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Hamlin v. State Compensation Insurance Fund

Court of Workers Compensation of Montana

December 29, 1995

DON HAMLIN Petitioner
v.
STATE COMPENSATION INSURANCE FUND Respondent/Insurer for HERITAGE INN Employer.

          Submitted: December 18, 1995

          FINDINGS OF FACT, CONCLUSIONS OF LAW AND JUDGMENT

          MIKE MCCARTER JUDGE

         Summary: 28-year-old hotel worker suffered work-related injury to left knee, leading to arthroscopic surgery. In following year, he re-injured the same knee outside work, leading to additional arthroscopic surgery. The parties disputed whether second injury was compensable as causally connected to the work injury. Claimant testified at length that his knee remained unstable after the first operation, including statements that he discussed the problems with his physician. The physician's records, however, did not support claimant's statements and the WCC found him lacking credibility in his testimony that his knee remained unstable after the first surgery.

         Held: Under section 39-71-407(5), MCA (1993), if a claimant who has reached maximum medical healing suffers a subsequent nonwork-related accident to the same part of the body, the insurer is not liable for compensation or medical benefits caused by the subsequent nonwork-related injury. However, the insurer remains liable if the new incident was itself precipitated by a residual condition caused by the original industrial accident. See Pulliam v. Liberty Mutual Ins. Co., 1994 MTWCC 1997. Here, section 39-71-407(5), MCA (1993) relieves the insurer of liability where 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.

         Topics:

Constitutions, Statutes, Regulations and Rules: Montana Code Annotated: section 39-71-407(5), MCA (1993). 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.
Causation: Injury. 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.
Injury and Accident: Subsequent Injury. 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.
Injury and Accident: Causation. 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.
Injury and Accident: Non-work-related. 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.

The trial in this matter was held on October 12, 1995, in Great Falls, Montana. Petitioner, Don Hamlin (claimant), was present and was represented by Mr. Cameron Ferguson. Respondent, State Compensation Insurance Fund, was represented by Ms. Ann E. Clark. The claimant testified on his own behalf. Additionally, Dr. Catherine Capps provided telephonic testimony. Exhibits 1 through 10, 13 and 16 were admitted without objection. Exhibits 12, 14 and 15 were withdrawn. Exhibit 11 was admitted over the objection of Mr. Ferguson. The deposition of claimant was submitted for the Court's consideration.

         Issues presented: The claimant contends that a non-work-related injury to his left knee which occurred in July 1994 is causally related to an earlier industrial injury he suffered July 31, 1993. He also seeks attorney fees and costs.

         Post-trial exhibits: Subsequent to trial the Court determined that the medical records of Dr. Melvin, who treated claimant for his injuries, were incomplete. I concluded that the missing records may provide helpful information concerning whether claimant's industrial injury contributed to his 1994 injury, and directed the parties to obtain the additional records. I also provided them with an opportunity to object to the additional records once obtained. The records were thereafter obtained by the parties and submitted to the Court without objection. They have been added to Exhibit 4 as pages three through six.

         Having considered the Pre-trial Order, the testimony presented at trial, the demeanor and credibility of the witnesses, the deposition and exhibits, and the arguments of the parties, the Court makes the following:

         FINDINGS OF FACT

         1. Claimant is 28 years old. He has a GED and has worked in the past as a construction laborer, cook, dishwasher, and caterer.

         2. In the summer of 1993, claimant was employed by the Heritage Inn in Great Falls, Montana, to set up banquet rooms for weddings, parties and other special events.

         3. On July 31, 1993, while working at Heritage and porting a heavy table down some stairs, claimant suffered an industrial injury. His left knee gave way as he was going down the stairs. Claimant felt immediate pain and fell. After getting up he was unable to straighten his left leg.

         4. At the time of the injury, Heritage was insured by the State Fund, which accepted liability for the claim for compensation. Following its acceptance of liability, the State Fund paid medical, temporary total, and permanent partial disability benefits.

         5. Immediately following his injury, claimant sought treatment at the Columbus Hospital emergency room. Dissatisfied with Columbus, he then went to the Montana Deaconess Medical Center emergency room where he was seen by M. F. Doubek, M.D. Dr. Doubek diagnosed lumbago and left knee pain but also felt that claimant was exhibiting behavior suggestive of malingering. Dr. Doubek prescribed analgesic and anti-inflammatory medications. (Ex. 5 at 2, 4; Hamlin Dep. at 52-53.)

         6. Claimant continued to have difficulty with his knee and was examined by Dr. Paul Melvin, an orthopedic surgeon, on August 4, 1993. Dr. Melvin suspected claimant had torn his medial meniscus and recommended an MRI . He took claimant off work. (Ex. 4 at 4; Ex. 3 at 3.)

         7. Claimant underwent an MRI on August 5, 1993. The MRI report revealed the following:

1. Small amount of fluid within the joint space.
2. Tear of the posterior horn of the medial meniscus.
3. Increased signal in the posterior cruciate ligament and apparent disruption of the anterior cruciate ligament.

(Ex. 9 at 2.)

         8. Dr. Melvin performed arthroscopic surgery on claimant's left knee on August 18, 1993 to repair a tear of the anterior cruciate ligament and a tear of the mid and posterior ...


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