Benefits: Medical Benefits: Sixty (60) Month Limitation

MONTANA SUPREME COURT CASES
Wiard v. Liberty Northwest Ins. Corp., 2003 MT 295 Supreme Court upheld WCC’s grant of partial summary judgment on insurer’s entitlement to rely on section 39-71-704(1)(d), MCA, provision that an insurer’s liability for further medical benefits terminates if medical benefits are not used for 60 or more months.
 
WORKERS' COMPENSATION COURT DECISIONS

Dauenhauer v. Montana State Fund [07/03/12] 2012 MTWCC 22 Where a claimant requested authorization to see his physician well within 60 months of his previous treatment, but the claims adjuster denied authorization and later denied the claimant further medical benefits under the 60-month rule, the claimant’s request for authorization constituted “use” under § 39-71-704(1)(e), MCA, since the requested treatment was for legitimate, reasonably necessary medical care related to his industrial injury.

Schellinger v. St. Patrick Hospital and Health Sciences Center [03/23/12] 2012 MTWCC 10 The purpose of the statute of repose is to protect insurers by providing them timely notice that a claimant is making a claim for benefits.  Petitioner continually sought treatment for her psychological and cognitive difficulties despite Respondent’s denial of liability.  After this Court ruled that Petitioner’s condition was compensable, she sent Respondent two written demands for payment of her medical treatment.  Petitioner’s treatment and demands for payment were made within the 60-month period afforded pursuant to § 39-71-704(1)(e), MCA.  Therefore, her claim is not barred by the statute of repose.

Wiard v. Liberty Northwest Ins. Corp. [7/20/01] 2001 MTWCC 31A Maximum medical healing is immaterial to the rule providing for termination of medical benefits if not used for 60 continuous months.
Wiard v. Liberty Northwest Ins. Corp. [7/20/01] 2001 MTWCC 31A Bony fusion of cervical vertebrae does not constitute a prosthesis under section 39-71-704(1)(d), MCA (1991).
Wiard v. Liberty Northwest Ins. Corp. [7/20/01] 2001 MTWCC 31A Prosthetic exception to the rule providing that medical benefits terminate if not used for 60 continuous months applies only to the replacement or repair of a preexisting prosthesis.
Wiard v. Liberty Northwest Ins. Corp. [7/20/01] 2001 MTWCC 31A Failure of insurer or adjuster to tell claimant that failure to use medical benefits for 60 months would result in termination of medical benefits was not a representation. There was no duty by the insurer to advise claimant of the 60-month limitation and no reliance on such omission. The 60-month limitation does not preclude claimant from seeking medical care during that time. Only purpose of requiring notice of requirement would be to allow a claimant to seek unnecessary care merely to toll the period, which would be tantamount to fraud.
Wiard v. Liberty NW [6/08/01] 2001 MTWCC 31 Under 1991 law - § 39-71-704 (1)(d) - an insurer's liability for further medical benefits terminates if medical benefits are not used for 60 or more months.