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Heisler v. State Compensation Insurance Fund

Court of Workers Compensation of Montana

June 1, 1995

MICHAEL E. HEISLER Petitioner
v.
STATE COMPENSATION INSURANCE FUND Respondent/Insurer for HINES MOTOR COMPANY Employer.

          ORDER DENYING SUMMARY JUDGMENT

          Mike McCarter Judge

         Summary: Claimant challenged State Fund's refusal to recognize his choice of treating physician or to pay certain medical bills.

         Held: Administrative requirement that claimant obtain approval prior to changing treating physician does not violate statutory or constitutional provisions.

         Petitioner, Michael E. Heisler (Heisler), alleges that the respondent/insurer, State Compensation Insurance Fund (State Fund), unreasonably refused to approve his choice of a treating physician and has failed to pay certain medical bills. He is now pursuing summary judgment despite his acknowledgment, found at page 3 of his Memorandum of Authorities in Support of Petitioner's Motion for Summary Judgment[1], that after the filing of the Petition for Trial the respondent recognized his choice of physician and paid the contested medical bills. His Motion for Summary Judgment is denied.

         Factual and Procedural Background

         Heisler was injured in an industrial accident on June 28, 1993, while working for Hines Motor Supply Company (Hines) in Great Falls, Montana. (Petition for Trial ¶ 1; Response ¶ 1.) At the time of the accident, Hines was insured by the respondent, State Fund. (Response ¶ 1.) The State Fund accepted liability for the claim. (Id.)

         A dispute arose concerning Heisler's treating physician. In his Petition for Trial, Heisler alleges that he chose Dr. Richard A. Nelson as his treating physician and that the State Fund refused to recognize his choice. (Petition for Trial ¶S 9, 10 AND 14.) In its Response to Petition the State Fund alleges that Heisler "changed" treating physicians without its prior approval. (Response to Petition ¶ 2.) Exhibit 1 to the Insurer's Response to Petitioner's Summary Judgment Memorandum suggests that claimant was initially treated for his injuries by Dr. William Shull. The State Fund further asserts that it is not responsible for medical treatment by Dr. Nelson or for treatment ordered by him because Heisler did not obtain its prior approval of Dr. Nelson. (Id.)

         In his Petition for Trial, Heisler itemizes a number of unpaid medical bills which are related to Dr. Nelson's care. The bills include Dr. Nelson's bills, pharmacy bills and charges for a cervical collar and an MRI.

         The Petition for Trial contains the following prayers for relief:

a. Whether the insurer acted reasonably in refusing to recognize Dr. Richard A. Nelson as the Petitioner's treating physician and/or to authorize the Petitioner's consultation with a neurologist of his choice for the neurological conditions from which he suffers;
b. Whether the Claimant has a right of choice of his physician under the provisions of § 33-22-111 M.C.A. (1991).
c. Whether the Insurer has a right to interfere with the Petitioner's full freedom of choice of physician pursuant to Article II Sections 3, 4 and 10 of the 1972 Montana Constitution and the 9th and 14th Amendments of the United States Constitution;
d. Whether the Petitioner has a right of full freedom of choice of physicians pursuant to Article II Sections 3, 4 and 10 of the 1972 Montana Constitution and the 9th and 14th Amendments of the United States Constitution;
e. Whether the Insurer's conduct is reasonable;
f. Whether the Insurer's conduct is unreasonable and entitles the Petitioner to recover penalties pursuant to the provisions of § 39-71-2907 M.C.A.;
g. Whether the Petitioner is entitled to recover his attorney's fees and costs incurred herein.

         Heisler did not request payment of the unpaid medical bills in his prayer. However, the Court believes that such request is implicit.

         This matter was originally set for trial during the week of June 27, 1994. However, on June 6, 1994, Heisler filed his motion for summary judgment, along with a supporting memorandum of law. In view of the lateness of the filing, and the lack of any supporting affidavits or discovery, I confirmed the trial setting and postponed consideration of Heisler's arguments until such time as the parties submitted proposed findings of fact and conclusions of law. Order Confirming Trial Setting; Order Postponing Briefs (June 8, 1994).

         Counsel for both parties then agreed that the substantive issues raised by the Petition for Trial were legal and not factual, and that they could be submitted by way of an agreed statement of facts and summary judgment. (June 9, 1994 Letter of Lawrence A. Anderson to Judge McCarter and June 16, 1994 Letter of Clara Wilson to Mr. Lawrence A. Anderson.) The Court held a pretrial conference on June 21, 1994. A briefing schedule was set for the motion for summary judgment and the trial was postponed. (June 24, 1994 Memo of Clarice V. Beck, Hearing Examiner.) The trial was reset for the week of October 3, 1994. (Rescheduling Order (June 24, 1994).) The briefing schedule was subsequently vacated by agreement of both counsel. (July 13, 1994 Letter of Norman C. Peterson to Ms. Clarice V. Beck.)

         The Court conducted a second pretrial conference on September 26, 1994. The pretrial notes reflect the following:

Counsel agree and the Court concurs that the trial which is scheduled for the week of October 3, 1994 will be vacated pending a decision on petitoners' [sic] motion. The issues ofattorney fees and costs and the penalty will be bifurcated, until the final resolution of the motion.

         Following the pretrial conference the parties submitted a final PRE-TRIAL ORDER and their briefs on the summary judgment motion. The final brief was

         In the meantime, the State Fund approved Heisler's choice of Dr. Nelson and paid the disputed medical bills. That development is acknowledged in Heisler's Memorandum of Authorities in Support of Petitioner's Motion for Summary Judgment.

Until after the filing of this summary judgment motion and initial brief, the State Fund had refused to recognize Dr. Nelson as Heisler's treating physician; and/or had refused to authorize his services as a consulting physician. Until June 13, 1994, the State Fund had refused to pay for the following medical services and medications incurred as a result of his industrial injury:
. . .
The State Fund has now recognized Dr. Nelson as Heisler's treating ...

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