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.

Rice v. Liberty Northwest Insurance Corp.

Court of Workers Compensation of Montana

November 4, 2004

JOHN T. RICE Petitioner
v.
LIBERTY NORTHWEST INSURANCE CORPORATION Respondent/Insurer.

          Submitted: October 22, 2004

          For Petitioner Thomas J. Lynaugh Attorney at Law

          For Respondent Larry W. Jones Attorney at Law

          DECISION AND JUDGMENT

          Mike McCarter Judge

         Summary:

         The claimant injured his neck and head in a 1996 motorcycle accident and underwent a diskectomy and fusion at the C4-5 level, however, he thereafter returned to work and worked successfully over a four-year period until he was thrown about the cab of his truck when a large boulder struck the truck. The incident was work related. The claimant thereafter experienced significant neck and arm pain, as well as headaches. A neurosurgeon diagnosed a C5-6 level herniated disk and performed a diskectomy and fusion at that level. Based on independent medical examination (IME) opinions, however, the insurer denied liability for the surgery, medical care, and indemnity benefits.

         Held:

         The opinions of the treating neurosurgeon are more persuasive in light of his greater expertise regarding the condition at issue, his continuing treatment of the claimant over the years, the fact that the claimant plainly suffered a significant increase of symptoms following the 2003 work-related incident, and the fact that the surgery resulted in a significant improvement of his symptoms. Dr. Ross' testimony that claimant's symptoms were anatomically inconsistent with a herniated cervical disk was unconvincing where the neurosurgeon plainly felt they were not.

         Topics:

Attorney Fees: Reasonableness of Insurers. The Workers' Compensation Court has indicated in past decisions that an insurer is entitled to rely on the opinion of an independent medical examiner. While the statement is generally true, the prior decisions should not be read as indicating that an insurer acts reasonably in every case in which a denial of liability is based on an IME opinion. The insurer has a duty to consider all facts and circumstances in determining liability. Other facts and circumstances may indicate that it cannot reasonably rely on an IME opinion.
Penalties: Insurers. The Workers' Compensation Court has indicated in past decisions that an insurer is entitled to rely on the opinion of an independent medical examiner. While the statement is generally true, the prior decisions should not be read as indicating that an insurer acts reasonably in every case in which a denial of liability is based on an IME opinion. The insurer has a duty to consider all facts and circumstances in determining liability. Other facts and circumstances may indicate that it cannot reasonably rely on an IME opinion.
Proof: Conflicting Evidence: Medical. Treating physician's opinions are more persuasive where he has more expertise in the area of medicine under consideration, where the opinions are more consistent with the claimant's history, and where the treatment prescribed by the treating physician is consistent with his opinions and in fact materially improves the claimant's condition.

         ¶1 The trial in this matter was held on October 22, 2004, in Billings, Montana. Petitioner, John T. Rice (claimant), was present and represented by Mr. Thomas J. Lynaugh. Respondent was represented by Mr. Larry W. Jones. Exhibits 1 through 3, 5, 7 through 10, and 12 were admitted without objections. Exhibits 4, 6, 11, and 13 were admitted over objections. The claimant, Debra Rice, Dr. Scott Ross, and Gary Schild were sworn and testified. In addition, the Court considered the depositions of the claimant, Dr. Robert C. Wood, Dr. Scott K. Ross, and Gary Schild.

         ¶2 After considering the trial testimony, exhibits, and depositions, the Court bench ruled in favor of the claimant, holding that he suffered an industrial injury to his neck on April 1, 2003, and that the injury and his subsequent medical treatment, including neck surgery, were causally connected to his industrial injury. Therefore, I ruled that Liberty Northwest Insurance Corporation (Liberty) is liable for indemnity benefits, which it has been paying under a reservation of rights, and for the claimant's post-injury medical expenses related to his neck and surgery. The rationale for my decision was delivered orally. The parties agreed that a transcript of the Court's oral decision may constitute its findings of fact and conclusions of law. A copy of the transcript is therefore attached.

         FACTUAL BACKGROUND

         ¶3 While the transcript of my bench ruling is attached, some factual background information is necessary to understand my ruling. The important facts are as follows:

         ¶4 The claimant is a heavy equipment operator for the Decker Coal Company at its Decker, Montana, mine. He has worked for Decker for thirty years.

         ¶5 The claimant was involved in a motorcycle accident in June 1996 when he hit a deer. He suffered neck, head, and other injuries.

         ¶6 Following the1996 motorcycle accident, the claimant was off work for approximately one year. He returned to work in June 1997, but in September 1998 began experiencing severe neck and arm pain attributable to his 1996 accident. He was diagnosed with a herniated cervical disk at the C5-C6 level. Dr. Robert Wood, a neurosurgeon, operated, doing a diskectomy and fusion at the C5-C6.

         ¶7 After the claimant recovered from the surgery, Dr. Wood asked Dr. Scott Ross, who specializes in occupational medicine, to evaluate the claimant with respect to a return to work. Dr. Ross saw the claimant in February of 1999 and approved claimant's return to work as an equipment operator without restrictions.

         ¶8 The claimant returned to work in 1999 but again sought medical advice from Dr. Robert Schultz in 2001 on account of left arm pain. At the time, the claimant's primary job was driving a dozer, which involved extensive use of his left arm in an outstretched position. His difficulty was felt to be positional and related to his dozer operation. Upon Dr. Schultz's advice, the claimant arranged with his employer to operate the dozer only occasionally, and even then to cease doing dozer work if his arm started to hurt.

         ¶9 The limitation of his dozer work alleviated his arm pain and he did not thereafter seek medical care until April 2, 2003, after an April 1, 2003 work-related incident where the truck he was driving was hit by a large boulder and he was thrown about the cab of the truck, hitting his head. Following that event, the claimant experienced extreme neck and arm pain, as well as increased headaches.

         ¶10 Dr. Wood, the neurosurgeon, resumed the claimant's care. He ultimately ordered a CT myleogram which disclosed a disk protrusion at the C6-C7 level. He thereafter performed a diskectomy and fusion at that level. The claimant's pain improved significantly following the surgery.

         ¶11 Liberty denied liability for the surgery on the ground that the surgery was unrelated to the April 1, 2003 incident. The denial was largely based on the opinion of Dr. Ross, who evaluated the claimant prior to the surgery. Dr. Ross evaluated the claimant on referral by Dr. Wood, however, Dr. Wood made the referral at the express ...


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.