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Coates v. Liberty Northwest Insurance Corp.

Court of Workers Compensation of Montana

November 18, 1996

AMMIE L. COATES Petitioner
v.
LIBERTY NORTHWEST INSURANCE CORPORATION Respondent/Insurer for VALLEY VIEW ESTATES NURSING HOME Employer.

          Date Submitted: November 4, 1996

          FINDINGS OF FACT, CONCLUSIONS OF LAW AND JUDGMENT

          MIKE MCCARTER JUDGE.

         Summary: 22-year old certified nurse's assistant fell while assisting patient. After her employment was terminated, she did not obtain other work, but complained about ongoing, debilitating back pain. Orthopedic surgeon evaluating claimant diagnosed lumbar strain, "if anything," noting there was not "enough organic, real evidence to justify an MRI." He found "dysfunctional pain behavior." Pain specialist assumed claimant's pain reports were truthful and diagnosed somatoform disorder, based on his observation the pain reports were grossly out of proportion with evidence of any objective medical condition. Claimant sought continued temporary total disability benefits.

         Held: WCC did not credit claimant's reports of pain and disability and found she purposefully exaggerated her complaints to obtain benefits. This conclusion was based on several factors, including: the lack of objective medical evidence of any continued condition; contradiction between her demeanor in court and records of pain behavior displayed for physicians; conflicts between her testimony and that of medical providers; conflicts between her deposition and trial testimony.

         Topics:

Benefits: Temporary Total Benefits.

Claim for continued TTD benefits denied where WCC did not credit claimant's reports of pain and disability and found she purposefully exaggerated her complaints to obtain benefits. This conclusion was based on several factors, including: the lack of objective medical evidence of any continued condition; contradiction between her demeanor in court and records of pain behavior displayed for physicians; conflicts between her testimony and that of medical providers; conflicts between her deposition and trial testimony; observations of pain behavior by medical providers.

Medical Conditions (By Specific Condition): Somatoform Disorder.

Although pain expert diagnosed somatoform disorder following back injury, WCC found claimant was purposefully exaggerating her complaints and alleged disability in order to obtain benefits. Further TTD denied.

Pain.

Claim for continued TTD benefits denied where WCC did not credit claimant's reports of pain and disability and found she purposefully exaggerated her complaints to obtain benefits. This conclusion was based on several factors, including: the lack of objective medical evidence of any continued condition; contradiction between her demeanor in court and records of pain behavior displayed for physicians; conflicts between her testimony and that of medical providers; conflicts between her deposition and trial testimony; observations of pain behavior by medical providers.

Witnesses: Credibility.

Claim for continued TTD benefits denied where WCC did not credit claimant's reports of pain and disability and found she purposefully exaggerated her complaints to obtain benefits. This conclusion was based on several factors, including: the lack of objective medical evidence of any continued condition; contradiction between her demeanor in court and records of pain behavior displayed for physicians; conflicts between her testimony and that of medical providers; conflicts between her deposition and trial testimony; observations of pain behavior by medical providers.

         The trial in this matter was held in Missoula, Montana, on October 21, 1996. Petitioner, Ammie Coates (claimant), was present and represented by Mr. Howard C. Greenwood. Respondent, Liberty Northwest Insurance Corporation (Liberty), was represented by Mr. Larry W. Jones.

         Exhibits: Exhibits 1 through 8 were admitted at trial without objection by either party.

         Witnesses and Depositions: Claimant, Rod Moore, and Martin Cheatle, Ph.D., testified at trial. In addition, the parties submitted depositions of Dr. James H. Chandler, Dr. Martin D. Cheatle, Dr. James R. Burton, Dr. Walker J. Ashcraft, and claimant to the Court for its consideration.

         No transcript of the trial has been prepared.

         Issues Presented: Claimant seeks additional temporary total disability benefits on account of a back injury she suffered on November 30, 1994. She also seeks attorney fees, costs, and a penalty.

         * * * * *

         Having considered the pretrial order, the testimony presented at trial, the demeanor and credibility of the witnesses, the depositions and exhibits, and the arguments of the parties, the Court makes the following:

         FINDINGS OF FACT

         1. Claimant is 22 years old and resides in Darby, Montana, with her 3 ½ year old daughter and her fiancé, Rod Moore.

         2. Claimant quit school in the ninth grade but subsequently obtained her GED.

         3. Claimant has previously worked at McDonald's, county fairs, and Kentucky Fried Chicken, and has cleaned houses.

         4. On November 30, 1994, claimant was working as a certified nurse's assistant (CNA) for Valley View Estates Nursing Home (Valley View). Claimant's job duties included bathing, dressing, moving, and feeding residents.

         5. On November 30, 1994, claimant strained her lower back while she and a co-worker were lifting a resident. The resident became combative and claimant's co-worker let go of the resident, causing claimant and resident to fall to the floor. Claimant felt immediate pain in her lower back.

         6. Claimant reported the accident that same day to the charge nurse. According to claimant, her employment at Valley View was terminated the following day. The circumstances and reasons for her termination are not an issue in this case and the Court makes no findings regarding the termination.

         7. At the time of claimant's industrial accident, Valley View was insured by Liberty. Liberty accepted liability for the claim and thereafter paid medical expenses and temporary total disability benefits.

         8. Rod Moore testified that on the date of the accident claimant came home from work and appeared to be in pain. He gave claimant a couple of Darvocet, a pain medication for which he apparently had a prescription. Claimant testified that the Darvocet made her "feel not so bad."

         9. Claimant described the location of her back pain as across her lower back. In her deposition she testified that it has worsened since the day of her injury. (Coates Dep. at 21, 24.) She further testified that she has also experienced tingling and numbness in her right buttock and upper leg. (Id. at 23.)

         10. Claimant described her activities in her deposition. She said that on an average day she arises around 7:30 a.m. and cooks breakfast. (Id. at 26.) Her mother helps her do the shopping, cooking and cleaning. (Id. at 33.) In the afternoon, she goes to town or visits relatives. (Id. at 26-28.) She testified that everyday activities, including lifting her "heavy" daughter, make her pain worse over the course ...


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