Settlements: Medical Benefits

Wiard v. Liberty Northwest Ins. Corp., 2003 MT 295 Noting that laws existing at the time a contract is formed become part of the contract, the Supreme Court held that a settlement reserving medical benefits to pro se claimant memorialized in DLI standardized petition form incorporated the 60-month limitation set forth in section 39-71-704(1)(d), MCA (1991).

Griffin v. Liberty Northwest Ins. Corp. [04/29/13] 2013 MTWCC 11 Although Petitioner testified, unconvincingly, that he did not understand that he was settling his entitlement to medical benefits when he entered into the settlement agreement at issue, Petitioner admitted that he “took [Respondent’s] money” while represented by counsel.  Petitioner cannot agree to settle, accept consideration for closing his medical benefits, and then demand that Respondent continue to pay for additional medical benefits.  Respondent is not liable for medical treatment which occurred after the parties closed Petitioner’s entitlement to medical benefits via settlement agreement.

Narum v. Liberty Northwest Ins. Corp. [06/04/08] 2008 MTWCC 30 Where, after reviewing the medical evidence and doctors’ opinions, Respondent accepted liability for Petitioner’s left hip condition and settled the claim with medical benefits left open, and where the settlement agreement stated that the parties acknowledge Petitioner may require a hip replacement in the future, Respondent cannot refuse to pay for the hip replacement surgery, arguing that it is not causally related to Petitioner’s industrial accident.

Hiett v. MSGIA [9/6/01] 2001 MTWCC 52 Where claimant has settled her entitlement to indemnity benefits but reserved "[f]urther medical and hospital benefits," she is entitled only to those benefits ordinarily available to her under statutory provisions for medical benefits. See Hiett v. Missoula County Public Schools, 2003 MT 213.
Miller v. State Fund [5/14/01] 2001 MTWCC 21 While the Court may approve under appropriate conditions a reasonable agreement to settle medical benefits negotiated between the parties, it does not have jurisdiction to order an insurer to settle claimant's entitlement to future medical benefits with a lump-sum payment.

Valance v. State Fund [3/10/98] 1998 MTWCC 23 Under its wide discretion to approve a settlement agreed to by the parties and in claimant's best interest, the WCC approves settlement of claimant's medical benefits where evidence indicates claimant and the insurer had numerous disputes relating to the nature and extent of authorized medical care. Medical evidence indicated claimant had become obsessed and paranoid regarding the workers' compensation delivery "system" and that this interfered with his health. Under the agreement, State Fund would pay claimant $50,000 in a lump sum and purchase an annuity paying him $965 per month for ten years, with any unpaid annuity amounts reverting to State Fund should claimant die before expiration of the ten years. The settlement was approved because its terms were reasonable and medical authority had spoken firmly that claimant must have final resolution of workers' compensation issues to achieve maximum recovery and health.

Tucker v. State Fund [11/14/97] 1997 MTWCC 63 Claimant and State Fund reached agreement to settle her entitlement to medical benefits, which had been left open following settlement of all other aspects of her claims, but the Department of Labor disapproved the settlement. Claimant petitioned the WCC to approve the settlement. Having tried the matter informally with claimant representing herself, the Court satisfied itself that claimant understood and appreciated the risks involved with settling a claim for medical benefits. Under the circumstances of this case, the Court approved the settlement. Those circumstances included the facts that claimant had lived with back pain for many years, her physician opined that additional surgery was not likely, but that chiropractic might help, and State Fund denied chiropractic treatment on the ground it was maintenance care and not compensable.
Ahl v. Transportation Ins. Co. [05/11/95] 1995 MTWCC 35 Where petitioner has failed to identify specific medical bills that he believes must be paid following settlement reserving medical benefits to him, it is impossible for the Court to determine whether those bills relate to the industrial injury, requiring denial of claimant’s motion for summary judgment. Claimant’s contention that all medical bills must be paid without regard to statutory and medical provider rules has no legal foundation.