Physicians: Treatment: Preauthorization

MONTANA SUPREME COURT DECISIONS

Gamble v. Sears, 2007 MT 131, 337 Mont. 354, 160 P.2d 537 Where the claimant’s condition was not causally connected to her industrial injury until after surgery was performed, her failure to obtain preauthorization as required by § 39-71-1101(2), MCA, must be excused as a matter of law.

Gamble v. Sears, 2007 MT 131, 337 Mont. 354, 160 P.2d 537 The procedural authorization rule of § 39-71-1101(2), MCA, allows the insurer an opportunity to choose a treating physician if the claimant no longer prefers the doctor he or she initially chose; it does not operate as an escape mechanism by which the insurer can avoid all liability for the cost of undisputedly necessary treatment arising from a work-related injury.

MONTANA WORKERS' COMPENSATION COURT DECISIONS

Hart v. Hartford Ins. Co. of the Midwest [04/07/10] 2010 MTWCC 8 Undisputedly necessary medical treatment arising from a work-related injury is compensable irrespective of prior authorization.  Where some medical bills have no corresponding medical records which would allow the court to assess the necessity of medical treatment and Petitioner’s behavior includes drug seeking and misrepresentations to physicians, it is impossible for the Court to decipher what bills remain unpaid that would fall into the category of undisputedly necessary.

Gamble v. Sears [01/30/06] 2006 MTWCC 5 Petitioner’s failure to obtain pre-authorization for surgery will not preclude Respondent’s liability when no one knew at the time she obtained treatment that her medical problem stemmed from her industrial accident. The fact that Petitioner petitioned this Court after the surgery was performed, and after the surgeon came to his conclusion that the fracture stemmed from the industrial accident, does not somehow absolve Respondent of its liability.