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Hiett v. Montana Schools Group Insurance Authority9/6/2001
Id. at 186, 188.)
C Claimant had been found disabled and awarded SSD benefits in January 1997. (Id. at 200-202.)
D On January 27, 1997, claimant submitted her application for retirement to the Public Employees Retirement System. (Id. at 197.)
At no time prior to the settlement did MSGIA tell claimant or her attorney that continued payment for medications were dependent upon claimant obtaining employment.
At the time of the settlement, the claimant believed that MSGIA would continue to pay for injury-related medications for the remainder of her life. She testified that had she known that it would not, then she would not have settled her claim. However, while claimant might have refused to enter into the settlement if she had been aware MSGIA would not pay for prescription drugs unless she was employed. I am persuaded that she is not in a worse position now than she would have been had she been aware of such fact. Even if she had refused to enter into the agreement her medical benefits would still be limited to those provided by statute. And she has failed to prove that she could have extracted any greater compensation benefits had she not settled. She did not, and does not, contend that she was entitled to permanent total disability (PTD) benefits. The sole dispute between the parties was the impairment award. (Ex. 1 at 200-216.) Except for the dispute over the impairment award, she got exactly what she demanded. As to the disputed impairment award, claimant has failed to present evidence showing that she could have obtained a greater impairment award than obtained through the settlement.
At the time of the settlement, claimant was not working. Since then she has worked occasionally selling tickets at high school sporting events. She was also employed from May 23, 2000 to November 21, 2000, as an assisted-living attendant for the Senior Village Residence (Senior Village). (Ex. 7 at 9.) Claimant left that job when hospitalized for drug withdrawal from narcotic medications she had been taking. She also testified that she has looked for work since losing her job with the School District but Wal-Mart and other businesses will not hire her because of her back condition.
MSGIA began paying for claimant's pain medications in May 1996 and for anti-depressants in August 1996. Following the settlement, it continued to pay for the medications until January 1999, when Charles Edquest (Edquest) began adjusting the claim. He determined that claimant was not working and was therefore not entitled to payment for her medications. He relied on section 39-71-704(1)(b), MCA (1995), which provides that "the insurer shall furnish secondary medical services only upon a clear demonstration of cost-effectiveness of the services in returning the injured worker to actual employment." Secondary services, by definition, are "those medical services or appliances that are considered not medically necessary for medical stability." ยง 39-71-116(29)(a), MCA (1995).
In cutting off payment for claimant's medications, Edquest did no investigation other than to review documents in the claims file. (Edquest Dep. at 27, 39-41, 48.) The file contains nothing indicating that MSGIA inquired as to claimant's job status or whether her medications were necessary for her to continue employment.
MSGIA did not inform claimant of the cutoff of benefits and did not tell her she might requalify for payment of medications if she returned to work. In fact, claimant did not learn that MSGIA had stopped paying for her medications until the Fall of 1999 when she went to Wal-Mart for a prescription refill and discovered she had an outstanding balance of appr
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