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Eastman v. Insurance Co.8/10/2000
ticularly without the second year of the program.
Finally, we reject Eastman's equitable estoppel claim. The case cited by Eastman, Kuzura v. State Fund (1996), 279 Mont. 223, 231, 928 P.2d 136, 141, states that " quitable estoppel applies when an employer or insurer has taken some positive action which either prevents a claimant from filing a timely claim or leads the claimant reasonably to believe she need not file such a claim." In Turjan v. Valley View Estates (1995), 272 Mont. 386, 395, 901 P.2d 76, 82 (citation omitted), we further held that "'the party . . . to be estopped [must] have knowledge that he is misleading the claimant and an intention to mislead the claimant to his detriment.'" Based on our finding that North America did not prevent the rehabilitation provider from formulating a rehabilitation plan for Eastman and that the denial of rehabilitation benefits for Eastman is attributable to his insistence on pursuing the vo-tech program despite the fact that the Workers' Compensation Court had found that plan unreasonable, the doctrine of equitable estoppel does not arise under these circumstances. North America neither prevented Eastman from pursuing any benefits nor misled Eastman to his detriment.
The judgment of the Workers' Compensation Court is affirmed.
W. WILLIAM LEAPHART
We concur:
J. A. TURNAGE
JAMES C. NELSON
JIM REGNIER
KARLA M. GRAY
Justice William E. Hunt, Sr. dissents from the majority opinion.
The majority opinion allows an insurer to wait and watch while an injured worker attempts on his own to rehabilitate himself and then pounce out at the last minute, just in time to avoid payment. Under the majority's decision, an insurer bears no risk but has everything to gain if the rehabilitation provider ignores its statutory obligations.
The Workers' Compensation Act provides no remedy for an injured worker who clearly is entitled to rehabilitation benefits, but the insurer refuses to allow a rehabilitation plan to be prepared. Whenever an insurer, or the rehabilitation provider it hires and pays for, fails to provide a rehabilitation plan for an injured worker, that injured worker must necessarily have the option of submitting his own rehabilitation plan. To hold otherwise would allow an insurer to effectively deny benefits to a deserving injured worker by simply not filing a rehabilitation plan.
The majority's premise that Eastman's uncooperativeness justifies the rehabilitation provider's failure to formulate a rehabilitation plan ignores statutory law. Section 39-71-2001(6), MCA (1991), expressly provides that the rehabilitation provider "shall continue to work with and assist the injured worker until the rehabilitation plan is completed." The statutory obligation to prepare a rehabilitation plan rests squarely with the designated rehabilitation provider. Further, if at any point in this process the insurer feels the injured worker is uncooperative, it may give a 14-day notice to the worker prior to termination of rehabilitative benefits. Section 39-71-1032, MCA (1991). Non-cooperation does not relieve the rehabilitation provider of its duty to provide a rehabilitation plan.
Here, the rehabilitation provider has never provided Eastman with a rehabilitation plan. Rather, the insurance company is allowed to attack Eastman's proposed plan without providing any alternatives. The majority seems to find something deplorable in Eastman's determination to rehabilitate himself while ignoring the rehabilitation provider's failure to comply with its statutory obligations. This line of reasoning ignores that it is
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