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

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.

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.

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.