Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Alocco v. Cigna Insurance

Court of Workers Compensation of Montana

December 6, 2000

CARL ALOCCO Petitioner
v.
CIGNA INSURANCE Respondent/Insurer for MONTANA REFINING COMPANY Employer.

          Submitted: November 8, 2000

          DECISION AND JUDGMENT

          MIKE MCCARTER JUDGE

         Summary: Insurer denied liability for claimant's surgery. The denial was adjudicated and this Court held that it was in fact compensable and that the insurer must pay medical bills. 1999 MTWCC 37. Claimant then filed this petition alleging that since his health insurer paid many of the bills he should be reimbursed for his health care insurance co-payments and deductibles.

         Held: The liability of the insurer is governed by statute, which specifies a fee schedule for medical payments. Medical providers are limited to those fees and in light of the insurer's denial of liability it has a duty to assist claimant in recovering amounts he paid which are in excess of co-payments specified in section 39-71-704.

         Topics:

Benefits: Medical. An insurer's liability for medical benefits is limited to fee schedules promulgated by the Department of Labor and Industry pursuant to section 39-71-704 (1995). Denial of a claim does not increase its liability.
Benefits: Medical. A claimant's liability to medical providers for medical care related to his industrial injury is limited to the co-payments required by 39-71-704(7). Any amounts paid by a claimant in excess of those co-payments must be refunded by the providers.
Benefits: Medical. Where the insurer denies liability for medical services and claimant pays for those services, in whole or in part, and the insurer is later found liable for the services, the insurer has a duty to assist claimant in seeking repayment from the medical providers.
Insurers: Duties. Where the insurer denies liability for medical services and claimant pays for those services, in whole or in part, and the insurer is later found liable for the services, the insurer has a duty to assist claimant in seeking repayment from the medical providers.

         ¶1 The claimant in this matter seeks to enforce a prior judgment of this Court ordering CIGNA to pay medical benefits and temporary total disability benefits. Alocco v. Cigna Insurance, 1999 MTWCC 37. Only the medical benefits are at issue here.

The judgment regarding medical benefits was as follows:
¶48 1. Petitioner is entitled to medical benefits for the surgery of May 9, 1997, and all medical treatments as a result of his injury and surgery, including chiropractic treatments in 1996 and 1997 for his low back and Dr. Margaris' April 1997 examination.
In his petition, the claimant alleges that some bills are in dispute and that the insurer has not fully reimbursed him for other bills. He argues that he should be reimbursed in full for all of his out-of-pocket medical expenses by CIGNA. Thus, he would not have to seek ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.