Hiett v. Missoula County Public Schools

• Decision Date: 14 August 2003
• Docket Number: No. 02-043.,02-043.
• Citation: 2003 MT 213,317 Mont. 95,75 P.3d 341
• Parties: Eula Mae HIETT, Petitioner and Appellant, v. MISSOULA COUNTY PUBLIC SCHOOLS, Respondent/Insurer/Employer.
• Court: Montana Supreme Court

75 P.3d 341

2003 MT 213

317 Mont. 95

Eula Mae HIETT, Petitioner and Appellant, v. MISSOULA COUNTY PUBLIC SCHOOLS, Respondent/Insurer/Employer.

No. 02-043.

Supreme Court of Montana.

Heard October 10, 2002.

Submitted October 29, 2002.

Decided August 14, 2003.

Sydney E. McKenna (argued), Tornabene & McKenna, Missoula, Montana, for Appellant.

Leo S. Ward (argued), Kimberly L. Towe, Browning, Kaleczyc, Berry & Hoven, Helena, Montana, for Respondent.

For Amicus Montana Trial Lawyers' Association, Patrick R. Sheehy (argued), Halverson, Sheehy & Plath, Billings, Montana.

Justice PATRICIA O. COTTER delivered the Opinion of the Court.

¶ 1 Eula Mae Hiett (Hiett) appeals the Workers' Compensation Court's (WCC) determination that she was not entitled to payment for certain prescription drugs. We affirm in part and reverse and remand in part.

¶ 2 Hiett presents one issue on appeal — did the WCC err when it determined that she was not entitled to payment for prescription drugs necessary to control pain and depression resulting from her compensable back injury?

FACTUAL AND PROCEDURAL BACKGROUND

¶ 3 On March 1, 1996, Hiett, then 59 years old, had been working for sixteen years as a custodian for the Missoula County Public Schools (School District). On this day, she lifted a 30-gallon trash can and suffered compression fractures of her T6 and T8 thoracic vertebrae.

¶ 4 At the time of the injury, the School District was a member of a school self-insurance pool known as Montana Schools Group Insurance Authority (MSGIA). MSGIA accepted liability for Hiett's condition and paid disability and medical benefits. Hiett sought treatment from Dr. Sable who found her to be at maximum medical improvement (MMI) in June 1996. Hiett was permanently restricted to sedentary to light-duty work.

¶ 5 In July 1996, Hiett returned to work as a part-time custodian with modified duties. This work, however, aggravated her back pain and she was forced to stop. Shortly thereafter, Dr. Sable diagnosed her with anxiety and depression triggered by her inability to work as a custodian because of her work-related injury. He prescribed various medications to address her anxiety and depression and MSGIA accepted liability for these medications. A psychiatrist also examined Hiett and concurred with Dr. Sable's conclusion.

¶ 6 In September 1996, Dr. Sable approved a number of jobs for Hiett. Based upon his determination that Hiett had reached MMI and his approval of a number of jobs, MSGIA terminated Hiett's temporary partial disability (TPD) benefits and tentatively calculated her permanent partial disability (PPD) at 26%, or $17,290.

¶ 7 Hiett was unable to obtain the desired School District job that had been approved by Dr. Sable because she was not qualified. A two-hour per day job was offered but she turned it down because it would have cost her more to get to and from work than she would have earned. A few other approved jobs were available during the last four months of 1996 but Hiett did not apply for them. In December 1996, the School District terminated Hiett's employment, effective January 3, 1997. Hiett then began receiving Social Security Disability (SSD) benefits retroactive to September 1996, and submitted her application for retirement to the Public Employees Retirement System.

¶ 8 Settlement negotiations began in January 1997, over Hiett's entitlement to PPD and rehabilitation benefits. Negotiations terminated in July 1997, with a settlement agreement under which Hiett received $27,930. The agreement closed rehabilitation benefits but reserved "further medical and hospital benefits." At no time prior to the settlement did MSGIA tell Hiett or her attorney that continued payment for medications was contingent upon Hiett obtaining employment.

¶ 9 At the time Hiett settled her claim she was not working nor, with the exception of the short-term modified custodial position in July 1996, had she worked since sustaining her March 1, 1996 injury. Subsequent to the settlement, she occasionally worked selling tickets at high school sporting events. She also worked from May 2000 to November 2000 as an assisted-living attendant at a retirement facility. However, she had to leave that job upon being hospitalized for drug withdrawal from medications she had been taking.

¶ 10 MSGIA paid for Hiett's pain medication from May 1996 until January 1999. It paid for her anti-depressants from August 1996 until January 1999. In January 1999, a new claims adjuster, Charles Edquest, took over Hiett's case file. Upon a review of the file, he concluded that Hiett's medications constituted "secondary medical services," and discontinued payment for these medications because Hiett was not working. Edquest did not contact Hiett to determine whether she was working at that time, nor did he notify her that he was discontinuing her prescription benefits. She learned that insurance was not paying for her medicine when, in the fall of 1999, she attempted to refill one of the prescriptions and was told there was a $1,600 bill outstanding with the pharmacist. She was then told that no insurance payment had been made for ten months.

¶ 11 Hiett's counsel contacted Edquest in early October 1999. Edquest then agreed to pay for Hiett's past prescriptions, in part because he had inadvertently failed to notify her that prescription benefits were to be discontinued. Several months passed, however, and the bills remained unpaid so Hiett requested mediation. After the first mediation, a $1,200 payment for prescriptions was made. Other bills remained outstanding and Edquest offered administrative reasons for the delay but agreed once again to pay them.

¶ 12 Hiett was ultimately notified that MSGIA contested its obligation to pay for further medications because Hiett was not working. She requested a second mediation upon being told benefits were to be discontinued. The second mediation was postponed pending an opinion from Hiett's doctor that Hiett's medications were essential to her well-being and would allow her to work. Upon receipt of a letter to this effect in September 2000, at which time Hiett was working for the retirement facility, MSGIA agreed to pay for Hiett's medication for as long as she worked.

¶ 13 Some prescription bills still remained unpaid as of December 31, 2000; therefore, Hiett requested a third mediation. By this time, however, Hiett had left her job with the retirement facility. As a result, the parties could not reach agreement regarding Hiett's entitlement to further payment of prescriptions. MSGIA maintained its position that such benefits were "secondary" benefits and would be paid only while Hiett was employed. Hiett petitioned the Workers' Compensation Court. Pending the court's ruling, MSGIA agreed to continue paying for Hiett's injury-related medications.

¶ 14 At the trial before the WCC held on April 11, 2001, Hiett and Edquest both testified. On September 6, 2001, the WCC issued its Findings of Fact, Conclusions of Law and Judgment holding that Hiett was not entitled to payment for her prescription drugs unless the medications would enable her to return to employment and, once employed, enable her to continue working. The WCC also concluded that Hiett was entitled to a penalty with respect to those benefits MSGIA agreed to pay but failed to pay within a reasonable time. The court's findings and conclusions will be discussed in further detail below.

STANDARD OF REVIEW

¶ 15 This Court employs two standards of review for decisions of the Workers' Compensation Court: we review the findings of fact to determine if they are supported by substantial, credible evidence, and we review conclusions of law to determine if they are correct. Geiger v. Uninsured Employers' Fund, 2002 MT 332, ¶ 13, 313 Mont. 242, ¶ 13, 62 P.3d 259, ¶ 13 (citations omitted). In workers' compensation cases, the law in effect at the time of the claimant's injury establishes the claimant's substantive right to benefits. State Compensation Ins. Fund v. McMillan, 2001 MT 168, ¶ 6, 306 Mont. 155, ¶ 6, 31 P.3d 347, ¶ 6.

DISCUSSION

¶ 16 Hiett advances several legal theories for her contention that the WCC erred in reaching its conclusion that she was not entitled to the prescription benefits she seeks, one of which is that the WCC misinterpreted and misconstrued the relevant statutory provisions. Because we resolve this case under the court's statutory interpretation, we need not address the other theories advanced by Hiett.

¶ 17 The Workers' Compensation Act (the Act), first enacted in 1915, provided for the "protection and safety of workmen in all places of employment and for inspection and regulation of places of employment...." Chapter 96, Laws of Montana, 1915. Several revisions later, in 1987, the Legislature revised the public policy behind the law to include:

It is an objective of the Montana workers' compensation system to provide, without regard to fault, wage supplement and medical benefits to a worker suffering from a work-related injury or disease....

Section 39-71-105(1), MCA (1995).

¶ 18 Despite its many changes, Montana's Act, like similar workers' compensation acts throughout the country, was primarily created to assure compensation and medical benefits to injured workers without requiring them to sue their employers and surmount a difficult burden of proof. We note as well that employers benefit from the Act in that it protects them from suits by injured employees and from potentially high damage awards.

¶ 19 In providing medical care benefits, the Act allows for payment of "primary medical services" and "secondary medical services." "Primary medical services" are defined as:

treatment prescribed by a treating physician, for conditions resulting from the injury, necessary for achieving medical stability.

Section 39-71-116(25), MCA (1995).

"Secondary medical services" are defined as:

those medical services or appliances that are considered not

...