Primary Medical Services

Benefits: Medical Benefits: Primary Medical Services

MONTANA SUPREME COURT DECISIONS

Hiett v. Missoula County Public Schools, 2003 MT 213 The phrase “achieving” medical stability and “achieved” medical stability as used in sections 39-71-116(25) and 39-71-704(1)(f), MCA (1995), respectively, mean the sustainment of medical stability. Given this interpretation, a claimant is entitled to such “primary medical services” as are necessary to permit him or her to sustain medical stability, which includes prescriptions for pain and depression prescribed for a claimant who has reached maximum medical healing, was not employed, and may well fall out of maximum healing without medication.

MONTANA WORKERS' COMPENSATION COURT DECISIONS

Barnhart v. Liberty Northwest Ins. Corp. [09/13/16] 2016 MTWCC 12 An insurer may deny authorization if it has legitimate grounds to argue that a particular recommended treatment may be maintenance or palliative care. However, this Court rejected the insurer’s position that all future medical treatment of the claimant’s neck condition would be maintenance or palliative care: this Court cannot give an advisory opinion when it does not know what treatment the claimant’s physicians might recommend in the future.

Koch v. Employers Ins. Group [05/19/14] 2014 MTWCC 14 Even if Petitioner had reached MMI, under Hiett, the insurer was still required to pay for her medications prescribed to treat her work-related injuries.

Bustell v. Ins. Co. of PA [2/26/03] 2003 MTWCC 11 Under section 39-71-704(a), MCA (1999), the petitioner is not entitled to reimbursement for home improvements, a handicap van, or a computer.

Hiett v. MSGIA [9/6/01] 2001 MTWCC 52 After claimant has reached MMI, she is not entitled to continued coverage of prescription medications under provisions authorizing primary medical services, § 39-71-704(1)(a), MCA (1995), because such services are defined as and limited to services "necessary for achieving medical stability." § 39-71-116(25), MCA (1995) (emphasis added). Hiett v. Missoula County Public Schools, 2003 MT 213

Miller v. State Fund [5/14/01] 2001 MTWCC 21. Claimant is not entitled to reimbursement for chiropractic and massage expenses incurred prior to insurer's acceptance of back condition as related to injury where credible evidence demonstrated his claim for those services had been previously settled. Claimant is not entitled to payment for foot fungus medication where prescribing physician opined condition was not related to industrial injury.

Cattaneo v. Liberty Mutual Fire Ins. Co. [11/4/96] 1996 MTWCC 69
Supermarket truck driver who broke jaw during employment was entitled to reimbursement for blender, vitamins, Aleve, baby food, and Ensure as reasonable and necessary primary medical services where physician recommended soft food, dietician recommended supplementing with vitamins, and claimant's wife described process of blending food and adding supplements.