Causation: Medical Condition

MONTANA SUPREME COURT DECISIONS
Polk v. Planet Insurance Co., 287 Mont. 79, 951 P.2d 1015 (1997) In light of the occupational disease proximate cause requirement, set out at section 39-71-408, MCA, and the aggravation statute, section 39-71-706, MCA, occupational aggravations of preexisting non-occupational diseases are compensable, as are occupational diseases which are aggravated by non-occupational factors. The test for compensability under the OD Act is whether occupational factors significantly aggravated a preexisting condition, not whether occupational factors played the major or most significant role in causing a particular disease. As long as an occupational exposure substantially aggravated a pulmonary condition, claimant is entitled to pro rata compensation for his disease. The DOL hearing examiner, and the WC Court, erred in basing their decision on medical opinions by physicians who operated under the mistaken assumption that occupational irritants had to be the major factor causing a pulmonary condition for claimant to receive compensation.
Satterlee v. Lumbermen's Mutual Casualty Co., 280 Mont. 85, 929 P.2d 212 (1996) Substantial evidence did not support WCC finding that claimant’s disabling depression and post-traumatic stress disorder arose after work-injury and were not compensable.
Satterlee v. Lumbermen's Mutual Casualty Co., 280 Mont. 85, 929 P.2d 212 (1996) An employer takes its employee as it finds her and if her disability is aggravated by an underlying physical or emotional condition, that employer is liable for disability which results from that aggravation.
Satterlee v. Lumbermen's Mutual Casualty Co., 280 Mont. 85, 929 P.2d 212 (1996) Substantial evidence did not support WCC finding that claimant's disabling depression and post-traumatic stress disorder arose after work-injury and were not compensable.
Briney v. Pacific Employers Insurance Co., 283 Mont. 346, 942 P.2d 81 (1997) Where physician testified that the most significant injury contributing to claimant’s current disability was the original injury for which the insurer was liable, WCC erred in concluding that insurer was relieved of liability due to subsequent exacerbations following MMI. Even though intervertebral disk had returned to its normal anatomical configuration, the deterioration of claimant’s condition and his present physical impairment were traced to the injury for which the insurer was liable.
Best v. State Compensation Insurance Fund, 276 Mont. 302, 916 P.1d 108 (1996) Claimant bears the burden of proving by a preponderance of the evidence that he was injured on the job and that a causal connection exists between his work-related injury and his current condition. Where evidence demonstrated claimant was permanently totally disabled and unable to perform even sedentary work since at least two years before the alleged injury, claimant was not entitled to PTD benefits from this employment incident.
Wilson v. Liberty Mut. Fire Ins., 273 Mont. 313, 903 P.2d 785 (1995) Substantial evidence supported the conclusion of the Workers’ Compensation Court that claimant did not prove connection between his 1988 and 1986 back injuries and back problems commencing in 1993. The initial injuries were relatively minor, medical treatment was sporadic, the Court credited medical testimony that the 1988 and 1986 injuries were likely strains that resolved within a few weeks, and claimant’s own testimony was not credible. Affirming Wilson v. Liberty Mutual Fire Ins. Co., 1995 MTWCC 9.
 
WORKERS' COMPENSATION COURT DECISIONS

Benson v. Uninsured Employers' Fund [08/21/13] 2013 MTWCC 22 Petitioner failed to meet his burden in proving he contracted Rocky Mountain spotted fever (RMSF) through his work as a hunting guide in November 2009. Although one physician who had never treated RMSF diagnosed him with the condition due to the presence of one of the disease’s antibodies, a specialist who had treated patients with RMSF testified it was more probable than not that Petitioner did not have the disease because: RMSF usually occurs in the spring and early summer; Petitioner did not exhibit the typical symptoms of the disease; and the RMSF antibody found in Petitioner can remain for years and likely represented an old infection.  Because Petitioner later developed reactive arthritis which is not known to be caused by RMSF but which is caused by prostatitis, it is just as likely, if not more likely, that Petitioner was suffering from prostatitis, the condition with which he was initially diagnosed.

Hardie v. Montana State Fund [11/20/12] 2012 MTWCC 44 An injured worker who slipped on ice and fell onto her buttocks in a parking lot at work, who limped for days afterwards and complained of low back pain until the pain dissipated, and who reported the incident to her employer, failed to relate a sudden onset of low back five months later to the slip and fall.  However, with no intervening event that could account for her torn annulus and bulging disk in her lumbar spine, and with her treating physician opining that the fall more probably than not caused her back condition, Petitioner sustained her burden of proving that her condition was traceable to her industrial accident.

Gary v. Montana State Fund [10/26/12] 2012 MTWCC 38 A conclusory statement from a treating physician that a cause and effect relationship exists between an industrial accident and a condition occurring five years later, without explaining the mechanism of causation, is insufficient to establish a causal connection between the condition and the injury under § 39-71-407(2)(a), MCA.

Tuttle v. First Liberty Insurance Corp. [10/23/12] 2012 MTWCC 37 While it is true that a temporal relationship between an injury and symptoms appearing two years later is insufficient to sustain Petitioner’s burden, Petitioner sustained her burden under § 39-71-407(7), MCA, by showing a direct causal link between her injury and her immediate complaints of low- and mid-back pain with positive sciatic tests noted by her post-injury providers, and the same clinical findings seen two years later by her treating physician who correlated those findings to herniated disks discovered on an MRI of her thoracic and lumbar spine.

Ingle v. Montana State Fund [02/03/11] 2011 MTWCC 3 Where one doctor opined that the claimant’s symptoms were caused by carbon monoxide exposure, but another physician offered a persuasive critique of that opinion and several others concluded that no connection existed between Petitioner’s symptoms and carbon monoxide poisoning, the Court concluded the claimant had not met her burden of proving that she suffered a work-related injury or disease.
Chapman v. Twin City Fire Ins. Co. [12/20/10] 2010 MTWCC 36 Although Petitioner opined that her work conditions aggravated or exacerbated her underlying degenerative disk disease, the only causal evidence presented was an opinion letter from an F.N.P. who stated that Petitioner’s job duties “may” aggravate her shoulder pain.  This evidence only indicates the possibility that Petitioner’s job duties may have aggravated her underlying condition and does not meet Petitioner’s burden of proving that it is more probable than not that her condition is work-related.
Brown v. Hartford Ins. Co. [12/16/09] 2009 MTWCC 38 The Court concluded that an insurer who was otherwise liable for Petitioner’s occupational disease claim was not liable for the medical expenses occurred when Petitioner suffered an anxiety attack brought on by her fear of telling her supervisor that she had been diagnosed with an occupational disease.
Dewey v. Montana Contractor Compensation Fund [05/16/09] 2009 MTWCC 17 Although the objective medical evidence established that the claimant had bilateral carpal tunnel syndrome, the claimant failed to prove under § 39-71-407(9), MCA, that events occurring on more than a single day or work shift are the major contributing cause of his carpal tunnel syndrome where the only medical provider who found a causative link had incomplete and inaccurate information and no access to older medical records.
Liberty Mutual Ins. Corp. v. Montana State Fund/Re Claim of Mitchell [12/23/08] 2008 MTWCC 54 The plain meaning of § 39-71-407(9), MCA, contains no requirement that the “employment” which is the major contributing cause of a claimant’s occupational disease derive from a particular employer. The statute calls for a comparison between occupational and non-occupational factors as part of the determination as to whether the OD is considered to “arise out of employment or be contracted in the course and scope of employment.” If such a determination is made, then the analysis moves forward to § 39-71-407(10), MCA, to assign liability to the employer of last injurious exposure.
Liberty Mutual Ins. Corp. v. Montana State Fund/Re Claim of Mitchell [12/23/08] 2008 MTWCC 54 Where a physician concluded that the accumulation of 30 years of heavy labor is responsible for a claimant’s current low-back condition, a different physician opines that the claimant’s ongoing employment from 2002 through October 2005 contributed to some degree to the development of the occupational disease, and the physicians’ opinions are supported by objective medical findings, the Court concludes that the major contributing cause of the OD is the claimant’s lifetime of heavy-labor employment.
Hagemann v. Montana Contractor Compensation Fund [07/10/08] 2008 MTWCC 35 The determination as to whether Petitioner’s pulmonary conditions were work-related came down to the conflicting opinions of two physicians – Petitioner’s treating physician, who is a board-certified internist who sees pneumonia and pulmonary embolisms as a regular part of her practice, and Respondent’s IME doctor, who has never treated a pulmonary embolism and last treated a case of pneumonia in the early 1980s. Not only does Petitioner’s treating physician’s opinion carry greater weight because she was the treating physician, but the Court also finds her qualifications regarding the diagnosis and treatment of pneumonia and pulmonary embolisms to be more substantial than the qualifications of Respondent’s IME doctor.
Rach v. Montana State Fund [04/29/08] 2008 MTWCC 20 The Workers’ Compensation Act provides specific guidance on the element of causation when the alleged injury is a heart condition. Based on test results, Petitioner’s treating physician initially opined that the blunt force trauma Petitioner allegedly suffered at work caused a torn cord. However, she further stated that a more specific diagnostic test could conclusively diagnose the condition. When presented with test results which did not support her diagnosis, the treating physician concluded Petitioner did not suffer a torn cord and rescinded her opinion that his heart condition was caused by his employment. Therefore, Petitioner has no basis for his contention that his heart condition is work-related.
Lanes v. Montana State Fund [09/10/07] 2007 MTWCC 39 Where Petitioner’s treating physician opined that Petitioner overloads his right knee to compensate for the left and the activities which Petitioner performed as a minister are the activities of daily living, Petitioner had to overuse his other limb to compensate for the injured limb, and therefore the overloading would have caused the development of problems in that limb, regardless of whether he engaged in subsequent employment.
Oksendahl v. Liberty Northwest [06/21/07] 2007 MTWCC 24 Where a doctor opined that the employee’s work as a lifelong carpenter “probably accelerated” osteoarthritis of the basilar thumb, the employment was a significant aggravation or contribution to the development of the employee’s occupational disease.
Oksendahl v. Liberty Northwest [06/21/07] 2007 MTWCC 24 A doctor’s conclusion that the worker’s employment was less than a 50% contribution is not grounds to deny compensability. Occupational factors need not play the major or most significant role in causing an OD, but must instead be a significant aggravation or contribution.
Foster v. Montana Schools Group [06/11/07] 2007 MTWC 18 Where an MRI was negative for a repeat medial meniscus tear and a physician testified that there is a 5-10% chance that the MRI missed a repeat tear, the Court concluded that Petitioner had failed to sustain her burden of proof establishing that Respondent is liable for a repeat arthroscopy.
Foster v. Montana Schools Group [06/11/07] 2007 MTWC 18 Where Petitioner established that she sustained avascular necrosis of the subchondral area of the lateral femoral condyle, but failed to show how the AVN condition was causally related to her initial injury or subsequent arthroscopy with objective medical findings, Petitioner failed to meet her burden of proof pursuant to the 1995 amendments to § 39-71-407, MCA.
Strom v. Montana Municipal Ins. Authority [07/22/05] 2005 MTWCC 42 Where the physician tendering an opinion on the relatedness of a medical condition to a work-related injury is unable to relate the condition to the injury and the medical evidence further demonstrates that the work-related injury fully resolved and that there were subsequent incidents associated with his medical complaints, the Court finds that there is no causal connection between the subsequent condition and the work-related injury.
Strom v. Montana Municipal Ins. Authority [07/22/05] 2005 MTWCC 42 An insurer is liable only for medical conditions which are causally related to a work-related injury.
Doubek v. CNA Ins. Co. [11/10/04] 2004 MTWCC 76 A workers' compensation insurer is liable only for medical conditions which are caused by the claimant's industrial accident or occupational disease.
McCauley v. Liberty N.W. [5/27/04] 2004 MTWCC 43 "Causation is an essential element to benefit entitlement. The claimant has the burden to prove a causal connection by a preponderance of the evidence." Hash v. Montana Silversmith, 256 Mont. 252, 257, 846 P.2d 981, 983 (1993).
Dolan v. American Protection Ins. Co. [2/19/04] 2004 MTWCC 9 Insurer is liable only for medical conditions in fact caused by an industrial accident.
Andersen v. Zurich Amerian Ins. Co. [6/27/03] 2003 MTWCC 45 Insurer is liable only for a medical condition and disability arising as a result of an industrial injury. It is not liable for a new, unrelated condition caused by a subsequent non-work-related accident even though both injuries involved the back since they involved different parts of the back and were distinct injuries.
Markovich v. Helmsman Management Services [1/31/03] 2003 MTWCC 4 An insurer is liable only for medical conditions and disability caused by the industrial accident. §§ 39-71-701 through 704, MCA (1999).
Hand v. Royal Ins. [12/19/02 2002 MTWCC 65 Where uncontradicted medical evidence and opinion indicated claimant's underlying, preexisting cervical stenosis caused both her neck surgery and disability, she was not entitled to additional benefits relating to work incident involving jar to her body when she stepped backwards off a garage onto ground approximately one foot lower.
Oswald v. Horizon CMS Healthcare Corp. [12/5/02] 2002 MTCC 62 While the Court was persuaded the former nurse's aide who was exposed to bodily fluids and blood of patients, frequently with open cuts on her hands and not wearing gloves, acquired Hepatitis C through contact with a patient's blood or bodily fluids, her occupational disease claim is denied where uncontroverted medical evidence established Hepatitis C is acquired through a single exposure.
Watkins v. State Fund [2/22/02] 2002 MTWCC 11 Where surgery was the direct and inevitable result of a prior injury, and a subsequent exacerbation of the preexisting condition did not cause the surgery or materially accelerate the need for surgery, the insurer for the subsequent exacerbation is not liable for the surgery.
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. The testimony of a tumor specialist, who was far more qualified than other testifying physicians, was persuasive that no link has been established between trauma and glioma-type brain tumors and that in any event glioma-type tumors develop slowly and could not have possibly developed in the short time in this case.
Munroe v. MT Electric & Telephone Pool [8/16/01] 2001 MTWCC 43 Court will not find current spinal condition was caused by an industrial accident where claimant's medical history, which demonstrates that claimant has long history of chronic pain problems and a long history of degenerative spine problems, and persuasive medical testimony shows that her spinal problems are not related to her industrial accident.
Stacks v. Travelers/State Fund [3/1/01] 2001 MTWCC 9 Where claimant had a long history of back and neck problems, including prior workers' compensation claims, insurer at risk at time of workplace fall aggravating claimant's neck and back carried its burden of proving the fall caused only a temporary aggravation of claimant's lumbar spine condition, but failed to prove the aggravation to claimant's neck was only temporary.
Romero v. Liberty Mutual & State Fund [1/29/01] 2001 MTWCC 5 Where condition develops over a period of years as a natural progression and result of an earlier workers' compensation injury, the insurer for the earlier injury is liable even though part of the progression occurred during subsequent employment. [Note: The Supreme Court affirmed the WCC decision in Romero v. Liberty Mutual Fire Ins. Co., 2001 MT 303N (a non-citeable decision.)]
Grayes v. Uninsured Employers Fund [7/24/00] 2000 MTWCC 46 Claimant was not entitled to occupational disease benefits where neither his treating physician nor the physician who conducted an occupational disease examination could relate his shoulder condition to his operation of a tractor.
LaPlant v. State Compensation Insurance Fund [11/24/99] 1999 MTWCC 75 Where State Fund failed to accept or deny a 1987 claim within thirty days, under section 39-71-606, MCA (1985) and Haag v. Montana Schools Group Ins. Authority, 274 Mont. 109, 906 P.2d 693 (1995), it is in the same position as though it had accepted the claim. State Fund is not, however, liable for a wide range of medical bills without proof of a causal relationship to the claimed elbow injury.
Kaiser v. Sears [6/28/96] 1996 MTWCC 47 Where an IME panel found claimant's 1995 complaints of pain related to his 1981 electrocution injury, even though likely exacerbated by deconditioning, and recommended three physical therapy sessions, the Court finds treatment by claimant's family practitioner and one month's physical therapy related to the original injury and reasonable medical treatment. Additional physical therapy was found not reasonable where prescribed without examination of claimant or discussion with the physical therapist.
Liberty NW Ins. v. Champion International [6/25/96] 1996 MTWCC 45 Based on the "last injurious exposure" language of section 39-72-303(1), MCA, in Caekaert v. State Compensation Insurance Fund, 268 Mont. 105, 885 P.2d 495 (1994), the Montana Supreme Court extended the subsequent injury rule to a subsequent occupational disease for which the initial insurer was liable. This case turns on whether claimant, a millwright who injured his back in 1992, materially and significantly aggravated his condition by subsequent work at the same mill under a different employing entity, with a different insurer. If his current condition were merely a recurrence resulting from his 1992 injury, or merely the result of a natural progression of his preexisting condition, then the first insurer would remain liable. The Court was persuaded, however, by testimony of two doctors and the claimant, that his subsequent work caused material and significant deterioration of his low-back condition and caused his disability. (Note: this decision was affirmed by the Montana Supreme Court in Liberty Northwest v. Stimson Lumber Company, 285 Mont. 76, 945 P.2d 433 (1997) (No. 96-368).
Erickson v. Champion International [3/12/96] 1996 MTWCC 23 WCC reversed and remanded DOL decision that claimant did not suffer from an occupational disease where the decision rested on the opinion of a doctor who applied an incorrect understanding of the law. The doctor opined that claimant's knee condition was not an occupational disease because not all mill workers develop similar knee conditions, ignoring the settled principle that an employer takes a worker as it finds him, making the fact that non-susceptible or non-predisposed workers would not be affected by working conditions irrelevant to a determination whether an occupational disease exists in a particular worker.
Erickson v. Champion International [3/12/96] 1996 MTWCC 23 The fact that claimant's underlying condition would ultimately have been totally disabling due to a natural progression of an underlying condition does not preclude compensation where the disability was hastened by a work-related injury or conditions.
Gallup v. State Fund [2/9/96] 1996 MTWCC 14 A 36-year old sales and delivery person developed a blister on the left side of her groin after unexpectedly performing delivery work involving substantial exertion in pantyhose and new slacks. The blister developed into an abscess and, despite medical treatment, claimant continued to develop abscesses and sores diagnosed as hidradenitis suppurative, a chronic disease. The insurer accepted the claim and conceded liability for treatment and disability associated with abscesses near the original blister, but disputed continued liability for claimant's chronic condition. From the medical evidence presented, WCC concluded that medical science is currently unable to determine what causes hidradenitis. Applying a line of cases decided under pre-1995 statutes, beginning with Moffett v. Bozeman Canning Co., 95 Mont. 347, 26 P.2d 973 (1933), and most recently including Prillaman v. Community Medical Center, 264 Mont. 134, 870 P.2d 82 (1994), the WCC held that where the etiology of a condition is not known, the presence of ongoing symptoms of the disease post-injury, joined with medical testimony that the condition may spread from one infected site to another, creates strong evidence that claimant's condition became symptomatic because of the industrial injury.
Best v. State Compensation Insurance Fund [8/23/95] 1995 MTWCC 62, aff’d Best v. State Compensation Insurance Fund, 276 Mont. 302, 916 P.1d 108 (1996) Claimant with long history of back pain was hired jointly with wife to work at bar and cafe. He suffered an acute flare-up after hitting his hip on a table. The insurer paid medical benefits relating to the flare-up, but refused to pay PTD benefits. Although a chiropractor opined claimant was worse off after the 1993 incident, the WCC found this opinion based on a misunderstanding of the facts where claimant’s wife had been performing 95% of the work at the bar and cafe. Claimant did not meet the definition of permanent total disability (section 39-71-116, (16), MCA (1991)) where his permanent total disability predated the 1993 incident and was not caused by that incident.
Hereim v. State Compensation Ins. Fund [06/26/95] 1995 MTWCC 52 Where physician testified he could not attribute claimant’s present medical condition, resulting from nerve root scar tissue, to claimant’s 1975 or 1983 accidents, and where claimant suffered deterioration of his back condition after several other subsequent injuries, including low-back surgery in 1992, claimant failed to prove causal connection between 1975 or 1983 injuries and his present medical condition. Medical and work records also suggested that present pain arose after 1984 injury for which this insurer is not liable.

Hanson v. State Compen. Ins. Fund [06/02/95] 1995 MTWCC 42 Where unrefuted opinion of the OD panel physician was that claimant does not have an occupational disease and was not placed at risk for developing carpal tunnel syndrome by her occupational activities as a personal care attendant, and claimant offered no other evidence linking her mild carpal tunnel condition to her employment, WCC affirms DOL order that claimant is not suffering from an occupational disease.

O'Connor v. National Union Fire Ins./Alexsis [05/19/95] 1995 MTWCC 38 Where a neurosurgeon testified on a more probable than not basis that claimant’s current symptoms result from a disk fragment attributable to the 1993 injury, she has carried her burden of proving entitlement to medical and indemnity benefits relating to her current condition.
Moore v. State Compensation Ins. Fund [04/17/95] 1995 MTWCC 29 The claimant has a duty to follow reasonable medical instructions with regard to treatment of her condition, including prescribed physical therapy and exercise. In light of her physician’s determination that her condition should resolve with appropriate treatment, she is cautioned that her failure to do so in the future may relieve the insurer of further liability for her condition.
Moore v. State Compensation Ins. Fund [04/17/95] 1995 MTWCC 29 Where claimant seeks continued medical benefits denied by an insurer, she must prove by a preponderance of the evidence that a causal connection exists between her injury and her current condition. However, if the insurer contends that injuries subsequent to the industrial accident permanently damaged her condition and relieve it of liability for continued medical treatment, it has the burden of proof. See, Lee v. Group Cable TCI of Montana, 245 Mont. 292; Walker v. United Parcel Service, 262 Mont. 450 (1993).
Irish v. State Compensation Ins. Fund [4/10/95] 1995 MTWCC 26 Where medical evidence along with claimant’s testimony indicates that his current condition results from the 1977 work injury, he is entitled to medical expenses related to that condition.
Beckers v. State Compensation Ins. Fund [02/08/95] 1995 MTWCC 11 Where medical evidence linked claimant’s ongoing need for treatment for his neck condition to industrial injuries, insurer’s reference to subsequent temporary aggravations of claimant’s condition did not sever its liability. Indeed, insurer’s denial of liability in absence of medical opinion that later incidents constituted permanent aggravation was unreasonable, justifying imposition of penalty and attorneys fees.
Wilson v. Liberty Mututal Fire Ins. [02/03/95] 1995 MTWCC 9 Where claimant is required under both the 1985 and 1987 Workers’ Compensation Acts to show that his disabling condition results from his industrial accident, and the credible evidence convinced the Court that claimants 1988 and 1986 back injuries were temporary strains, he is not entitled to further permanent partial disability benefits for a back condition commencing in 1993.