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.

Davis v. Liberty Insurance Corp.

Court of Workers Compensation of Montana

July 25, 2017

ALAN DAVIS Petitioner
v.
LIBERTY INSURANCE CORPORATION Respondent/Insurer EMPLOYMENT RELATIONS DIVISION, DEPARTMENT OF LABOR AND INDUSTRY Intervenor.

          ORDER DENYING RESPONDENT'S MOTION TO AMEND

          DAVID M. SANDLER, JUDGE

         Summary: Respondent moved to amend its Response to Petition for Hearing to assert affirmative defenses based on its contention that the compromise settlement of Petitioner's wage-loss benefits precludes him from asserting that he is permanently totally disabled. Respondent maintains that Petitioner's medical benefits terminated under the 60-month limitation of medical benefits in § 39-71-704(1)(f)(i), MCA (2011), and that Petitioner does not have the right to ongoing medical benefits under § 39-71-704(1)(f)(ii), MCA, (2011) which provides that the 60-month limitation "does not apply to a worker who is permanently totally disabled as a result of a compensable injury."

         Held: This Court denied Respondent's Motion to Amend because its proffered affirmative defenses are not legally tenable defenses. As a matter of law, the issues settled via a compromise settlement remain "uncertain or undetermined." Thus, Petitioner may litigate the issue of whether he is permanently totally disabled under the definition at § 39-71-116(28), MCA (2011), for purposes of establishing his right to medical benefits under § 39-71-704(1)(f)(ii), MCA (2011), notwithstanding the compromise settlement of his asserted right to PTD benefits under § 39-71-702, MCA (2011). Moreover, Petitioner expressly reserved medical benefits "to the extent allowed under the Workers' Compensation Act, " which includes the contractual right to maintain that he is permanently totally disabled for purposes of medical benefits under § 39-71-704(1)(f)(ii), MCA (2011).

         ¶ 1 Respondent Liberty Insurance Corporation (Liberty) moves to amend its Response to Petition for Hearing. Petitioner Alan Davis argues that Liberty should not be permitted to amend because its proposed amendments do not set forth tenable defenses and are therefore futile. This Court agrees with Davis.

         Facts and Procedural History

         ¶ 2 Davis was injured on October 7, 2011.[1] Liberty accepted liability for his claim.

         ¶ 3 In the early summer of 2016, Davis and Liberty entered into a compromise settlement of his wage-loss benefits. In relevant part, the Petition for Settlement states:

Significant disputes exist concerning Claimant's entitlement to wage loss and/or rehabilitation benefits for his October 7, 2011 claim. Based on these and other disputes between the parties, and rather than face the uncertainty of litigation, the parties have agreed to resolve all disputes between them by way of compromise settlement. Pursuant to this agreement, the Insurer shall pay and the Claimant shall accept the sum of Seventy-Two Thousand Two Hundred Seventy-Three and 30/100 Dollars ($72, 273.30). The settlement resolves any and all claims by Claimant for benefits arising out of his October 7, 2011 workers' compensation claim including, but not limited to, any claims for past or future temporary total disability benefits, permanent partial disability benefits, temporary partial disability benefits, permanent total disability benefits, death benefits, rehabilitation benefits, and any claim for costs or attorney's fees pursuant to the Workers' Compensation Act. Claimant is responsible for the payment of any attorney fee that is owed as a result of this settlement.
Medical benefits are expressly reserved by Claimant for any medical condition causally related to the October 7, 2011 workers' compensation claim to the extent such benefits are allowed under the Workers' Compensation Act, and the Insurer reserves any and all defenses at law or equity to any claims for medical benefits.[2]

         The Petition for Settlement and the Settlement Recap Sheet states: "This settlement is based on consideration of Claimant's permanent total disability benefit rate after that rate has been adjusted to reflect the offset the Insurer would be entitled to take against an award of social security benefits." The Settlement Recap Sheet also states:

The [part-time job Davis worked for about four years] is no longer available to Claimant and the party's [sic] dispute claimant's disability status and whether he is entitled to additional wage loss and/or rehabilitation benefits for his October 7, 2011 claim. Based on these and other disputes between the parties, and rather than face the uncertainty of litigation, the parties have agreed to resolve all disputes between them by way of compromise settlement.

         ¶ 4 The Employment Relations Division of the Department of Labor and Industry approved the settlement on July 8, 2016.

         ¶ 5 On October 17, 2016, Liberty denied liability for Davis's ongoing medical benefits pursuant to § 39-71-704(1)(f), MCA. That statute provides:

(i) The benefits provided for in this section terminate 60 months from the date of injury or diagnosis of an occupational disease. A worker may request reopening of medical benefits that were terminated under this subsection (1)(f) as provided in 39-71-717.
(ii) Subsection (1)(f)(i) does not apply to a worker who is permanently totally disabled as a result of a compensable injury or occupational disease or for the repair or replacement of a prosthesis furnished as a direct result of a compensable injury or occupational disease.

         ¶ 6 In his Petition for Hearing, Davis alleges that he is permanently totally disabled and, therefore, that his medical benefits remain open pursuant to § 39-71-704(1)(f)(ii), MCA. In the alternative, Davis challenges the 60-month limitation on equal protection and due process grounds.

         ¶ 7 In its Response to Petition for Hearing, Liberty counters that Davis is not permanently totally disabled. Liberty also asserts that ...


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.