Submitted: March 9, 1998
In 1992, claimant and State Fund settled his claim for
indemnity benefits, reserving medical benefits. Subsequently,
there were numerous disputes between claimant and the insurer
relating to the nature and extent of authorized medical care,
the identity of authorized medical providers, and payment of
medical expenses. Evidence from claimant's physicians and
a psychologist indicated that claimant had become obsessed
and paranoid concerning the workers' compensation
delivery "system" and that this interfered with his
health. Medical care providers, the claimant, and State Fund
were in agreement for settlement of medical benefits and had
negotiated an agreement whereby State Fund would pay claimant
$50, 000 in a lump sum and purchase an annuity paying him
$965 per month for ten years, with a clause that unpaid
annuity amounts would revert to State Fund should claimant
die before expiration of the ten years. The parties sought
Court approval of the settlement so that the matter would be
considered fully and finally resolved by all.
The WCC has wide discretion to approve a settlement on the
basis suggested where the parties are in agreement and
settlement is in claimant's best interests. Where medical
authority speaks firmly that claimant must have final
resolution of workers' compensation issues to achieve
maximum recovery and health, an appropriate basis for
settlement exists. The settlement is approved.
Settlements: Medical Benefits. Under its
wide discretion to approve a settlement agreed to by the
parties and in claimant's best interest, the WCC approves
settlement of claimant's medical benefits where evidence
indicates claimant and the insurer had numerous disputes
relating to the nature and extent of authorized medical care.
Medical evidence indicated claimant had become obsessed and
paranoid regarding the workers' compensation delivery
"system" and that this interfered with his health.
Under the agreement, State Fund would pay claimant $50, 000
in a lump sum and purchase an annuity paying him $965 per
month for ten years, with any unpaid annuity amounts
reverting to State Fund should claimant die before expiration
of the ten years. The settlement was approved because its
terms were reasonable and medical authority had spoken firmly
that claimant must have final resolution of workers'
compensation issues to achieve maximum recovery and health.
The Court assumed jurisdiction of this cause under section
39-71-2905, MCA, and ordered an evidentiary hearing on the
question of whether to approve a tentative resolution of the
controversy between the parties. The evidentiary hearing came
before the Court on March 6, 1998, at 11:00 a. m. Mr. Tom L.
Lewis represented the petitioner. Ms. Susan C. Witte
represented the State Compensation Insurance Fund (State
Fund). Ms. Carol Gleed appeared on behalf of the Department
of Labor and Industry (Department). Jeremy Shawn Valance, the
petitioner, and Henry P. Worsech, Jr., Senior Adjuster for
the State Fund, were sworn and testified.
On September 26, 1989, while in the course and scope of his
employment with Louie D. O'Brien in Libby, Lincoln
County, Montana, the claimant injured his spine when he was
on top of a load of logs chopping off limbs and slipped on
wet logs falling on his tailbone.
The claimant settled his claim by compromise settlement in
May 1992. By the settlement order, claimant reserved medical
benefits under the Workers' Compensation Act. Subsequent
to the settlement there were disputes between the claimant
and the insurer relating to the nature and extent of
authorized medical care, the identity of the medical
professionals who were to provide medical services, and
payment of medical expenses submitted to the insurer.
The mediation procedures set forth in the Workers'
Compensation Act have been complied with by the parties.
After mediation and extensive negotiations, the parties
reached a tentative resolution of the controversy between the
parties, whereby the insurer would pay the claimant $50, 000
in a lump sum and purchase an annuity paying him $965 per
month for ten years. The parties are unwilling to consummate
this compromise agreement without an Order of the Court based
upon full disclosure of the relevant facts, so that there can
be no question that this matter is finally resolved.
The claimant suffered injury to his spine as a result of his
industrial accident. He has undergone lumbar laminectomy and
cervical fusion. He is still under treatment for his injuries
and has undergone extensive evaluations, which objectively
document a basis for ongoing treatment including medication
(Lortab elixir) for chronic pain, surgery to accommodate a
problem swallowing food diagnosed as pharyngeal phase
dysphasia with epiglottic dysfunction, surgery on his
tailbone, and possible repeat lumbar surgery.
Confounding treatment of these objective medical problems is
a lack of trust in the workers' compensation delivery
"system" reinforced by ongoing disputes with the
insurer to the point that the claimant became obsessive and
paranoid concerning workers' compensation. This lack of
trust is dysfunctional and interferes with his treatment. The
claimant's primary treating physician and psychological
counselor have also documented the fact that claimant must
have a complete financial settlement with State Fund so that
he can manage his life-long medical and psychological care on
his own. Based upon the testimony and medical documentation
reviewed, the lack of closure of claimant's workers'
compensation dispute exacerbates his extreme obsessiveness
about his injuries and pain. Medical care providers recommend
a "fair settlement" so that the claimant can
achieve a treatment plan and appropriate therapy.
Medical care providers, the claimant, and the State Fund are
in agreement that the best course of action is to settle all
aspects of his workers' compensation case, so that
claimant will have the funds to secure medical care and
treatment from physicians with whom he has full confidence,
without any interference from workers' compensation.
Unless this matter is put behind claimant, it appears that he