Injury and Accident: Causation

King v. TTC Illinois, Inc., 2000 MT 260 Where WCC credited testimony indicating the decedent, an over-the-road truck driver, died of longstanding severe atherosclerotic disease, claimants failed to meet their burden of establishing that death was casued by a specific event on a single day or during a single work shift as required by section 39-71-119(2)(d), MCA (1993).
Burglund v. Liberty Mutual Fire Ins. Co., 286 Mont. 134, 950 P.2d 1371 (1997) Supreme Court affirmed WCC determination that cause of claimant's current back-related disability was 1984 injury and not occupational disease insurer claimed arose after claimant returned to work. Claimant met his burden of establishing a clear connection between his current condition and the 1984 injury through physician's testimony. Insurer did not prove causation through occupational disease where doctor could not determine with any precision what effect claimant's resumed work had on his condition, testified claimant's low back condition would have deteriorated even if he had not resumed his UPS duties, and testified that post-injury work was not a substantial cause of the degeneration.
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 disc had returned to its normal anatomical configuration, the deterioration of claimant’s condition and his present physical impairment was 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.

Warburton v. Liberty Northwest Ins. Corp. [01/07/16] 2016 MTWCC 1 Although Petitioner tripped over a clothing rack at work and fell backwards, landing on the floor, and the medical evidence indicated that Petitioner has problems with her head, neck, and shoulders, the medical opinions which connected these problems to her industrial accident were based on inaccurate and incomplete medical histories Petitioner provided her doctors and she therefore failed to satisfy her burden of proving causation.

Martin v. Montana State Fund [08/26/11] 2011 MTWCC 25 Although Petitioner’s treating physician identified objective medical findings to support Petitioner’s claim of lumbar spine problems, the evidence demonstrated that Petitioner had had recurring sciatic pain for a significant period of time prior to the date of his alleged industrial injury.  Furthermore, neither Petitioner’s co-worker nor his employer could corroborate Petitioner’s account of an industrial accident, and between his deposition and trial testimony Petitioner contradicted himself on whether he reported an injury to his employer.  Petitioner failed to prove that his lumbar spine condition was caused by an industrial injury.

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.
Heffner v. Montana State Fund [07/13/07] 2007 MTWCC 29 Where Petitioner suffered several serious injuries as a result of an industrial accident that occurred approximately eight years prior to the first concrete piece of medical evidence indicating a possible disk herniation at the L4-L5 disk level, and some twenty-four years prior to the detection of a large fragment at the same level, the Court finds that Petitioner failed to satisfy his burden of proof that his herniation and fragment are the result of his industrial accident. The mere possibility that his disk herniation is related to the accident is not sufficient to satisfy this burden. Viewed in its totality, the evidence relating the herniation and fragment is too scant to meet Petitioner’s burden.
Cooper v. Chevron Corp. [3/05/03] 2003 MTWCC 16 The insurer is not liable for subsequent conditions of the same body part which are caused by intervening events and not by the original injury.
Sloan v. American Home Assurance Co. [5/8/98] 1998 MTWCC 38 Protective order granted against IME with cardiac surgeon where Larson v. Cigna Ins. Co., 271 Mont. 98, 894 P.2d 327 (1995) establishes that even if a worker is totally disabled on account of a pre-existing non work-related heart condition, the worker is still entitled to workers' compensation total disability benefits if his industrial injury is also totally disabling. Petitioner must, however, prove that his work-related injuries are in fact totally disabling. Where evidence indicates that claimant's heart condition may have caused memory loss, WCC notes that if claimant is contending the industrial injury caused memory loss, then the insurer would be entitled to an IME.
Munroe v. MT Electric & Telephone Pool [8/16/01] 2001 MTWCC 43 Court will not order insurer to pay for proposed surgery on three levels of claimant's spine that is not related to a 1997 industrial accident.
Thoreson v. UEF [6/28/00] 2000 MTWCC 40 Based on claimant's smoking the equivalent of three marijuana joints within a couple of hours of going on a roof to work, and his bizarre, reckless conduct of walking along the very edge of the roof like a tightrope walker, claimant was in fact intoxicated and the intoxication was a leading cause of his accident and injury within section 39-71-407, MCA (1995). However, employer did have knowledge of claimant's drug use and failed to attempt to stop same, making claimant entitled to benefits.
King v. Credit General Ins. Co. [11/10/99] 1999 MTWCC 72 WCC was not persuaded that work activities of over-the-road truck driver caused an arrhythmia leading to his death, but credited testimony indicating claimant died from longstanding "severe atherosclerotic disease." Thus, claimants failed to prove that death resulted from a specific event on a single day or during a single work shift as required by statute. Note: WCC affirmed on appeal, King v. Credit General, 2000 MT 260 ("the Kings did not meet their burden of establishing that Russell King's death was ‘caused by a specific event on a single day or during a single work shift' as required under section 39-71-119(2)(d), MCA (1993).")
Liberty Northwest Ins. Co. v. Michael Stolz [11/9/99] 1999 MTWCC 71 While the insurer's counsel's questioning tried to make it appear that claimant's pain resulted from one incident, a complete reading of claimant's testimony shows that while there may have been one day on which claimant began experiencing pain, it was not associated with a specific event or incident. Physician's testimony suggests it is more probable that lifting over several days led to the condition, making it an occupational disease.
Branch v. Liberty Northwest Ins. Co. [9/27/99] 1999 MTWCC 57 Motel housekeeper filed claim for injury but credible evidence indicated her cervical disk condition arose over two week period due to lifting heavy laundry, not from any accident causing sudden onset. Although claimant had not filed an occupational disease claim, and no occupational disease examination had been conducted, the parties waived their rights to a medical panel examination and stipulated that the Court may determine whether she suffered an injury or occupational disease.
Burglund v. Liberty Mutual Fire Insurance Co. [8/29/96] 1996 MTWCC 60 UPS driver and insurer disputed whether claimant's current disability was result of 1984 back injury and following surgery or occupational disease resulting from claimant's return to work. Based on medical testimony, Court found condition was result of earlier injury. Physician's testimony left no doubt that claimant's 1991 surgery, and thus his 1984 injury, are substantial and material factors in claimant's current disability. WCC was persuaded claimant's continued employment may have hastened the degenerative process, but was not persuaded it substantially or materially did so. Most importantly, physician testified that even had claimant not returned to a labor intensive job, his degenerative condition would have ultimately progressed and that the current condition is consistent with a natural progression of the underlying condition. (Note: WCC decision affirmed by Supreme Court in Steven K. Burglund v. Liberty Mutual Fire Ins. Co., 286 Mont. 134, 950 P.2d 1371 (1997).)
Cheetham v. Liberty NW [6/11/97] 1997 MTWCC 37 51-year old heavy equipment and crane operator suffered an aortic dissection after spending 20 to 30 minutes trying to start a gas powered pump, requiring 50 to 70 pulls on a cord similar to those on lawn mowers. The general criteria for a compensable injury under section 39-71-119(2), MCA (1995) are met where an usual strain at work caused claimant internal physical harm, verified by objective medical findings. In cases of cardiovascular incidents, section 39-71-119(5)(a), MCA (1995), permits compensation "only if the accident is the primary cause of the physical condition in relation to other factors contributing to the physical condition," with "primary cause" defined as "a cause that, with a reasonable degree of medical certainty, is responsible for more than 50% of the physical condition." Where two physicians, one a cardiologist, credibly testified claimant's aortic dissection was more than 50% attributable to his episode of high blood pressure, which in turn was caused by strenuous work activities, the condition is compensable.
Hamlin v. State Fund [12/29/95] 1995 MTWCC 113 Section 39-71-407(5), MCA (1993) relieves the insurer of liability for claimant’s knee condition following non-work related fall where he had reached MMI after knee surgery following industrial accident and the Court finds, as a matter of fact, that claimant did not suffer from instability of his knee following his first surgery and that his non-work related fall was not caused by a pre-existing work-related knee condition.
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.
Rooney v. Credit General Ins. [06/29/95] 1995 MTWCC 53 Although claimant has significant pre-existing back conditions, the insurer is liable for his current condition if his industrial injury lit up, aggravated or accelerated his back condition. A preponderance of the evidence establishes that the 1993 injury lit up and worsened claimant’s underlying spondylolisthesis and spinal stenosis. While claimant occasionally had low back pain prior to the accident, he never sought treatment for such pain, which is now worse and radiates into his legs.
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.

O'Connor v. National Union Fire Ins./Alexsis [05/19/95] 1995 MTWCC 38Where 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.