Montana: Carrier’s Decision to Stop Paying For Pain Medication Did Not Justify Attorney’s Fee Award Where Decision Was Based On Prior Decision of Workers’ Compensation Court

Stressing that “reasonableness” is a question of fact and that the review the Workers’ Compensation Court’s findings of fact were to be affirmed if supported by substantial credible evidence, the Supreme Court of Montana recently affirmed a WCC finding that while an injured employee was entitled to continued payment of medical expenses in the form of pain patches prescribed by her treating physician, she was not entitled to an award for attorney’s fees for the unilateral interruption of payment for those expenses since the insurance carrier had a legitimate defense based upon an earlier holding of the WCC Court. Reliance on a prior order from the WCC created a reasonable basis for denying liability; the insurer’s actions were not unreasonable [Stewart v. Liberty Northwest Ins. Corp., 2013 MT 107, 2013 Mont. LEXIS 130 (Apr. 23, 2013)].  

The employee suffered an injury in the course and scope of her employment. The carrier accepted liability for the injury and paid wage loss and medical benefits with an 18% whole person impairment rating. The employee underwent two arthroscopic surgeries over the next few months, but she continued to have issues with pain and range of motion in her knee. Another physician examined the employee and indicated that the employee’s knee pain was of “unknown etiology.” The employee sought additional impairment benefits. In a subsequent deposition in anticipation of trial, the physician could not point to any medical evidence supporting the conclusion that there was a relationship between the employee’s surgeries and her pain symptoms. In its decision, the WCC found that the employee failed to carry her burden of proof regarding additional impairment. The employee did not appeal. The carrier stopped paying for the pain medication (in the form of patches) and the employee sought to reinstate the benefits and recover attorney’s fees for the unilateral decision of the carrier in stopping the reimbursements (the carrier later reinstated the benefits with a reservation of rights).

The court held that reliance on a prior order of the WCC created a reasonable basis for denying liability; the carrier’s actions were not unreasonable and the WCC’s decision not to impose sanctions or penalties was appropriate.