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Stephenson v. Cigna Insurance Company3/29/2001
FINDINGS OF FACT, CONCLUSIONS OF LAW AND JUDGMENT
Summary of Case: Claimant injured his back in 1987 while employed by ARCO. He lostthree weeks of work and worked for ARCO for another eight and one-half years, then waslaid off on December 31, 1995. His back continued to hurt and he sought further medicalcare in 1992 and 1995. Following his lay off, he was employed for short periods in 1996,then ceased working. Meanwhile, he suffered increasing back and left leg pain, causinghim to again seek medical care in July 1998. He has been released by an IME physicianto return to work in two sedentary positions with the proviso that he begin on a part-timebasis and increase his hours as his pain tolerates. He claims that his pain precludes himfrom returning to any job .
Held: (1) Claimant's present back condition is the result of his 1987 injury . While the 1987 injury merely "lit up" and made his underlying back disease symptomatic, it constituted amaterial aggravation for which the insurer remains liable absent it showing that the present condition arose independently of the aggravation from some subsequent event. (2)Claimant's pain complaints are credible and such that he cannot hold regular employment. (3) Since claimant prevailed, he is entitled to attorney fees. The 1985 law applies anddoes not require that he prove that the insurer's denial was unreasonable. (4) Claimantis not entitled to a penalty since the insurer reasonably questioned his claims concerning the severity of his pain and therefore his disability.
Injury and Accident: Aggravation: Generally. Where an industrial injury lights up or makes symptomatic a pre-existing condition, the insurer is liable for the condition unless some subsequent event or condition intervenes.
Benefits: Permanent Total Benefits: Generally. While pain is only one component to be considered in determining whether a claimant is permanently totally disabled, where pain is of such magnitude that it prevents the claimant from holding regular employment, the claimant is permanently totally disabled.
Attorney Fees: Denial or Delay of Payment. Under 1985 law, which applies in this case, the claimant is entitled to attorney fees since the insurer denied his request for permanent total disability benefits and he prevailed in his request.
Penalties: Insurers: No penalty where the claim for permanent total disability is based upon pain and the insurer reasonably questioned the claimant's credibility as to his pain complaints.
Montana Code: 39-71-611 (1985). Under 1985 law, which applies in this case, the claimant is entitled to attorney fees since the insurer denied his request for permanent total disability benefits and he prevailed in his request.
Montana Code: 39-71-2907 (1985). No penalty where the claim for permanent total disability is based upon pain and the insurer reasonably questioned the claimant's credibility as to his pain complaints.
The trial in this matter was held on February 22, 2001, in Butte, Montana. Petitioner, Sam Stephenson, III (claimant), was present and represented by Mr. Bernard J. Everett. Respondent, Cigna Insurance Company (CIGNA), was represented by Mr. Robert Cameron.
Exhibits: Exhibits 1 through 4 and 8 were admitted without objection. Exhibits 5 through 7 were admitted over objections. Exhibit 9 was withdrawn.
Witnesses and Depositions: The parties agreed that depositions of claimant and Dr. Catherine C. Capps, M.D., shall be considered by the Court. Claimant and Kathryn Kleinkopf were sworn and testified.
As stated in the pre-trial order, the issues are as follows:
1. Whe
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