MARCOTT v LOUISIANA PACIFIC CORPOR
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NO. 95-015 IN THE SUPREMECOURT OF THE STATE OF MONTANA 1996 BRUCE MARCOTT, Petitioner and Appellant, v APPEAL FROM: Workers' Compensation Court, The Honorable Mike McCarter, State of Montana, Judge presiding. COUNSEL OF RECORD: For Appellant: Chris J. Ragar; Ragar Law Office, Bozeman, Montana For Respondent: Kelly M. Wills; Garlington, Missoula, Montana Submitted Filed: Lohn & Robinson, on Briefs: Decided: August February 24, 1995 14, 1996 Justice Karla M. Gray delivered Bruce Marcott by the Workers' statutory appeals of the judgment and attorney fees. 1. substantial evidence denial finding of Marcott's 2. claim Did the Workers' in refusing to apply the on appeal: issues Court's for We affirm. the following Compensation entered Court which denied his request We address Does of the Court. from the portion Compensation penalty the Opinion that support Louisiana the Pacific Workers' Corporation's was reasonable? Compensation "the Holton Court err as of law a matter rule"? FACTUAL AND PROCEDURAL BACKGROUND Bruce Marcott head mechanic under Plan worked for Louisiana at its No. Belgrade, 1 of the Pacific Montana, Montana Corporation plant. Workers' (LP) as LP is self-insured Compensation Act (the Act). On February Quillen, job the disabled then behind left Marcott repairs and another on a disabled them to use a second forklift one. Using the operative dismounted. the forklift After mechanic, LP forklift. to lift forklift, dismounting, Gene The the cab off Marcott Marcott lifted of the was walking when he heard a loud snap and felt pain in his calf. Quillen Quillen "gone 1994, were performing required cab, 17, transported Marcott asked what had happened, out." Matt happened and whether Harris, Marcott to the Marcott Marcott's had tripped, LP plant responded supervisor, slipped, When office. that his leg had asked what had or been running. Marcott answered forklift] when it other he was different Robert Family walking at the time clinic and his the other Marcott's Marcott LP personnel of the LP whether and medical records injury sustained information, 1994, that LP would work. whose duties claims After Mikkelson The letter his dated an the March 21, also if claim of evaluating claim. are personnel compensability by letter reevaluate diagnosed calf. Marcott his by nine informed he provided any information. LP first learned and turning Marcott's information, including King. at notified Jackson physicians. the his he was doing supervisory regarding walking LP was denying additional briskly while indicated During compensation by Marcott's advice Mikkelson that Marcott from legal the attending Marcott Dr. examinedinformationprovidedby obtained by John Mikkelson, compensable, also to questions examination left workers' provided the anyone that in his director [of injury. subsequent muscle and safety advising Clinic, At the clinic, as a torn back Jackson, did not inform than walking. injury include and Dr. Valley doctors, anything the personnel he was just to around In responding at the Gallatin transport "coming went out on me." supervisory physician that that any unusual sharply counsel April demands placed 29, reviewed provided King indicated assertion at the time dated LP personnel information Dr. of Marcott's that by 3 he was walking of his injury 1994. In Marcott's another Marcott's on Marcott that in a letter light medical physician, injury of this records, Dr. David was not caused by by his employment. Mikkelson considered Dr. King's understanding that deny liability for Marcott information the injury Marcott's the his injury Workers' was compensable he was entitled to temporary also contended LP was unreasonable that attorney fees. disputes regarding resolution his injury Marcott's court in contending and that under disability the the compensability the refusing Act a and He to statutory that for benefits. accept penalty factual of Marcott's it Court to and and legal injury required had not unreasonably denied claim. At trial, Marcott was walking "pretty down on his right testified foot. further lack of experiencing detail Marcott of his that to John Campbell, more probable injury. Dr. walking across Marcott's LP relied Marcott's than King, not regarding orthopedic that a floor would he told his not provide supervisors he by both medical evidence that caused testified an adequate was LP and Dr. occurred. opined strain coming pain how the injury surgeon, he but attributed questions substantial practitioner, while leg and just significant the an unusual a family left occurred he was walking, also provided testimony injury that and the absence of follow-up the physicians. in support only his on his He admitted physicians the that turning fast," and attending for total and sought LP responded, by the legal LP continued Compensation that for his claim. that liability with was not compensable. petitioned determination to be consistent it was Marcott's that merely explanation injury. on Marcott s original 4 statements to LP personnel and his physicians regarding correspondence fromDr. sharply the "not his that, benign while specifically walking activities. Marcott's Dr. injury and on June 1994, briskly and turning King also occurred caused by any unusual opined at work, demands placed it in was on him by employment." LP also relied on the orthopedic surgeon receiving Marcott's it briskly turning on the calf injury activities by any individual generally The Marcott places of turning the risk age in normal daily Dr. Harrell agreed that than life. in stress that given the work that faced On cross- some unusual rupture result walking Marcott's of injury his that fact because and sharply" increase view, an claim examination Harrell's was an unusual Harrell, Marcott's and to cause a muscular injury Donald no unusual him at no greater and, his force therefore, activity at of the injury. Workers' Compensation was compensable. was not briskly In Dr. is required the time injury sharply however, Marcott's denying at work was coincidental, placed examination, Dr. opined on direct structure. occurred of after "walking Dr. Harrell while testimony retained information. that occurred King describing as relatively letter how the injury entitled to It the Court also concluded concluded, statutory that however, penalty or Marcott's that Marcott attorney fees. appeals. DISCUSSION In addition Act authorizes to substantive a 20% increase workers' in the full 5 compensation benefits, the amount of benefits, and an award of attorney claim later Court determines Sections fees, adjudged 5 39-71-2907, compensable that 39-71-2907 the MCA, was not of a legitimate Deaconess Foundation Hosp. 1283 (citation In this Marcott's Marcott unusual thus, intended rapidly according under fees against LP--denial adjudged compensable. The court each of Ricci's several bases determine whether Workers' and, MCA. This for however, conclusion the penalty a claim that basis, or attorney and later LP's denial fees. "reasonableness" the a question court of 256, Compensation are injury was caused by an on that on which 261 Mont. they when the liability found, that Court's supported by finding relied to and for its Stordalen v. 862 P.2d 393, 394. fact. 258, declined findings substantial of fact to evidence. 862 P.2d at 394. Stordalen, It of that determination sharply (a), court's is Food Farm (1993), the 673 P.2d concluded an award of both penalty the Reasonableness We review for was reasonable challenges the finding. factor the statutory Marcott 444, Court the injury § 39-71-119(2) attorney award Marcott an insurer's 440, based on its to the court, the threshold claim in Paulson v. Bozeman 207 Mont. and turning satisfies of Marcott's set forth eliminate Compensation was compensable strain a unreasonable. The penalty to for Compensation was to liability. (1984), the Workers' was walking occurred; Workers' denial MCA. liability omitted). case, injury insurer's defense denies and the and 39-71-611, assertion 1281, when an insurer is important to note at 6 the outset that neither the compensability of law, issue of Marcott's of LP's legal here. credible injury turning sharply that while Marcott's injury contemplated injury by basis, caused was by § 39-71-119(2), over the briskly and the court an to be a whether or walking On that is at found Marcott dispute walking as a matter compensability Court a factual favor. correctness, regarding he was merely in his the Compensation and resolved occurred nor interpretation The Workers' witness claim determined unusual as therefore, MCA, and, strain that the was compensable. Only denial the Workers' of Marcott's We will address reasonableness LP's overall Compensation claim in turn was reasonable each reason Before finding. position Court's because is its Compensation Court's "reasonableness" Briefly stated, LP asserted that whether Marcott was merely walking sharply dispute, which involved at Marcott's were merely because it § 39-71-407, the walking of more arose time than credibility. at did not arise the for we summarize in understanding supports a factual the Workers' two dispute or walking injury months his injury the that, was not factual injury, if Marcott compensable as required MCA. evidence finding 7 and the after employment existed quickly and that LP also contended out of Marcott's 1. Does substantial Court's Compensation its finding. the time, LP's us on appeal. however, evidence that articulated importance of whether turning substantial so, our analysis over before the court doing of finding the Workers' support that LP'S denial of by Marcott's a. claim Factual dispute The Workers' relied on the denied Compensation Marcott's reasonable was reasonable? Court information in claim, and because, to by that whether its as that LP's rapidly and turning sharply related to Marcott's a LP reasonably when it initially continued denial factual legitimate only in that, LP's circumstances surrounding walking his when dispute regarding the incident obtained LP relied on this Marcott's claim. Thus, evidence supports medical facts. LP's reliance on this Marcott Several at Quillen facts records, information we conclude its that information at the to different times unchanged; reinforced initial Court's those denial of credible finding of the initial time the was just substantial Compensation the supervisory remained which in the Workers' dispute related ruptured. and walking injury, which and the reported Marcott's Marcott's was that injury Marcott or The factual following muscle interviewed walking left." possession the calf personnel LP also to his establishes information was simply was credibility. The record claimant that possession time, existed determined that denial was reasonable. The record denial This also of the claim, letter sharply asserted at the LP received time that reflects that, LP received more than one month after a letter from Marcott's that Marcott was walking of his injury; the letter Marcott alleged anything 8 rapidly counsel. and turning was the first other than LP's that notice he was simply walking at the legal interpretation understanding Marcott of the claim dispute counsel the injury by the Workers' resolution part the on LP's injury; containing resulted that the above, original LP's version in LP's continued injury dispute existed Court; credibility, a related we conclude that denial regarding which and that that receipt a different a factual LP's namely, to the record, Compensation Marcott's AS noted large According surrounding involved in on two bases: circumstances injury. surrounding walking. regarding of Marcott's resolution facts from Marcott's of the facts the of the hinged was merely of the letter time required the factual issue requiring by the court. Based on this supports record, the Workers' of the claim Compensation Court's based on the existence substantial finding that of a legitimate evidence LP's denial factual dispute was reasonable. b. Legal LP's a worker interpretation position was that was merely a muscle walking employment under 5 39-71-407, determined that defend against spontaneously daily the basis bounds determination interpretation, LP's the work on heart compensability irrespective legitimate constituted did which not MCA. The Workers' reliance as a result of at rupture of of an ordinary of work raised legal attack arise based on the facts 9 out and other a condition activity of by the court cases people In do on a essence, reported, to arises issue that his Court which a colorable as originally while Compensation advocacy. a finding occurred LP's within this legal was not unreasonable. In Hunter v. Gibson Products of Billings 481, 485, 730 P.2d 1139, 1142, we clarified insurer's decision interpretation of case reasonableness finding contest to substantial penalty with our contained eliminate the Paulson, standard conclusion 269, at in Holton Mont. 263, from doubt, constitutes making of legal fact Paulson on its Court's subject to the clarification was that the MCA, was never also to an defense statutory intended to to liability. with our Land & Lumber Co. (1981), Stoltze was consistent 195 the existence standpoint, that excuse denial for any of a genuine liability of a claim exists or delay in payments. as jurisdiction a general has clearly rule, decided in advance of an insurer's applicability evidence that It regard based This a legitimate v. F.H. a legitimate Thus, clear in 637 P.2d 10, 14, that a of of review. 1283. with 224 Mont. Compensation a question § 39-71-2907, assertion 673 P.2d Workers' 1984 holding in that, compensability the remains evidence consistent law, (1986), 730 P.2d insurer at bases an issue decision of the earlier supporting the contest where a finding its decision decided, the lack evidence supporting of regarding constitutes the issue interpretation has decision may constitute clear a finding by the Workers' 10 competent compensability not the substantial Compensation is unreasonable. where of compensability, by the Workers' Conversely, legal court to contest over compensability 1142. a & upon Court Hunter, which been an clearly substantial Compensation Court that insurer's the Therefore, injury legal we determine sustained been clearly a claimant Court's 143 Mont. Construction Perkins is not unreasonable. the compensability merely walking of an at work has decided. cases upon which and compensability (1964), is here only whether while Among this liability interpretation (1983), in contesting were Ness v. Diamond Asphalt 560, 393 Co. (1979), LP relied P.2d 43; 183 Mont. 202 Mont. Dumont v. Wickens 190, 598 P.2d 1099; 157, 656 P.2d 816. Co., Inc. Pros. and Wise v. We address each case in turn. In Ness -I laborer the decedent and died occurred or as the result at his workplace. us was whether that influenced that between a physician's the decedent's as the rather exerted than determined affirmed as a result that the that the judgment the opinion that the of decedent's the episode widow 11 there and the court of heart during that the course and the was not and of his The record was no relationship "occurred the record disease cause of his Ness -I supported finding The 393 P.2d at 44. work." record of employment. himself employment statement his Ness -, court's before was not in any way caused had no history on the day he died. also contained Board the decedent which The issue the district infarction man and infarction 393 P.2d at 44. demands of he had not visibly employment well the maintenance a myocardial supported myocardial by established of Ness -, the evidence the decedent's that worked as a general death, while 393 P.2d court's at entitled at work, 45. finding Industrial as We and Accident to workers' compensation death In Dumont, Ness, benefits. we addressed definition of injury--which happening of unusual died as the Dumont, 598 P.2d arteriosclerosis, nature applied result of at 1967 amendment to required a traumatic strain"--and the 393 P.2d at 45. it a heart that the injury "from 1106-09. occurring but his widow attempted by his medical the employment. witness death ruled death. the failed record the unexpected affirmed workers' "to absence cause the out that at least resulting compensation element validity in according of its work-related the to the facts result that argument that that occurred to strain or heart attack, we judgment denying case by pointing occurred first the "unexpected 12 of Dumont, 598 P.2d at 1109. Marcott the injury date unusual Court's the episode that between 598 P.2d at 1108. decedent's from the work. in addition, the The widow's the that of to unusual We determined NeSS and Dumont to the present we required be met and, preceding Dumont, Compensation as in those cases, here, cases, any that connection unusual work. death benefits. caused by and did not those of Workers' LP analogizes to his site. a history was subjected on or anything job to demonstrate 598 P.2d at 1108. disclose in relation the deceased" on events Dumont, had causal or an employee who 598 P.2d at 1101. out any possible and work-related decedent's Based Dumont, cause, at his The decedent death was compensable because the decedent strain be a tangible an unexpected to a case involving attack the statutory at work but, reported, It observes cause/unusual we implicitly was not that, strain" recognized must be work-related; in the that is, that the injury LP also observes pretrial that it and direct work activities of must "arise injury place and that interpretation relied walking to briskly injury usually the period operation of in bar fourteen to twelve which such during opportunity a to be off day his risk sharply did case based In Wise -I and bartender, putting hours on her, for standing most of the claimant was unable to sit indeed, at all during she seldom the week. and her diagnosed legs as thrombophlebitis compensation benefits. The employer claimant's which, traumatic results and in phlebitis at that nature time, feet; her of both -, Wise had Wise -I harm. 656 swelling ultimately legs and she sought among other was not an injury injury from an unexpected in physical condition the was workers' 656 P.2d at 817. Wise argued, defined worked she By the end of the week, she was experiencing in each. responsibility P.2d at 817. pain on its LP also in Wise. all not hours per day, and, her feet Marcott's structure. this fell On one or more occasions, all that and one-half unexpectedly to eighteen Harrell's was not compensable, a week during the approximately the time. of on Dr. turning of our decision eight regard, did not increase worked as a custodian in work days of around Over rely on the calf liability Marcott's In this opinions while in stress on the inapplicability the claimant at medical contest that to of the injury time increase In deciding the work. was entitled examination at the an unusual out of" -, Wise under things, § 39-71-119(l), as a "tangible cause or unusual 656 P.2d at 819-20. 13 that happening strain" the MCA, of a which The Workers' Compensation Court constituted unusual a tangible during that that time, benefits. at work happening the issue work is to from an unusual of whether compensable an injury has not by implication 656 P.2d at 820. that constitute work hours merely merely by this arguably on walking according while been decided in Wise a work-related Thus, strain. an and affirmed excessive sustained from Wise, from determination of the claimant's was sufficient issue the claimant's Wise -I the compensability at nature we agreed and was not based on a determination tangible week establishing on evidence standing least work a traumatic out was premised feet the of award of compensation LP points or happening work schedule the court's that Based on the evidence strain. excessive her determined could to LP, walking Court at and, be decided at in its favor. Read as a whole and on a stand-alone to sufficient constitute Compensation Court's unreasonable in light addresses the cases on which above, before issue not legal conclusion that issue is those whether upon which whether to contest LP's was walking liability that to these only us is whether briefly, injury cases provided liability; for stated an injury at work has been so clearly 14 is those not LP with decided and this cases compel a reasonable basis the issue while a The compensable. differently, sustained Marcott As discussed inappropriate. Marcott's was not reported. altogether not Workers' interpretation as originally LP relies cases appear the support LP's legal of the facts is the evidence finding summary approach basis, is an employee as to negate any genuine doubt defense LP asserted Paulson, Inc. this 157 Mont. ruptured meeting definition finding of injury the "unusual strain" time from an unexpected that v. whether cause, the disc at Workers' was happening strain. sustained result (1947). Robins, 485 was of "Injury" of a traumatic by 1967 the issue as the R.C.M. or unusual 39-71- work met the more precisely, occurred as a tangible § evidence. of water to § 92-418, his interpretation a herniated the Act; Foods, claims of that legal Ogle as an unexpected requirement LP's condition pursuant at that on Robins he contends a pail under claimant's strain" by substantial we addressed when lifting whether relies compensable basis, is not supported claimant defined absolutely On this Court's In Robins, 637 P.2d at 14. primarily "unusual the P.2d at 1142; 730 146, 666 P.2d 758, under which he is the MCA. reasonable unreasonable 328, 485 P.2d 692, and Shepard v. Midland muscle Compensation and render See Hunter, Holton, Marcott 205 Mont. calf 119(2) (a), the to liability. regard, (1983), effect standpoint 673 P.2d at 1283; In (1971), from a legal an was nature P.2d at 693. The claimant her disc in Robins had been mopping the floor herniated, and we observed was not unusual mopping was being reflected, "twisted Robins, from however, [her] 485 back" P.2d at that the perspective of done. that Robins, 485 she had "picked the P.2d 694. Noting in which 694. [the bucket] moving the bucket 15 at time the The record up wrong" and removing a herniated the she suffered the manner while that strain at disc and the mop. resulting from picking up a bucket the mop constituted of effect, a strain we stated strain qualifies R.C.M. 1947." In existing heavy that as could result performed extremely in he slipped sharply knee. knee in order underlying degenerative sufficiently that the same had over a period his left the pressure off his According to heavy work of minor favored injured the left medical aggravated even absent of knee and and subsequently a series lead his the 1980 fall work-related a pre-existing our conclusion can apply to an unexpected to an injury involved was not unusual at (citations evidence routine under employer 760. a pre- 666 P.2d at 760. aggravate condition, his of The claimant Sheoard, reiterated existing injury Robins. knee condition, could substantial in routine disability 761 at claimant's aftermath. 92-418, a claimant's in 1980, twisting to take 666 P.2d the We noted a compensable and fell evidence, and its from on the edge of a step, Sheoard, section an aggravation primarily heavy work for striking from a work-related under whether interpreted many years; up from the standpoint result strain' to pick 485 P.2d at 695. definition right unusual resulting statutory his unusual we addressed condition it which was unusual "[aln 'an Robins, Sheuard, work in the wrong manner and turning for omitted). of and condition compensable from earlier resulting injury On the job. basis in the Act, and "unusual injury the of any strain" the effort Sheuard, of which result even though work-related absence to under cases that the particular 16 traumas 666 P.2d undisputed aggravating evidence and a pre- that the claimant that did heavy the knees reasons was not of his Compensation Workers' claimant's work outside Court's had deteriorated supported employment, we concluded determination for other by substantial that than the work-related evidence. Sheoard, 666 P.2d at 762-63. We observe that Robins and Sheuard were decided Dumont and Wise .------I 1983, respectively. legal interpretation, were decided None of the cases discusses, upon which in LP relied in 1979 and 1983, much less 1971 and for its respectively. distinguishes or overrules, any of the others. We agree with Marcott l'unusual regarding did not, nature whether as that address a specific the injury 71-407, Robins strain" however, related that of the activity clearly states the term is used in the Act. question In the heart we concluded attack that compensation claims the work- with advanced regard genuine evidence underlying to the specific case, under the § 39- hand, workers' activity cases are distinguishable legal interpretation and from and issue here by LP. On that Marcott's employment caused by work-related those Thus, in this on by LP, on the other conditions were not as raised Marcott's cases relied the were not compensable. Robins out of" or, Robins MCA. "arose at issue regarding law basis, injury doubt we conclude that had not been so clearly from a legal supports standpoint. the Workers' the decided as to negate We hold that Compensation 17 compensability Court's of any substantial finding that LP's legal injury interpretation regarding the compensability was not unreasonable. Investigation C. Marcott's final assertion of error Compensation Court's investigation of Marcott's claim. the court rejected of the hearing, investigation LP reasonably Marcott Marcott's with reasonableness was so inadequate found that from of Marcottrs relied and from regard finding In its relates oral Marcott's to the Workers' to decision at the end contentions that as to be unreasonable. on the information his medical that records insurers LP'S The court it in LP'S received deciding both to deny claim. It is undisputed workers' investigate compensation have an affirmative duty to claims. [Aln insurer has a duty to make at least a minimal investigation of a claim's validity in light of the relevant statutes. Absent such [an1 investigation, denial of a claim for benefits is unreasonable. Stevens v. State 886 P.2d 962, Comp. Mut. 966, Lumbermens Mut. 663 (quoting 279, 288, the record on other (Mont. 1995), 268 Mont. srounds 467, Kloepfer bv 460, v. 899 P.2d 1081, Comp. Mut. reflects the only witness walking Marcott's medical doctors example, Cas. Co. Love11 v. State was just his overruled Fund (19941, Ins. 52 St.Rep. Fund (1993), 260 Mont. 860 P.2d 95, 101). Here, Quillen, Ins. to the Dr. Jackson's LP interviewed to the incident; when the reports, that injury occurred. which contained same effect. statement These that 18 both stated Marcott that LP also Marcott's reports "[platient and Marcott obtained statements included, was walking to for across a level floor aware of and felt striking Campbell any objects reported work, taking left calf that a step . an immediate . or Marcott and liability Based on this evidence he was not . pop in LP sought Dr. while advice on these reported of the at the back of his legal issues vis-a-vis and evaluation Similarly, . . male something Finally, compensability pain any mishaps." was a 'I. and feeling .'I sharp claim, the facts. LP denied liability. Marcott argues that contends, among other Marcott's initial LP's things, investigation that statements whether when his calf in to a question to is contact different report report the injury on the Dr. Jackson indicated LP's In claimant's received form report Marcott accident ascertain the investigation Stevens, to relies in Fund that whether left related response the patient's LP had an obligation any additional support accepted or and why the form a work-related of his liability benefits. the claimant 19 and argument and unreasonable. and began paying an anonymous tip pain a purported affirmative was due to on Stevens State with from Marcott condition to his Marcott's whether was inadequate the between accident," had been received that faced inquiring on to ask Marcott or turning and the doctor's "due to a work-related history accident. that Jackson's He rely was in agonizing rapidly and that, regarding condition was walking ruptured; Dr. not reasonably LP was required muscle inconsistency history Marcott LP could because Marcott at the time they were made; that Quillen was inadequate. for the Thereafter, it was working; the tip and subsequent compensation Stevens, claim originated 886 P.Zd separate regarding statements at investigators. benefits was available It was known not to be the witnesses; that a witness version of the it had even though spouse, or she attempt with nor did the State Court the reports interviews two both knowledge former for from statements, through spouse. terminated Fund investigative claimant's Compensation the Workers' the reports claimant's the "accuser's" accusations or other the former Fund arranged State on its against of the workers' claimant s received the read evaluate the claimant testify did commissioned, validate and based solely to the The State Thereafter, claimant's injury. with 963-64. investigations the invalidity to the either Fund opt to petition to terminate benefits. we concluded that Stevens, 886 P.2d at 966-67. Under had failed these circumstances, to make "a reasoned the case . . . followed Stevens, reviewed." failure review by an impartial rose to the substantial Court's level evidence determination Stevens duty has in prior unreasonable not support that the State Fund's evidence concluded to terminating the Fund in of the evidence and evaluation conduct; did Stevens, was reasonable. insurer's of We also review were completed--and available evaluation 886 P.2d at 968. to make even a minimal investigations of all the State thus, that this after the benefits-we held that Workers' Compensation termination of benefits 886 P.2d at 968. no application investigating here. That and evaluating 20 case involved information an upon which it ultimately terminated failure to even review Stevens does not support liability the surrounding own his Marcott's support the theory claimant additional an effort injury that to establish might In facts final 450, 865 P.2d that by questions also to the does not duty to ask uncover facts by the claimant the duty in of the the further conclude finding that LP's by a preponderance Service While (1993), our to reasonably must attempt duty to build claimant's the 262 Mont. we reaffirm to expand that of to cases investigate by imposing a case for own statements to a the the doctors. that Workers' relied burden injury on insurers the claimant's Parcel we decline discounting We conclude remains 1116. an insurer and to his reasonably It it 1113, a claim, requirement support occurred. containing the compensability v. United an affirmative and evaluate employer circumstances doctors those provided of his See Walker claimant the on neither upon which analysis, evidence. imposing can rely has an affirmative from, compensability 454, injury in evaluating be more clear. the the from his and its had commissioned. that, an insurer follow-up or different it regarding an insurer specific to, issues, how the being paid, contention nor reports of already materials statements injury same description prove investigative and compensability claimant's the benefits the record Compensation on the that contains Court's information the Workers' investigation provided Compensation was not 21 substantial evidence finding by that Marcott. Court's unreasonable to LP We implicit pursuant to Stevens is supported by substantial evidence 2. Did the Workers' Compensation Court of law in refusing to apply "the Holton Compensation The Workers' several of injury was regarding the Marcott's physicians work-related, entitled legal to the Court's conclusions Stordalen, of were that not Marcott pursuant We review even though reports was incorrect penalty law. that, their opinions interpretation as a matter in of the injury. statutory Holton concluded noted these the compensability court's Court err as a matter rule"? conclusive contends because to our his that he is decision in the Workers' Compensation whether are correct. of law to determine they 862 P.2d at 394. Marcott relies on the following language from Holton: event for The triggering the purpose of awarding penalties for unreasonable delay or refusal to pay insurer's compensation is the receipt of medical injury. Unless such verification of a compensable verification contradicts other evidence sufficient to verification inherently incredible, make the the insurer's duty to pay commences and failure to pay (or deny a claim) will expose the carrier to the possibility of penalties after thirty days. Holton, 637 P.2d at 13 (citations pursuant to this language, compensation benefits from his one of position, which however, Holton omitted). legal LP's Marcott to duty began as soon as it doctors that his does not take was decided into injury that, pay him workers' received an indication His was work-related. account or the totality argues either the facts of our decision upon in that case. In Holton, the claimant was injured 22 at work in late 1972, required--and left recuperated Stoltze's was laid which employ off from--surgery, for less strenuous soon thereafter. resulting to work. work at better He ranched he managed a bar. stiffness and returned He continued for to from the work-related pay, a time, but following experience injury. He pain Holton, and 637 P.2d at 11. The insurer physician the was notified in gave him a 5% total insurer's insurer physician offered claimant to rendered settle time. Other issues basis and heard years; aside, rating. of the determined that but imposition of the statutory rating that and the rating. more The from the were paid during that Compensation Court Workers' the claimant claimant's Thereafter, nothing no benefits ultimately denied the a 10% impairment on the for more than four 1974 that body impairment made a counteroffer insurer early suffered a 40% disability, penalty. Holton, 637 P.2d at 11-13. The claimant case, he was entitled discussed both triggering delay argued the event" or to to pay "is of a compensable rending the verification to begins "possibility such medical and of the inherently penalties." in stating Holton, his We "the unreasonable of medical 637 P.2d at 13. incredible, 23 for and absent exposes of that receipt Holton, pay facts MCA, penalty. insurer's injury." to law the of the penalty verification failure under 5 39-71-2907, imposition of that, and case for receipt pay the statute refusal verification on appeal other evidence the insurer's the 637 P.2d On duty insurer at to 13 (citations the Contrary omitted). did not resolve controlling to Marcott's the penalty rule injury, automatically results The facts both the rendered ratings was made and rejected, four 39-71-2907, and, after is true: the undisputed legitimate excuse genuine from doubt, liability delay the dispute in Holton that the insurer 10% disability is the existence or legal 637 P.2d at standpoint, undisputed had "no legitimate insurer excuse for to the hearing. by section delay, as provided justified." Holton, 637 P.2d at 14. 24 of anv omitted). compensation that only that 14 (citations of those unreasonable any 'I [Tlhe as to the total prior pay 13. the claim the at be paid; On the basis indeed, compensation of § to delay P.2d 637 should benefits. right for that promptly as of March 31, 1975, claim offer We observed hearing; a duty had whatsoever the agreed disability of the case. to a medical Holton, exists." Notwithstanding parties for as a matter settlement no action a formal has Holton, compensation. benefits, physician an initial the insurer until insurer of of a was based were that 637 P.2d at 13. the payment of any compensation converse verification insurer's took MCA, does not provide they become a our resolution and the Holton, statements of the penalty in Holton the insurer years. nor did nonpayment for on which our decision physician these of medical by set the stage impairment more than receipt in the imposition claimant's here, in Holton; followed They merely of law. issue of law that compensable arguments due, both at least a 10% made no payments facts, of we determined delay in paying The penalty 39-71-2907, the for MCA, is It is clear to those that the facts in Holton. events surrounding Marcott Here, a factual originally interpretation the injury Compensation interpretation a legal Court Indeed, line cases of as set determined a legitimate defense Paulson, Nothing on a the statutory to preclude as legal the the legal in Holton that the a medical or reason to or benefits. Holton is delay Holton, only 637 P.2d one case in a penalty in an insurer's See, e.s., to liability. facts either above, that 2907, MCA, was never intended disputed We stated compensation clarifying the the that a legitimate forth of relied doubt over liability--from payment of workers' at 14. LP concerning claim was not compensable; was not unreasonable. of genuine existed on the basis them, standpoint--constitutes refuse 1142; and, reported case are not analogous dispute under which Marcott's Workers' existence of Marcott's § 39-71- assertion Hunter, of 730 P.2d at 673 P.2d at 1283. in Holton legitimate compensability requires factual and liability Workers' Compensation to apply immediate or exist. Holton. payment of benefits legal We hold, issues Affirmed. 25 relating therefore, Court did not err as a matter where that to the law in refusing sitting for Retired Fred J. Weber Justice 26 Justice Terry Ii. I dissent in this from case majority not Further only what Marcott on February 17, 1994, His forklift, took two forklift, it facts is was LP had during the course conduct arrogant necessary basis while forklift. At weight sounded left in for himself, and order to its denial his employment and his this went Following of his to injury, off from the of the behind the he placed his rear around turn, he heard a loud an extreme of the when questioned he was walking, room, to in catch and sat by his pop pain He was able floor. part crutches, and told that First Marcott by Dr. a calf by the the down Gene down employer's felt a pop in his to a Belgrade leg, out. an injury Physician's to another that his with the experienced off, condition, he was examined Following to to to walk he began fell over he explained leg left and as he pushed a gun going struggled personnel, to his jumped steps where and nearly In brisk of a forklift he foot, like on a chair. repair point left calf, to after three sharply the on his working occurred or and turned received the little injury where of was injured Quillen. his The employer's claim. Bruce that opinion. unreasonable, review appreciate Marcott's dissenting. the was oppressive. fully Trieweiler muscle, him to treatment, Report insurer was taken Jackson. Robert treated return if him conservatively, his Jackson Dr. and Dr. Initial on February 27 condition did completed Treatment 23. Jackson On that form, diagnosed gave not an Bill, clinic him improve. Attending which was he was asked whether the condition work-related accident. When Marcott's considerably, condition where day, an Treatment he Bill. a work-related Campbell's activity In the he also King, Dr. for 1994, Dr. a Report answered that the ruptured Campbell and same question release from he developed that King to also Initial regarding it the was caused by physician. to more general report history given by history, regarding Marcott, his leg the for further course Marcott injury, and by Dr. of that about the and received than had been given in which had been asked previously. that and of his activity questions following he was treated questioned of that in hospital During specifically description hospital clots the hospitalization, a family the blood he was engaged in at the time a later an him to the hospital First he was readmitted During a more specific response Physician's surgery, treatment. treatment, 25, worsened John Campbell, surgically On February to Marcott's which B. but instead 21 by Dr. admitted to a "yes." him In response was due to accident. Subsequent David treated injury, Marcott did not improve, Campbell Attending cause of Marcott's for Dr. muscle. completed lungs he treated He answered surgeon. gastrocnemius Dr. which he was seen on February orthopedic same for conversation, his conclusions he related based on as follows: Mr. Marcott has indeed given me the history of the event occurring while making a sharp turn at a brisk walking was during the hospitalization and in pace. . . . [I]t the context of reviewing the events of his original injury with an eye towards trying to better understand 28 the that the sequence of events which have been spontaneous, followed. uncoached, I consider and valid it testimony. to . To summarize, Bruce suffered what in my experience is a most unusual injury from a relatively benign activity which has led through a series of complications leaving him with the long term problem which I have just described. There is no reason to suspect that there is anything other than a cause and effect sequence at work, initiated by the brisk walking with a sharp turn to the left causing a minor muscle injury which unfortunately led to the compartment syndrome and swelling ultimately leading to the surgery and finally to the blood clot. There is likewise no reason to doubt that this happened at the time and place Bruce suggests. It occurred at work. While it is not specifically caused by any unusual demands placed on him by his employment (we all walk briskly and turn suddenly) it in fact happened at work and led to the above complications as described. During the complications other which insurer for injury injury denying related, that physicians for various was seen by five submitted injury bills was work Marcott and to the related. the suggested them ever billed that but work related. until information, at no time the date of trial the defendant's claim, employees contact ever opinion, description information had information gathered 29 Bill Fleming who were responsible one of activity the doctors from the date did either why, in their or what specific than the general Marcott Not one of of this to determine on, or whether injury, examined services. Marcott's treatment Marcott's physicians of all or John Mikkelson, physicians of these was anything of Marcott's for original indicated their In spite prolonged All eight Altogether, of his from physicians. insurer his course his of Marcott's injury they were relying about his activity by witnesses was work other at the scene of the accident hospital type when Marcott than engaging of activity or Mikkelson treated Marcott any doctor about how this something injury other to the the specific Never did who had actually could seen or have occurred than normal activity on March 21, 1994, Mikkelson him activities. that his injury Subsequent following distinctions getting while would have to cause such an injury. Instead, told question about or whether been required and in semantic about he was engaged in when he was injured. Fleming walking, was more concerned entry in his to simply related was not that office date, wrote to Dr. to Marcott employment Campbell made the notes: I think all these problems are related to his initial qastrocnemius rupture which I documented at surgery which happened at work. I feel this is a work related injury, and all these complications are secondary to this work related injury. That office mately April note 29, which 1994, counsel explained he sent a notarized Marcott who confirmed turning sharply. additional for the nature had been engaged at the time and this by Marcott's employer on approxi- 7, 1994. On April employer was received of his statement that In spite from Marcott of all Marcott sent a letter of activity injury. the in which Along with only Marcott the letter person working had been walking rapidly of the undisputed LP continued documentation, to the medical with and records to deny Marcott's claim. Instead for of paying his groceries, one cent to Marcott with which make his house and car payments, 30 he could pay pay his medical bills, and support would have to Compensation to review the his family, defend Court expert history him. review and testify a until it in money hiring it did examine however, pay that and issue a report, at the time the an expert personally did, concluded petition Even then to It the records briefly its records. consultant from against and spent Marcott's LP waited consultant Marcott or consultant asking take we cited 962, the part authority of any insurer for the a $725 to $2500 to appear trial. In Stevensv. State CompensationMutual Insurance Fund (1994) , 268 Mont. 886 P.2d it Workers' not bother and another of Marcott's that following obligation 460, on or employer: Our case law provides that "an insurer has a duty to make at least a minimal investigation of a claim's validity in light of the relevant statutes. Absent such investigadenial of a claim for benefits is unreasonable." tion, Love11[v. State Camp. MA. Ins. Fund (1993) , 260 Mont. 279, 2881 , 860 P.2d [951 at 101. See also; Gamer v. Montana Dept. of Highways (1990), 243 Mont. 414, 421, 795 P.2d 77, 81. Stevens, 268 Mont. In this Marcott's at 466-67, case, claim if for the employer workers' uncontroverted medical it obligation had a clear least one of his Although authority, the following an insurer care conclusion is (1981), has acted compensation about that to further health statement was not going documentation we have clearly LandandLumberCo. 886 P.2d at 966. so benefits obvious so held 195 Mont. the triggering unreasonably: 31 based grant on the before it denying should the not at claim. require In Holton v. F.H. Stoke 637 P.2d event then by questioning in the past. 263, simply had been provided, investigate providers to for 10, we made the a finding that The triggering event for the purpose of awarding penalties for unreasonable delay or refusal to pay compensation is the insurer's receipt of medical verification of a compensable injury. Unless such verification contradicts other evidence sufficient to make the verification inherently incredible, the insurer's duty to pay commences and failure to pay (or deny a claim) will expose the carrier to the possibility of penalties after thirty days. 195 Mont. Halton, In spite at 268, of the obvious failure justify its doctors believe this it conduct based obligation on its any accident Although since not the opinion it that that testimony was not irrelevant Judge made a total farce Court what the basis finding gives is for seen his enough, new and dangerous irrelevant to claimant and was asked by or her opinion the Workers' by going observation." some such testimony, the was. If Compensation on to conclude of many, many medical the adjuster's that to automatically was work related for of matters own review can validate opinion at work who had his injury same adjuster on its adjuster's would have been totally one doctor and LP's way, LP was allowed was no foundation that "[bIased to investigate, occurring there had been true case expressed obvious to do so in any meaningful work related. even if 637 P.2d at 13. depositions, The trial meaning to the notion that the judge's of "judicial notice." In summary, based on all conduct was unreasonable was whether turning conducted Marcott sharply at absolutely for of the evidence two reasons. was simply the time in this if First, the real walking or was walking of injury, no investigation 32 his then from which it case, briskly the LP's issue and employer could make that determination. relied It on an inadequate inadequate while other Second, of whether of accident. Section Workers' Compensation medical We have Act, Even assuming opinions, medical which they consultation, gastrocnemius walking, claim walking are relied simply an that at an was normal on point. In to the work-related as when used to in either and an the cause unqualified the benefit Marcott's been walking accident without the a doctor. was a refers of ruptured unusual result from or brisk. upon by LP to justify not by correct, have or arbitrary arrived would the The cases held strain" were muscle whether defines LP's to of no difference MCA, that and concerned or caused "unusual an scene walking was repeatedly on pain absolutely injury then based hospital merely and the at the was 39-71-119(2), strain." effect. to in events excruciating makes his of claimant getting sharply "unusual or the claimant whether satisfaction description than and turning question great he was experiencing nothing briskly took interrogation accident about simply its denial of Marcott's Nessv. DiamondAsphalt Co. neither 393 P.2d 43, nor Dumont v. WickensBrothers ConstructionCo. (1979), 183 Mont. 190, 598 P.2d 1099, evidence employees' 143 (1964), Mont. that work-related the fact 560, the In activity. that Marcott's activity forklift. In walked to the an effort back of to the this case, injury Marcott (walking) attacks heart was there do that, forklift, by to he hopped fix off and was attempting 33 any caused were there by was no question caused was attempting was a about work-related his employer's the forklift, to go behind it. The only Therefore, reason his for this was normally or was pursuant to our whether at in the employee died that activity in P.2d at even of that could 816, unusual caused the his injury walking majority, 157 Mont. accident. In by death 328, 485 his an to in reaction was concerned effect of at 192, to the had the with of his 598 that he activities 202 Mont. 157, whether the not whether strain," effect was "unusual testify Wisev. Perkins (1983), the survivor the was no witness was even Dumont, constituted that was an "unusual compensation the Dumont , 183 Mont. in again by was strain" contention problem Finally, issue out no contention of an unusual he only her activity cause she been an strain. qualifies 695. that as an "unusual In Holton, or unreasonably uncontroverted Ho/ton, only there in. injury The "unusual or strain." In Robins, we held at injury the simply employer. related." pointed language "unusual claimant's receive the Furthermore, he had engaged his his irrelevant. of and was an complained 656 P.2d before bed as is which 1101. of serve Robins v. Ogle (1971), definition There was in distinction included activity time decision that strain." "work However, Ness was decided the clearly the briskly. 692, was to activity dispute P.2d activity 195 Mont. strain. we held delays an unusual that payment I from of 637 P.2d benefits it documentation, at 34 normal at 13. or which has activity at 333, Robins, 157 Mont. when an insurer medical 268, result 485 P.2d employer are acted denies justified by unreasonably. In Stevens, we held that, absent is a reasonable unreasonable. this The entire burden unemployed lost a $40,000 live its for per year to out the never which Workers' to in have, rights. Justice opinion. to benefits at P.2d 966. 1n any consequence. now be born the of his he was with by it prevent injured the past, reasons William E. the Hunt, Sr., benefits -612, that supposed attorney fees reluctance to pass the the hiring the for disability The when to somehow insurer from essential I dissent to to recover Court a time workers and forced for responsible at no entitled. and this only with he is dollars so clearly not and been have been required comes been these of causes injury disability income, case He has future Court to this Marcott. near former should in a work-related family See §§ 39-71-611 For due in because changed for must evidence for his litigation disturbing job Compensation unnecessary conduct hardship how to pay thousands that to 886 and avoided the for a fraction benefits for reemployment represent services a claim 467, unreasonable and on and provide figure cases disregard injustice prospects three at of claimant. The majority's an extreme all of denial 268 Mont. Stevens, LP ignored case, the investigation, is laws the of cost of especially have been attorneys enforcement of who their MCA (1987). from j oins 35 the in majority the opinion. foregoing dissenting Justice W. William I dissent "minimal holding Leaphart, dissenting from the majority investigation of in Love11 v. State 260 Mont. 2.79, 288, Marcott's claim a claim's making 95, LP failed validity" Compensation 860 P.2d without opinion. 101. Mutual Under such a minimal unreasonable. 36 to make the as required Ins. Lovell, by our Fund (1993), denial investigation of was
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