39-71-606, MCA


Chaney v. U.S. Fidelity & Guaranty, 276 Mont. 513, 917 P.2d 912 (1996) Where Workers’ Compensation Court found that insurer’s failure to accept or deny a claim within thirty days constituted acceptance as a matter of law (see § 39-71-606(1), MCA, and Haag v. Montana Schools Group Ins. Auth., 274 Mont. 109 (1995)), the Court erred in failing to hold the insurer liable for claimant’s present condition. Once a claimant shows acceptance of a claim as a matter of law under Haag, and that his original injury was the same kind of injury to the same parts of his body for which he now seeks benefits, he has met his initial burden of proof. To avoid liability, the insurer must then show that claimant attained maximum medical healing and suffered another injury causing his present condition, not shown in this case.

[1991] Haag v. School Dist. No. 1, Great Falls Pub. Schs., 274 Mont. 109, 906 P.2d 693 (1995) When an insurer fails to act on a claim for compensation within thirty days, either by accepting or denying liability pursuant to section 39-71-606(1), MCA, or by beginning payments with a reservation of rights under section 39-71-608, MCA, the claim is deemed accepted as a matter of law.

Clapham v. Twin City [08/01/12] 2012 MTWCC 27 Section 39-71-606(5), MCA, which specifically limits the remedies available for noncompliance with the statute to attorney fees and a penalty, likewise applies to claims placed under § 39-71-608, MCA.  It would be absurd to hold an insurer who invokes § 39-71-608, MCA, potentially liable for automatic acceptance of the claim while an insurer who simply denies the claim would not face the possibility of this action.

[1985] LaPlant v. State Fund [11/24/99] 1999 MTWCC 75 Where State Fund failed to accept or deny a 1987 claim within thirty days, under section 39-71-606, MCA (1985), and Haag v. Montana Schools Group Ins. Authority, 274 Mont. 109, 906 P.2d 693 (1995), it is in the same position as though it had accepted the claim. State Fund is not, however, liable for a wide range of medical bills without proof of a causal relationship to the claimed elbow injury, nor for compensation benefits during all periods of unemployment without proof of disability and causal relationship of disability to the "accepted" claim.

[1997] Gunder v. CIGNA [5/3/99] 1999 MTWCC 31 Claimant appealed from the decision of Department of Labor holding that failure of the insurer to deny an occupational disease claim within 30 days does not preclude the insurer from contesting the claim. Claimant asked the WCC to find the "retroactive" application of section 39-71-606(5), MCA (1997) unconstitutional. That section, which specifies that failure to deny within 30 days does not constitute acceptance, was expressly made applicable by the Montana Legislature to matters pending prior to its enactment. The WCC held that application of section 39-71-606(5), MCA (1997), to claims existing prior to the effective date of the statute does not violate the contract clause of either the Montana or United States Constitutions. Given the statement in section 39-72-103, MCA (1995), that rights to compensation for occupational diseases did not vest and could be changed by the legislature, an occupational disease claimant had no contractual right to benefits as described in a particular year's legislation. Given this and in light of applicable precedent, the retroactive application of the 1997 amendment to section 39-71-606(5), MCA, was constitutional. [Note: the appeal to the Montana Supreme Court, Gunder v. CIGNA, No. 99-337, was ordered dismissed on May 18, 2000, based upon notice from the parties that the matter had settled.]
[1989] Wylie v. State Fund [4/3/97] 1997 MTWCC 35 Where section 39-71-606(1), MCA, requires an insurer to accept or deny a claim "within 30 days of receipt of a claim for compensation," it is the insurer's receipt of a claim that triggers the obligation, not the employer's.
[1993] Guedesse v. Liberty Mutual Fire Insurance Company [3/12/97] 1997 MTWCC 10 Where the claim form signed by claimant did not state any specific event or any specific time or place for an alleged injury, it fails to identify an industrial accident or injury within the meaning of the Workers' Compensation Act. The "automatic acceptance" rule of Haag v. Montana Schools Group Ins. Authority, 274 Mont. 109, 906 P.2d 693 (1995) comes into play only if the insurer has received a valid claim for injury, containing sufficient information to inform the employer and insurer of the nature and basis of the claim. As the insurer argues, the claim submitted in this case, at best,
[1991] Smith v. National Union Fire Ins. Co. [10/15/96] 1996 MTWCC 65 A claimant's failure to provide 30 days notice to an employer is a defense to liability. Haag v. Montana Schools Group Ins. Authority, 274 Mont. 109, 906 P.2d 693 (1995) precludes the insurer from raising any defense, including this one, if the claim was not accepted or denied within 30 days as required by section 390-71-606(1), MCA (1991)