Montana Rail Link v. Cusa Prts., LLC.

• Decision Date: 22 December 2009
• Docket Number: No. DA 09-0244.,DA 09-0244.
• Citation: Montana Rail Link v. Cusa Prts., LLC., 222 P.3d 1021, 2009 MT 432, 354 Mont. 101 (Mont. 2009)
• Parties: MONTANA RAIL LINK, a Montana Corporation, Plaintiff and Appellee, v. CUSA PRTS., LLC, a corporation, d/b/a Powder River Transportation, Defendant and Appellant.
• Court: Montana Supreme Court

222 P.3d 1021

2009 MT 432

354 Mont. 101

MONTANA RAIL LINK, a Montana Corporation, Plaintiff and Appellee, v.CUSA PRTS., LLC, a corporation, d/b/a Powder River Transportation, Defendant and Appellant.

No. DA 09-0244.

Supreme Court of Montana.

Submitted on Briefs November 18, 2009.

Decided December 22, 2009.

For Appellant: Steven S. Carey, Andrew D. Huppert, Carey Law Firm, P.C., Missoula, Montana.

For Appellee: Darla J. Keck, Matthew A. Baldassin, Datsopoulos, MacDonald & Lind, P.C., Missoula, Montana.

Justice PATRICIA O. COTTERdelivered the Opinion of the Court.

¶ 1 CUSA PRTS., LLC (Powder River), appeals from a decision in the Thirteenth Judicial District Court ordering it to indemnify Montana Rail Link (MRL).We affirm in part, reverse in part and remand for further proceedings consistent with this Opinion.

FACTUAL AND PROCEDURAL BACKGROUND

¶ 2 MRL contracted with Powder River to provide employee transportation for MRL's workers.MRL and Powder River entered into a contract for services.The contract contained an indemnity provision, which required Powder River to "[i]ndemnify and hold MRL harmless from and against any and all loss, liability, damages, claims, demands, costs and expenses of whatsoever nature arising out [of] contractors [sic] actions in performing this agreement."

¶ 3Thomas Salazar(Salazar) was a locomotive engineer for MRL.On March 3, 2004, Salazar was injured when a van operated by Powder River was involved in a rollover accident en route to Helena, Montana.As an employee of MRL, Salazar was covered under MRL's "Wellness Program."The Wellness Program is an ERISA-compliant plan created as a result of a collective bargaining agreement entered into between MRL and Salazar's labor union, the Brotherhood of Locomotive Engineers.The Wellness Program provides certain medical and wage continuation benefits for covered injuries.The Wellness Program confers substantial discretion upon the administrator of the Wellness Program regarding eligibility determinations to receive benefits.For instance, Section 2.2 of the Wellness Plan, entitled "Requirements for Benefits for a Covered Injury," reads in part as follows:

(a) A Qualified Employee who incurs a Covered Injury must notify his or her immediate supervisor; and make and submit to the Company a report (in the manner and at the time required by Plan Rules) of the circumstances giving rise to the Injury.A Qualified Employee who is a member of a collective bargaining unit must comply with any reporting requirements imposed by the collective bargaining agreement.

...

(c) The Plan Administrator has the right to have a Physician of its choice examine the Qualified Employee as needed to determine the extent of the Injury and the limitations restricting work.

(d) The Plan Administrator has the right to obtain information to administer the Plan, including information to determine eligibility, validity of claims, and the benefits payable under the Plan.A Qualified Employee must provide the information requested for Plan administration purposes.

...

(f) The Plan Administrator is entitled, in its sole discretion, to rely upon the opinion of an independent medical expert's evaluation as to whether medical treatment and/or a work restriction is the direct and proximate result of a Covered Injury.

¶ 4 Four days after the accident, Salazar filed a personal injury report with MRL.Jacquie Duhame(Duhame) was the program administrator at that time.Salazar described his injuries as pertaining to his ribs and neck muscles.Salazar was seen by Dr. Kevin McCrea, M.D., an emergency room physician, on March 8, 2004.Duhame had preapproved the visit.Dr. McCrea noted that Salazar had right-sided musculoskeletal pain, and gave him medication to treat these symptoms.On March 10, 2004, Dr. Lawrence Splitter, D.O., performed a return-to-work physical on Salazar.Salazar reported that he had sore ribs on his right side, soreness from his right hip to the right shoulder blade, and soreness on the right side of his neck.Dr. Splitter diagnosed Salazar as having "right chest wall contusion, cervical strain, and right hip pain."Dr. Splitter discharged Salazar and cleared him to return to work.

¶ 5 On March 24, 2004, Salazar was seen by Dr. Patrick Clancy, a chiropractor.Although Salazar was allowed to return to work, he received treatment from Dr. Clancy on March 24 and July 13, 2004, for pain in his neck, shoulders, and back.These visits were preapproved by Duhame.Salazar continued to experience symptoms from the accident.Duhame subsequently approved Salazar to see Dr. Steven Rizzolo, M.D. on October 4, 2004.Salazar's main complaint was low back pain.Salazar also indicated a "little bit of neck and right arm pain" but stated that these were "minor" complaints, and had been occurring prior to the accident.Dr. Rizzolo conducted x-rays of Salazar.Dr. Rizzolo diagnosed Salazar with "probable cervical and lumbar soft tissue sprains, numbness and tingling in his hands."Dr. Rizzolo recommended an MRI to rule out compression of the spinal cord given the hand numbness and tingling, and stiffness in Salazar's neck.Dr. Rizzolo also recommended EMG and nerve conduction velocities of the upper extremities to rule out carpal tunnel syndrome.Dr. Rizzolo suspected that Salazar had soft tissue injuries and simply needed more time to heal.

¶ 6 Salazar saw Dr. Rizzolo for a follow-up on November 22, 2004.Prior to the visit, Salazar had further diagnostic tests conducted, including x-rays and a bone scan.Based on the results of the tests, Dr. Rizzolo concluded Salazar suffered from soft tissue injuries and sprains.Dr. Rizzolo cleared Salazar for work activities.Dr. Rizzolo also noted that Salazar had numbness and tingling in his hands and recommended EMG studies consistent with the recommendation in the previous exam.EMG tests were conducted by Dr. Arturo Echeverri on April 19, 2005.Dr. Echeverri concluded that the results of the tests demonstrated neurophysiological evidence of a mild bilateral carpal tunnel syndrome.Dr. Rizzolo subsequently reviewed the test results and diagnosed Salazar with "possible carpal tunnel syndrome."Dr. Rizzolo recommended that Salazar be seen by Dr. Ralph Costanzo, M.D., for further examination of the nature and cause of the carpal tunnel symptoms.In his note, Dr. Rizzolo stated as follows:

At this point, my only recommendation is for evaluation with Dr. Costanzo.Initially, I think this should be covered by work comp.If he think[s] it is carpal tunnel and not related to the motor vehicle accident, that would be his decision.With regards to his neck and back, he will follow-up with me after he sees Dr. Costanzo.No change in work restrictions.He is at maximum medical improvement for his neck and back.

¶ 7 On August 31, 2005, Dr. Costanzo examined Salazar.Salazar reported developing numbness and tingling in his hands radiating proximally into his forearms roughly four weeks after the accident.Dr. Costanzo examined Salazar, and performed several tests.Dr. Costanzo concluded that Salazar had mild carpal tunnel syndrome and recommended a conservative management of his symptoms, including the use of corticosteroid injections and splinting.Dr. Costanzo did not place any activity or work restrictions on Salazar.With respect to the causation of his carpal tunnel syndrome, Dr. Costanzo concluded "I am doubtful that his current hand symptoms are likely a result of the motor vehicle accident."Duhame subsequently approved Salazar's treatment of corticosteroid injections with Dr. Costanzo.Salazar had a follow-up visit with Dr. Costanzo on October 10, 2005, where they further discussed Salazar's symptoms, as well as further treatment options including carpal tunnel release surgery.At the time, Salazar indicated that he did not wish to undergo surgery.

¶ 8 On November 7, 2005, Salazar was referred to Dr. Jeffrey Hansen, M.D. Salazar reported numbness in both hands and pain in his right shoulder.Dr. Hansen suggested that Salazar was suffering from cuff tendonitis bursitis as well as carpal tunnel.Dr. Hansen ordered an MRI and opined that Salazar would likely improve from carpal tunnel surgery.On January 1, 2006, Dr. Hansen saw Salazar again and reviewed his MRI.The results confirmed that Salazar was suffering from carpal tunnel syndrome and tendonitis.Dr. Hansen opined that Salazar had a good chance of improving from carpal tunnel release surgery, and recommended that he have the surgery as well as arthroscopic subacromial decompression of the shoulder.

¶ 9 On January 18, 2006, Dr. Hansen wrote a letter confirming Salazar's diagnosis of rotator cuff tendonitis and impingement and carpal tunnel syndrome.Dr. Hansen opined that Salazar was in need of carpal tunnel surgery and rotator cuff decompression with arthroscopy.Duhame approved the surgery.Dr. Hansen performed right carpal tunnel release and right shoulder surgery on March 14, 2006, and performed left carpal tunnel release surgery on April 11, 2006.Dr. Hansen released Salazar to return to work on September 18, 2006.After his release, Salazar had follow-up visits with Dr. Hansen.On October 24, 2006, Salazar reported pain in his left hand and right shoulder, especially when engaging the right shoulder in overhead functions.Salazar did not complain of carpal tunnel symptoms.At that time, Dr. Hansen opined that Salazar was permanently totally disabled and recommended that Salazar be pulled from work and placed on long-term disability.

¶ 10 On December 7, 2006, Salazar filed a negligence suit against Powder River and MRL.On March 30, 2007, MRL answered and filed a cross claim against Powder River seeking to be indemnified for Salazar's damages, including medical expenses and wage loss claims, as well as attorney fees incurred in its defense of Salazar's claims.On July 3, 2007, Powder River answered Salazar's complaint, but did not at that time respond to...