Benefits: Interim (39-71-610)

Hartford Fire Ins. Co. v. Hostetter [06/25/13] 2013 MTWCC 14 Where the Court found that uncertainty existed as to whether the alternative job offered by the claimant’s time-of-injury employer fit within the restrictions set for him by a medical provider (and assuming arguendo that this provider qualified as the claimant’s treating physician), the Court further found that a question remained as to whether the offered position was appropriate for the claimant.  The Court therefore concluded that the claimant had tendered a strong prima facie case for reinstatement of his TTD benefits.

Hartford Fire Ins. Co. v. Hostetter [06/25/13] 2013 MTWCC 14 Where the Court found the claimant had presented substantial evidence that his treating physician was one of his choosing and not the alleged treating physician chosen for him by the insurer, and that the claimant’s actual treating physician had not released him to return to work in any capacity, the Court concluded that the claimant had tendered a strong prima facie case for reinstatement of his TTD benefits.

Hartford Fire Ins. Co. v. Hostetter [06/25/13] 2013 MTWCC 14 Where the claimant filed an affidavit asserting that: his TTD benefits were his only significant source of income; termination of his benefits had left him unable to afford gas to travel to his medical appointments; and he had not been able to pay his rent that month, the Court concluded claimant had fulfilled the third factor by demonstrating that he would suffer significant financial hardship if he did not receive interim benefits.
Alberts v. Transportation Insurance Co. [10/12/06] 2006 MTWCC 34 This Court has held that a claimant must tender substantial evidence which, if believed, would entitle claimant to interim TTD benefits pursuant to this statute, and has articulated a four-factor test. Montana Health Network v. Graham, 2002 MTWCC 61, ¶¶ 5-6. Where Petitioner puts forth no argument in support of her motion and no facts into evidence to demonstrate that these factors have been met, her motion is denied.
Montana Health Network v. Graham [12/5/02] 2002 MTWCC 61 Claimant's own expected testimony that she suffered a work related injury plus the opinion of her physician that her current condition is work-related and currently disabling constitutes a strong prima facie case for benefits despite the insurer's proffer of statements from other witnesses indicating she was not injured at work and IME opinions indicating her condition is not work related. The treating physician's opinion is entitled to some deference, especially in a proceeding for interim benefits and conflicts in testimony raise credibility issues which can only be resolved after a full trial on the merits of the claim for benefits.
Montana Health Network v. Graham [12/5/02] 2002 MTWCC 61 In an accepted claim case in which the insurer has paid temporary total disability benefits and the claimant is suffering severe financial hardship, the Court will order interim benefits under section 39-71-610, MCA, where claimant tenders her own testimony that she suffered a work related injury and her treating physician's opinion that her current condition is work related and disabling.
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 on the merits to the benefits.
Schneider v. Liberty Mutual Ins. [4/20/01] 2001 MTWCC 14 Claimant must repay interim temporary total disability benefits awarded under section 39-71-610, MCA (1999), where the Court finds that the insurer properly terminated TTD benefits and that he is not entitled to them.
Liberty Northwest Ins. v. Lennie Thompson[8/31/00] 2000 MTWCC 53 Benefits. In ruling on a request for interim benefits, the Court looks to three factors: (1) whether there is a strong prima facie case on the merits; (2) financial need; and (3) duration of previous benefits. Where there are conflicting medical opinions, one supporting claimant, the first factor is satisfied.
Schneider v. Liberty Northwest Insurance Corporation, [4/13/00] 2000 MTWCC 18A While the Court intends to handle requests for interim benefits informally and quickly whenever possible, it will not unduly proscribe the presentation of a party’s case for or against interim benefits. On the other hand, section 39-71-610 proceedings should not become a hearing on the merits, which would require discovery and considerable delay.
Schneider v. Liberty Northwest Ins. Corp. [4/4/00] 2000 MTWCC 18 Insurer appealed DOL order for payment of 49-day benefits. After telephonic conference with both counsel, WCC reviewed case on basis of medical records and physician correspondence. In this accepted liability case, the Court examined length of time benefits were paid, existence of financial hardship to claimant, and facts supporting case for reinstating TTD. Seven months of benefits is not insignificant. No information regarding financial hardship was presented. The prima facie case for benefits is the critical factor. Where records show conflicting medical opinion, WCC would more probably than not find "strong prima facie case" for reinstatement of benefits because claimant need not prove in 49-day benefits case that he will prevail, only that there is some evidence in his favor which is substantial and not facilely disregarded. 49-day benefits not ordered, however, where medical opinion favorable to claimant indicates he is not at MMI because he needs PT and work hardening, which he was offered but dropped. Having provided no justication for failing to treat, claimant has not presented a sufficient case.
Smith v. State Fund [2/17/00] 2000 MTWCC 9 Resolution of 49-day benefits cases will be guided by facts and circumstances of each case. In an accepted liability case where benefits have been paid for a lengthy period of time, where the claimant will suffer severe financial hardship from any interruption of benefits, and where the claimant has, at least at first glance, a strong prima facie case for reinstatement of benefits, an order for 49-day benefits will likely issue. On the other hand, in a case of contested liability where there is an absolute defense of likely merit, where the case for reinstatement of benefits is facially weak, or where little financial hardship will result, the facts may go against claimant. Here, request for 49-day benefits denied where the insurer never accepted liability and the insurer has what appears to be a good argument the claim is time-barred.
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.
Liberty Northwest Ins. v. Loren Hams [10/5/99] 1999 MTWCC 61 After DOL awarded claimant 49-day benefits, insurer appealed, arguing that 1997 Act applied to claimant's substantive right to benefits and did not allow benefits prior to the filing of a petition in the WCC. Insurer relied on 1999 revisions to section 39-71-610, MCA, which expressly state that 49-day benefits are available prior to petition. WCC held that 1997 statute allowed 49-day benefits where an insurer terminates biweekly compensation benefits and the termination is disputed by claimant. Whether or not the 1999 legislature believed it was expending eligibility for 49-day benefits, such benefits are available under the 1997 Act pre-petition. Benefits ordered where medical reports show genuine dispute and other evidence showed pressing financial obligations which claimant could not meet without benefits.
State Fund v. Nancy (Anderson) Blatnik [4/21/99] 1999 MTWCC 29 Overruling Liberty Mutual Fire Ins. Co. v. Blancher, WCC No. 9511-7443, the WCC finds it does have jurisdiction to consider State Fund's emergency petition challenging an order of the DOL awarding claimant 49-day benefits under section 39-71-610, MCA (1997). The State Fund's is legitimately concerned that it could be left without remedy if section 39-71-610, MCA (1997) is interpreted to require repayment by claimant of 49 day benefits only if claimant files a petition in the WCC seeking benefits and claimant fails to pursue her claim in the WCC. Thus, the WCC affirms the DOL order of 49-day benefits with the proviso that should the parties not resolve their dispute at mediation, the claimant shall diligently prosecute a petition with the WCC until settlement or judgment or shall repay the 49-day benefits. (See 1999 revisions to section 39-71-610, MCA and subsequent WCC decisions.)