins. [1/15/98] 1998 MTWCC 2 The lack of a reasonable
investigation into a claimant's demand for inclusion of the actual
value of meals into wage rate is itself sufficient to impose a penalty
on the insurer. |
[1995]
Ardesson
v. Legion Ins. [1/15/98] 1998 MTWCC 2 Penalty awarded to claimant
litigating inclusion of actual value of meals in wages for purposes
of TTD benefit rate. Insurer unreasonably delayed payment of benefits
corresponding to at least $3.00 valuation of meal. Unreasonable conduct
included the insurer's failure to investigate the meal issue following
claimant's demand, withholding of increase related to conceded $1.50
because claimant demanded more, and two-month delay in issuing check
for conceded back benefits. |
[1989]
Stevens v. National Union Fire Ins. Co. of Pittsburgh [7/17/97] 1997
MTWCC 45 Insurer's persistent denial of medical benefits was
unreasonable. Three doctors consistently opined her condition was
related to the injury. While the claims adjuster suspected another
accident caused the exacerbation, she took no affirmative steps to
investigate that possibility. Claimant was entitled to a twenty-percent
penalty on medical benefits under section 39-71-2907, MCA (1989),
even though the insurer acknowledged liability prior to trial. Although
the statute refers to "an order by the workers' compensation
judge" granting benefits, the Supreme Court has found the section
ambiguous and construed it to allow penalty in cases where the insurer
unreasonably denies benefits, even if the claim is settled prior to
trial. Mintyala v. State Compensation
Insurance Fund, 276 Mont. 521,
527, 917 P.2d 442, 445-446 (1996); Handlos
v. Cyprus Industrial Minerals,
243 Mont. 314, 317 794 P.2d 702, 703-704 (1990). |
[1993]
Church
v. Travelers [5/27/97] 1997 MTWCC 31 Insurer paid PPD claimant
benefits corresponding to 17.5% of 350 weeks for the labor factor
under section 39-71-703, MCA (1993), representing a "split"
between 15% and 20% on the theory that claimant went from the ability
to do heavy lifting to an ability falling somewhere between medium
and light duty. WCC held there is no statutory or factual basis for
"splitting" the labor factor portion of PPD benefits, making
the insurer's position unreasonable. The fact that the insurer required
trial over $1,631.88 in benefits magnifies its unreasonableness. Penalty
and attorneys fees awarded. |
[1995]
Martinez
v. State Fund [3/5/97] 1997 MTWCC 9 Insurer is liable for
penalty on all accrued, unpaid benefits based on unreasonable delay.
Where insurer has conceded it delayed unreasonably after a particular
point, the delay impacted all benefits accrued to that date, not merely
benefits accruing after that date. Indeed, the delay is more unreasonable
as to earlier accrued benefits as they were past due for a longer
period. Attorneys fees awarded as well. |
[1995]
Gubler
v. Liberty Northwest Ins. Co. [1/6/97] 1997 MTWCC 1 Penalty
not awarded where insurer relied on version of events described by
supervisor when denying liability for motor vehicle accident. While
Court found another version of events to have occurred, insurer's
reliance on supervisor's recollection was not unreasonable. |
[1993]
(Evans)
Brian v. State Fund [11/22/96] 1996 MTWCC 73
Penalty awarded where insurer unreasonably refused to pay for back
surgery although overwhelming evidence indicated claimant's accident
caused increased, totally disabling back pain. Reliance on fact that
pre- and post-accident MRIs were the same, and fact that surgery had
been recommended prior to the accident, was not reasonable where claimant
and physicians made clear her pain increased and total disability
ensured, where she had previously been working. |
[1995]
McClanahan
v. State Fund [7/5/96] 1996 MTWCC 50 Penalty awarded where
Insurer's conduct was unreasonable for failure to investigate. Insurer
took employer's story that claimant did not injure his back at face-value,
failing to interview witnesses, ignoring consistent medical records,
and not facing conflicts within employer's version of events. |
[1993]
Larsen-English
v. Lumbermens Mutual Casualty [6/14/96] 1996 MTWCC 43
When claimant, a waitress,
slipped and aggravated her existing knee condition, she was following
a cook who playfully stole a pan from her after tossing whipped cream
on her. Insurer's contention claimant was acting outside the course
and scope of employment was not only unreasonable, but also mean-spirited,
where the clear facts show the incident was precipitated for a work-related
reason, that claimant did not initiate the incident, and that some
horseplay, in any event, was tolerated by the employer. Insurer's
reliance on out-of-state cases regarding horseplay was not reasonable
where it ignored reasonably clear Montana precedents. |
Burgan v. Nationwide Ins. Co. [10/04/95] 1995 MTWCC 75 Claimant is also entitled to a penalty under section 39-71-2907, MCA (1985) because the claimant’s right to some amount of permanent partial disability benefits should have been patently clear to the insurer, but it made no offer to settle claims for permanent partial disability benefits, but tied its offers to relinquishment of all claims for TTD and PTD benefits. |
[1993] Marcott v. Louisiana Pacific Corp. [12/07/94] 1994 MTWCC 109 Crediting mechanic’s testimony that he was rushing and turned sharply, placing unusual strain on his calf muscle, the Court finds ruptured calf muscle compensable. Where a legitimate factual dispute existed over whether claimant was merely walking or walking rapidly and turning, the employer’s denial of compensability was not unreasonable. Attorneys fees and penalty were denied. |