Disability: Permanent Total
MONTANA SUPREME COURT DECISIONS |
McFerran
v. Consolidated Freightways [12/28/00] 2000 MT 365 Regular
employment" within section 39-71-116(24), MCA (1997) includes part-time
work which is "both substantial and significant." A pharmacy
delivery job paying $5.50 per hour was not substantial and significant
where a written job analysis stated hours could be as low as six hours
per week. |
Larson v. Cigna Ins. Co., 276 Mont. 283, 915 P.2d 108 (1996) (Larson II) The definition of permanent total disability within section 39-71-116(13), MCA (1979) contains both medical and non-medical components. The non-medical component requires claimant to establish “no reasonable prospect for employment in the normal labor market,” which requires showing of (1) what jobs constitute his or her normal labor market, and (2) a complete inability to perform the employment and duties because of his or her work related injury. Once the claimant has presented evidence affirmatively showing that he cannot return to work in his normal labor market, the burden of proof shifts to the insurer to show that suitable work is available. |
Larson v. Cigna Ins. Co., 276 Mont. 283, 915 P.2d 108 (1996) (Larson II) A claimant’s ability to perform a few odd jobs for a short period of time does not preclude a finding of permanent total disability. |
Larson v. Cigna Ins. Co., 276 Mont. 283, 915 P.2d 108 (1996) (Larson II) Where 58-year old former laborer faced significant barriers to employment given his light duty restrictions, did not have experience in some identified jobs, and did not receive rehabilitative services, and where insurer’s vocational expert failed to identify specific jobs available to claimant, claimant was permanently totally disabled (Workers’ Compensation Court reversed). |
MONTANA WORKERS' COMPENSATION COURT DECISIONS |
Thompson v. Montana State Fund [08/30/13] 2013 MTWCC 25 Physician-approved job analyses were incongruous with Petitioner’s physical limitations and her sedentary-only release assigned by her treating orthopedist in light of Petitioner’s two neck fusions, her carpal tunnel syndrome, and her right-side vocal cord paralysis that left her voice barely audible at best and completely inaudible when fatigued. In consideration of the totality of Petitioner’s limitations, the Court concluded Petitioner did not have a reasonable prospect of physically performing regular employment once she reached MMI for both her orthopedic condition and her vocal cord injury and was, therefore, permanently totally disabled within the meaning of § 39-71-116(25), MCA (2007), and entitled to PTD benefits retroactive to when her TTD benefits were discontinued. |
Wilson
v. Ace American Ins. [6/7/02] 2002 MTWCC 32 Where there are conflicting
medical opinions as to claimant's ability to return to work after reaching
maximum medical improvement, the Court adopts the opinions of the physicians
with the greater expertise where those opinions are supported by information
showing that claimant failed to seek further treatment for the alleged
disabling condition and an FCE showed that she could work despite her
pain behaviors. Claimant's credibility was also a factor. |
P.
Davis v. Credit General Insurance Company [8/9/00] 2000 MTWCC 48
Claimant's testimony that right shoulder pain prevents him from using
his right arm and therefore from working does not prove PTD status where
medical testimony established that his reported pain is inconsistent with
his medical condition, objective medical evidence, and anatomical dermatomal
patterns; and that his reported lack of use of his right arm is inconsistent
with objective findings of muscle mass. Moreover, claimant denied engaging
in activities he is shown doing during videotaped surveillance. Affirmed
in nonciteable decision 2002 MT 11N. |
Eric
Johnson v. State Compensation Insurance Fund [8/20/99] 1999 MTWCC 52
A 63-year old truck driver fell and hit his head, shoulder, and lower
back. Insurer accepted liability, but terminated TTD benefits when a physician
released claimant to return to work. Medical records indicate claimant
exaggerated his symptoms and failed to cooperate with medical testing
and examination. His in-court testimony about his pain and limitations
was not credible. While claimant unquestionably suffers from osteoarthritis,
there was no objective medical evidence that he could not return to work
in identified jobs. While it is possible claimant suffers genuine neck
and low-back pain, his invalid responses during IME and FCE testing, his
questionable responses during other medical examinations, and his behavior
in Court make it impossible for the WCC to determine the true nature of
his pain and disability. TTD benefits properly terminated; claimant is
not PTD. |
Wall
v. National Union fire of Pittsburgh [8/16/99] 1999 MTWCC 50 [aff'd
2000 MT 389N (nonciteable opinion)] A 52-year old mechanic/laborer
was injured while operating grinder. Insurer accepted liability for shoulder
condition, but denied liability for neck condition and that claimant was
PTD. Where several jobs recommended by vocational providers were approved
by physicians, and claimant's testimony led WCC to conclude he was merely
unmotivated to seek employment, PTD claim denied. |
Palmer
v. Home Insurance Company [7/21/99] 1999 MTWCC 42 A 46-year old
laborer with sixth grade education and lower back injury was released
to work in sedentary and light-duty jobs. Vocational Rehabilitation Provider
identified three jobs as appropriate without further training or rehabilitation:
small products assembler, keno caller, and telemarketer. Claimant agreed
he could physically work as a keno caller or small products assembler
if the jobs did not require much speed. Claimant's vocational expert raised
questions about some jobs, and indicated claimant would at the least need
considerable vocational assistance. Claimant failed to convince court
he was PTD, but Court held that claimant's limited intelligence, skills,
and abilities restrict his employability and that a trial period of employment,
including special supervision and training, is necessary for him to have
a reasonable prospect of employment. The rehab plan was insufficient in
that it did not provide sufficient time for a realistic job search, a
trial work period, or for training or assistance in new job. Further vocational
assistance ordered. |
Winfield
v. State Compensation Insurance Fund [7/20/99] 1999 MTWCC 41.
Disability is not a wholly medical determination. In addition to claimant's
age, education, work history, skills and abilities, pain is another factor
the Court must consider in deciding whether claimant is permanently totally
disabled. Pain may be so severe for some individuals that it renders them
physically incapable of performing regular employment within section 39-71-116(16)
(1991), MCA. Court credited claimant's pain reports and found him PTD,
noting that inability to work on a regular, sustained basis is not the
equivalent to inability to engage in any sort of activity. |
Kloepfer
v. Lumbermen’s Mutual Casualty Co. [9/18/95] 1995 MTWCC 70,
affirmed Kloepfer
v. Lumbermen’s Mutual Casualty Co.,
276 Mont. 495, 916 P.2d 1310 (1996) While
pain must be considered in determining the ability of an injured worker
to return to work, WCC was persuaded this claimant’s ability to return
to work was purely a function of her motivation. Although surgeon opined
she could work part-time only, his opinion was based on claimant’s pain
reports, not objective physical limitations. More persuasive opinions
came from IME conducted by occupational health and chronic pain experts
who found no neurological or physical deficits, pain amplified by psychological
factors, and lack of motivation to work. The Supreme Court affirmed in Kloepfer v. Lumbermen’s Mutual Casualty
Co., 276 Mont. 495, 916 P.2d 1310 (1996), finding substantial
evidence to support the WCC’s finding. |