Benefits: Medical Benefits: Generally

Moreau v. Transportation Ins. Co. [08/26/15] 2015 MTWCC 17 Where an employer funded an entity which in turn paid medical bills of Libby residents affected by asbestos, regardless of their employment status, neither the employer nor the entity can be said to have paid “benefits” within the meaning of the WCA.

Moreau v. Transportation Ins. Co. [04/08/14] 2014 MTWCC 9 Where the claimant had received medical services paid for by the Libby Medical Plan, and the Libby Medical Plan subsequently rejected Respondent’s offer to reimburse it for the amount it expended for the claimant’s care, the Court concluded that Petitioner, the personal representative of the claimant’s estate, was not entitled to receive the funds which the Libby Medical Plan rejected.  The claimant received the value of the medical benefits because he actually received the medical services.  To award his estate the cash value of the services received would be a double-recovery.

Sherwood v. Watkins & Shepard Trucking [08/22/05] 2005 MTWCC 51 Where one of the claimant’s treating physicians opines that implantation of an occipital nerve stimulator for control of the claimant’s headaches is not medically reasonable; that opinion is supported by a panel of physicians consisting of a neurosurgeon, a neurologist, and a psychiatrist; and the panel neurologist provides persuasive and reasoned testimony supporting a finding that the procedure is not medically reasonable, the Court finds that in fact it is not medically reasonable and denies the claimant’s petition requesting the Court to order the insurer to authorize and pay for the procedure.
Sherwood v. Watkins & Shepard Trucking [08/22/05] 2005 MTWCC 51 An insurer is required to pay for only necessary and reasonable medical treatment.
Cunnington v. UEF & Gaub [9/24/04] 2004 MTWCC 66 A claimant is not entitled to payment for endless medical evaluations and opinions merely because he is unhappy with the opinions of his treating physician.

Cunnington v. UEF & Gaub [9/24/04] 2004 MTWCC 66 Where a claimant seeks payment for a third evaluation, he must present medical evidence demonstrating that such evaluation is medically necessary and reasonable.

Beaulieu v. Human Dynamics Corp. [9/22/04] 2004 MTWCC 65 Where an insurer cuts off payment for prescription headache medications it has paid for several years and provides no facts supporting its cutoff, the insurer is liable for the continued payment for the medications.
Olenick v. EBI [3/10/03] 2003 MTWCC 18 Where the medical evidence establishes that the claimant's ostoarthritis and Carpel Tunnel Syndrome of his hands are due to aging and repetitive use of his hands in his work and not on account of 1990 injuries he suffered in a flash fire caused by an electrical explosion, the insurer liable for his 1990 injuries is not liable for medical benefits for those conditions.

Davis v. Ins. Co. of PA [8/20/01] 2001 MTWCC 45 Claimant suffering from right-sided glioma-type brain tumor failed to persuade the Court her tumor was caused by work-related blow to the left side of her head, therefore she is not entitled to medical benefits for treatment of the tumor.

Ahl v. Transportation Ins. Co. [05/11/95] 1995 MTWCC 35 Where petitioner has failed to identify specific medical bills that he believes must be paid following settlement reserving medical benefits to him, it is impossible for the Court to determine whether those bills relate to the industrial injury, requiring denial of claimant’s motion for summary judgment. Claimant’s contention that all medical bills must be paid without regard to statutory and medical provider rules has no legal foundation.