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Davis v. Liberty Insurance Corporation

Court of Workers Compensation of Montana

July 27, 2017

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

          Submitted: July 7, 2017

          ORDER DENYING RESPONDENT'S MOTION TO DISMISS OR IN THE ALTERNATIVE MOTION FOR SUMMARY JUDGMENT

          DAVID M. SANDLER JUDGE

         Summary: Respondent moved to dismiss Petitioner's claim that he is permanently totally disabled and therefore has the right to medical benefits under § 39-71-704(1)(f)(ii), MCA (2011). Respondent contends that this Court does not have jurisdiction because Petitioner has not gone through the administrative process to reopen his medical benefits. In the alternative, Respondent alleges that Petitioner settled the issue of whether he is permanently totally disabled, and must reopen his settlement before he can argue he is permanently totally disabled.

         Held: This Court denied Respondent's motion. Under the plain and unambiguous language of § 39-71-704(1)(f)(ii), MCA, a permanently totally disabled claimant's medical benefits do not terminate 60 months from his date of injury, and a permanently totally disabled claimant is not required to petition the DLI to "reopen" his medical benefits. Moreover, Petitioner is not attempting to reopen his settlement agreement. He did not settle the issue of whether he is permanently totally disabled; he settled his claimed right to PTD benefits on a compromise basis, thereby leaving the issue of whether he is permanently totally disabled "uncertain" and "undetermined." And, the settlement agreement states that his medical benefits remained open "to the extent such benefits are allowed under the Workers' Compensation Act." This includes the contractual right to medical benefits under § 39-71-704(1)(f)(ii), MCA.

         ¶ 1 Petitioner Alan Davis contends that he has the right to ongoing medical benefits notwithstanding the 60-month limitation for medical benefits in § 39-71-704(1)(f)(i), MCA. Davis alleges that he is permanently totally disabled and therefore entitled to ongoing medical benefits under § 39-71-704(1)(f)(ii), MCA, which states, inter alia, that the 60-month limitation on medical benefits does not apply to a claimant who is permanently totally disabled. In the alternative, Davis alleges that the 60-month limitation is unconstitutional on due process and equal protection grounds.

         ¶ 2 Respondent Liberty Insurance Corporation (Liberty) moves to dismiss on the grounds that this Court lacks jurisdiction to hear and decide Davis's claim.[1] Liberty asserts that Davis did not exhaust his administrative remedies and that this Court must dismiss this case and wait for Davis to have his claim determined by the medical review panel and complete mandatory mediation before it has jurisdiction to hear and decide Davis's claim that he is permanently totally disabled. In the alternative, Liberty asserts that under the terms of the compromise settlement of his wage-loss benefits, Davis settled the issue of whether his "disability status is PTD." Liberty maintains that Davis is attempting to reopen his settlement, and must mediate that issue before this Court has jurisdiction.

         ¶ 3 Davis counters that, under the plain statutory language stating that the administrative reopening procedure "does not apply" to a permanently totally disabled claimant, he was not required to petition the Department of Labor and Industry (DLI) to reopen his medical benefits. Davis also argues that the compromise settlement of his claimed right to permanent total disability (PTD) benefits does not preclude him from asserting he is permanently totally disabled for purposes of claiming a right to medical benefits under § 39-71-704(1)(f)(ii), MCA. For the following reasons, Davis is correct.

         Facts[2] and Procedural History

         ¶ 4 Davis was injured on October 7, 2011.[3] Liberty accepted liability for his claim.

         ¶ 5 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.[4]

         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.

         ¶ 6 The Employment Relations Division of the DLI approved the settlement on July 8, 2016.

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

         ¶ 8 Davis did not petition the DLI to reopen his medical benefits under ...


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