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Hiett v. Montana Schools Group Insurance Authority9/6/2001
oximately $1600.(1)
On October 7, 1999, claimant's attorney contacted Edquest about paying for claimant's medications, specifically for her anti-depressants. (Id. at 246.) She wrote that MSGIA had previously agreed to pay for the anti-depressants. (Id.) Edquest agreed to pay for the medications, in part because he had not informed claimant or her attorney regarding the termination of her medical benefits. (Edquest Dep. at 25-26, 34, 46, 49, 55-56.) However, the bills for claimant's medications remained unpaid for several months.
Since the bills remained unpaid, claimant requested mediation. On March 13, 2000, following mediation, MSGIA paid $1,200 in prescription bills, however, some bills which Edquest promised to pay were not paid. Claimant's attorney again wrote to Edquest on April 14, 2000, advising him that some prescription expenses for claimant were still outstanding. (Ex. 1 at 267.) Edquest was apologetic for the delays in payments which he had agreed to pay, citing various explanations for the delay. Essentially, the reasons he gave were institutional ones, involving oversight or processing problems.
At some point, claimant and her attorney were notified that MSGIA contested payment for further medications if claimant was not working. A second mediation was held in September 2000. At the time of the second mediation, claimant was working as an assisted-living attendant at the Senior Village, so the mediation was postponed pending a response from claimant's treating physician as to the necessity of claimant's medications. (Id. at 300.) Dr. Smith responded on September 20, 2000, that claimant's depression and pain medications were "essential" for claimant and would control her pain to a degree that would allow her to work. (Id. at 276.) MSGIA then agreed to pay claimant's medical bills as long as she works. (Edquest Dep. at 54.)
Some prescriptions still remained unpaid as of December 31, 2000, and a third mediation was requested. However, by the time of that mediation, claimant was no longer working and the parties could not reach agreement as to claimant's further entitlement to payment for prescription drugs. MSGIA maintained its position that it is not liable for claimant's prescription benefits because they are secondary benefits and claimant is not working.
Claimant then petitioned the Court. Pending a final decision by the Court, MSGIA agreed to continue to pay for claimant's injury-related medications under a reservation of rights. At the time of trial, all medications had been paid.
CONCLUSIONS OF LAW
The 1995 version of the Workers' Compensation Act applies to claimant's injury since that was the law in effect on the date of her injury. Buckman v. Montana Deaconess Hospital, 224 Mont. 318, 321, 730 P.2d 380, 382 (1986.)
The claimant has the burden of proving by a preponderance of the evidence that she is entitled to compensation . Ricks v. Teslow Consolidated, 162 Mont. 469, 512 P.2d 1304 (1973); Dumont v. Wicken Bros. Construction Co., 183 Mont. 190, 598 P.2d 1099 (1979).
This case involves interpretation and application of provisions for medical benefits. Those provisions are found in section 39-71-704(1), MCA (1995). Some of the terms used in the section are defined in section 39-71-116, MCA (1995).
The portions of section 39-71-704(1), MCA (1995), potentially applicable to the present case are as follows:
(1) In addition to the compensation provided under this chapter and as an additional benefit separate and apart from compensation benefits actually provided, the following must be furnished:
(a) After the happening o
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