New Hampshire Ins. Co. v. Matejovsky [08/07/15] 2015 MTWCC 1 Claimant made a prima facie case for reinstatement of benefits by demonstrating that her refusal to attend an IME exam was not unreasonable for two reasons: (1) there is a legitimate dispute over whether claimant’s reason for refusing to attend was “unreasonable”; and (2) the insurer waited until just before the exam before informing the claimant she could not videotape it.  Since IME’s are the most invasive type of discovery and implicate a person’s constitutional right to privacy, an insurer may not coerce a claimant to attend an IME by making an ultimatum to attend or lose benefits when there is a legitimate dispute over the conditions of the IME.

New Hampshire Ins. Co. v. Matejovsky [08/07/15] 2015 MTWCC 15 Where claimant testified that the insurer accepted liability for the claim and paid benefits for eight months, she satisfied the first two of the four factors this Court considers for an award of interim benefits.  Claimant satisfied the third factor when she testified that having her biweekly benefits terminated would put her family at risk of losing their vehicles and having their bills put into collection.  It is sufficient to show significant financial hardship by demonstrating that claimant will go into default or will fall behind on bills if her benefits were terminated without having to actually endure that hardship.

New Hampshire Ins. Co. v. Matejovsky [08/07/15] 2015 MTWCC 15 The Court considers four factors in determining whether a claimant is entitled to interim benefits: (1) was liability for the claim accepted; (2) were benefits paid, especially for a significant period of time; (3) has the claimant demonstrated significant financial hardship if interim benefits are not re-instated; and (4) has the claimant tendered a strong prima facie case for reinstatement of the benefits she seeks?  To meet the fourth factor, claimant need not prove an entitlement to benefits, only that she tender substantial evidence which if believed would entitle her to benefits.

New Hampshire Ins. Co. v. Matejovsky [08/07/15] 2015 MTWCC 15 Where an insurer argued that it only “suspended” a claimant’s TTD benefits for “unreasonably” refusing to attend an IME exam unless she was allowed to videotape it, which the doctor refused, DLI had jurisdiction to order interim benefits since the use of the word “terminates” in § 39-71-710, MCA, means to “stop paying benefits,” which the insurer did.

Hartford Fire Ins. Co. v. Hostetter [06/25/13] 2013 MTWCC 14 Appeals from Department determinations regarding interim benefits under  § 39-71-610, MCA, are subject to de novo review by this Court.  This Court considers four factors in making a determination: (1) whether liability was accepted; (2) whether benefits were paid, especially for a significant time period; (3) whether the claimant has demonstrated he will suffer significant financial hardship without interim benefits; and (4) whether the claimant has tendered a strong prima facie case for reinstatement of the benefits.  To meet the fourth factor, a claimant need not prove entitlement to TTD benefits, but need only tender substantial evidence which, if believed, would entitle him to the benefits.

Klinkam v. MACo Workers' Compensation Trust [07/10/12] 2012 MTWCC 25 Petitioner sought review of a Department of Labor & Industry (DOLI) ruling denying her additional benefits under § 39-71-610, MCA, which provides that, upon termination of biweekly benefits, the DOLI may order an insurer to pay additional benefits.  However, Petitioner admitted that she was still receiving compensation benefits, only of a different type.  A conversion of benefits from one type to another does not qualify a claimant for “additional biweekly compensation benefits” under the statute.

Klinkam v. MACo Workers' Compensation Trust [07/10/12] 2012 MTWCC 25 A proceeding before this Court pursuant to the terms of § 39-71-610, MCA, is a new proceeding and is not subject to mediation.  It is therefore a proceeding de novo.

[1999] Thompson v. Liberty Northwest Ins. Corp. [6/12/02] 2002 MTWCC 34 An insurer is not entitled to reimbursement for 49 days of interim benefits paid pursuant to section 39-71-610, MCA, where the claimant proves that he was entitled to the benefits on the merits.

[1997, 1999] Ballard v. Stillwater Mining Co. [12/23/99] 1999 MTWCC 84, 84A Claimant involved in dispute with Montana and Alaska insurers over which, if either, is liable for his present ankle condition requested interim benefits during pendency of proceeding. Under ARM 24.5.308, the WCC had previously ordered six weeks of interim benefits following delay in proceeding caused by insurer's filing of motion to join third party without properly serving third party. WCC held that ARM 24.5.308 did not apply at present, meaning the only source of additional authority to order interim benefits is section 39-71-610, MCA, which allows no more than 49 days of interim benefits pending resolution of a workers' compensation dispute. Where claimant has already received 42 days of interim benefits under the prior order, the Court declines to order additional benefits, particularly where the issues suggest it is possible neither insurer could be liable to claimant, making any repayment possibility questionable.