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Sears v. Travelers Insurance

Court of Workers Compensation of Montana

February 24, 1998

STEPHEN A. SEARS Petitioner
v.
TRAVELERS INSURANCE Respondent/Insurer for COULTER CORPORATION Employer.,

          Submitted: October 31, 1997

          ORDER DENYING MOTION FOR RECONSIDERATION

          MIKE MCCARTER JUDGE

         Summary: Claimant requested reconsideration of order denying summary judgment. Claimant repeated his argument that TTD benefits were not properly terminated under criteria of Coles v. Seven Eleven Stores, WCC No. 2000 (1985) where physician had not been given a "technically accurate" job description for purposes of considering claimant's ability to work.

         Held: Motion denied. The statutes governing temporary total disability benefits expressly provide that a claimant is entitled to TTD benefits only until such time as the claimant reaches maximum medical healing. Section 39-71-609, MCA (1995) sets out the requirements for terminating TTD benefits. Under subsection (2) of that section, TTD "benefits may be terminated on the date that the worker has been released to return to work in some capacity." While insurers are well advised to continue following the practices identified in Coles, including providing technically accurate job descriptions to physicians evaluating return to work, the Coles criteria are not mandated by statute. Extending TTD benefits for non-compliance with Coles criteria irrespective of whether statutory criteria for terminating benefits are met would in effect impose a penalty of sorts on the insurer, without statutory justification. Where claimant does not contend he was in fact still TTD, the Court refuses to extend TTD benefits based on alleged non-compliance with one of the criteria of Coles.

         Topics:

Constitutions, Statutes, Regulations and Rules: Montana Code Annotated: section 39-71-609, MCA (1995). Where claimant does not contend he was in fact still TTD, the Court refuses, on motion for reconsideration, to extend TTD benefits based on alleged non-compliance with one of the criteria of Coles. Claimant had repeated his argument that TTD benefits should have been continued because the insurer failed to provide the physician evaluating his ability to return to work a "technically accurate" job description. WCC adheres to original ruling that technical failure to comply with Coles does not warrant extending TTD benefits where statutory criteria for terminating benefits are met.
The statutes governing temporary total disability benefits expressly provide that a claimant is entitled to TTD benefits only until such time as the claimant reaches maximum medical healing. Under section 39-71-609(2), MCA (1995), TTD "benefits may be terminated on the date that the worker has been released to return to work in some capacity." While insurers are well advised to continue following the practices identified in Coles, including providing technically accurate job descriptions to physicians evaluating return to work, extending TTD benefits for non-compliance with Coles criteria irrespective of whether statutory criteria for terminating benefits are met would in effect impose a penalty of sorts on the insurer, without statutory justification.
Benefits: Termination of Benefits: Coles. Where claimant does not contend he was in fact still TTD, the Court refuses, on motion for reconsideration, to extend TTD benefits based on alleged non-compliance with one of the criteria of Coles. Claimant had repeated his argument that TTD benefits should have been continued because the insurer failed to provide the physician evaluating his ability to return to work a "technically accurate" job description. WCC adheres to original ruling that technical failure to comply with Coles does not warrant extending TTD benefits where statutory criteria for terminating benefits are met. The statutes governing temporary total disability benefits expressly provide that a claimant is entitled to TTD benefits only until such time as the claimant reaches maximum medical healing. Under section 39-71-609(2), MCA (1995), TTD "benefits may be terminated on the date that the worker has been released to return to work in some capacity." While insurers are well advised to continue following the practices identified in Coles, including providing technically accurate job descriptions to physicians evaluating return to work, extending TTD benefits for non-compliance with Coles criteria irrespective of whether statutory criteria for terminating benefits are met would in effect impose a penalty of sorts on the insurer, without statutory justification.

         ¶1 On April 8, 1997, this Court issued an Order Denying Summary Judgment. The summary judgment was sought by claimant based upon an alleged failure of the insurer to comply with (1) the Coles criteria applicable to the termination of temporary total disability benefits and (2) the requirement that the Department of Labor and Industry be notified of such termination. Claimant thereafter moved for reconsideration with respect to the first issue. Oral argument on the motion was held on October 31, 1997.

         ¶2 After extensive reflection on the matters raised by claimant during the oral argument, the motion for reconsideration is denied.

         Discussion

         ¶3 As explained in the original Order, the Coles criteria were adopted in this Court's November 20, 1984 decision in Coles v. Seven Eleven Stores, WCC No. 2000 (affirmed on unrelated grounds in 217 Mont. 343, 704 P.2d 1048 (1985)). The criteria were ratified by the Supreme Court in Wood v. Consolidated Freightways, Inc., 248 Mont. 26, 30, 808 P.2d 502, 505 (1991). As set forth in those decisions, the insurer must satisfy four criteria prior to terminating temporary total disability benefits. The criteria are:

"(1) a physician's determination that the claimant is as far restored as the permanent character of his injuries will permit;
"(2) a physician's determination of the claimant's physical restrictions resulting from an ...

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