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Hiett v. Montana Schools Group Insurance Authority9/6/2001
FINDINGS OF FACT, CONCLUSIONS OF LAW AND JUDGMENT
The trial in this matter was held on April 11, 2001, in Missoula, Montana. Petitioner, Eula Mae Hiett (claimant), was present and represented by Ms. Sydney E. McKenna. Respondent, MSGIA, was represented by Mr. Leo S. Ward.
Exhibits: Exhibits 2, 3, and 8 were admitted without objection. Exhibits 1 and 4 through 7 were admitted over relevancy objections. If mentioned in this decision, they are relevant.
Witnesses and Deposition: The parties submitted the deposition of Charles Edquest for the Court's consideration. Claimant and Charles Edquest were sworn and testified.
Issues Presented:
1. Did the Insurer breach the settlement agreement when it stopped paying medical benefits.
2. Was the Insurer's unilateral decision to terminate benefits and subsequent failure to notify claimant of that decision unreasonable.
3. If the Insurer's actions were unreasonable, is claimant entitled to attorney fees.
4. Was the delay in payment of benefits promised unreasonable and if so is claimant entitled to a 20% increase in those benefits.
5. Is the Insurer estopped from termination of claimant's medical benefits.
6. Are claimants medical benefits secondary medical benefits and thereby not owed even though the Insurer agreed to reserve medical benefits. (Pretrial Order at 2.)
Having considered the Pretrial Order, the testimony presented at trial, the demeanor and credibility of the witnesses, the deposition and exhibits, and the parties' arguments, the Court makes the following:
FINDINGS OF FACT
Claimant is 64 years old. She has a history of back pain dating back to 1980. (Ex. 1 at 736.) She also has a history of asthma dating back to 1981. (Id.) She presently suffers from asthma, chronic obstructive pulmonary disease, and osteoporosis, as well as a bad back.
In 1981 the Missoula County Public Schools (School District) hired claimant as a custodian. (Id. at 24.) She continued working for the School District through 1996.
On March 1, 1996, claimant was lifting a 30-gallon trash can into a dumpster when she experienced a sharp pain in her back. (Id. at 24.) She was subsequently diagnosed as suffering compression fractures in the thoracic spine at the T6 and T8 levels. (Ex. 1 at 727, 732, 734.)
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). (Uncontested Fact No. 2.) MSGIA accepted liability for claimant's condition and paid disability and medical benefits. (Uncontested Fact No. 3.)
Claimant continued to experience back pain. She began treating with Dr. Aaron W. Sable, a physiatrist. Dr. Sable found her at maximum medical improvement (MMI) on June 5, 1996, and permanently restricted her to sedentary to light-duty work. (Ex. 1 at 744-45.)
On July 29, 1996, claimant returned to work in a part-time, modified school custodian position. Initially she worked two hours a day; later on she worked four hours a day. (Id. at 37-38, 60-61.) In August she reported to Dr. Sable that she had been working four hours a day as custodian but that the window washing, climbing ladders, mopping, and cleaning bathrooms were aggravating her back pain. (Id. at 749.) He recommended that she contact Kathy Kleinkopf (Kleinkopf) to see if she could get a hall monitor job with the School District. (Id.รท
When claimant followed-up with Dr. Sable on August 27, 1996, he noted that she was depressed about her situation at work a
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