No. DA 06-0172
IN THE SUPREME COURT OF THE STATE OF MONTANA
2007 MT 131
MARY ANN GAMBLE,
Petitioner and Respondent,
v.
SEARS, the parent SEARS HOLDINGS
CORPORATION, subsidiaries and affiliates
KMART, the parent SEARS HOLDINGS
CORPORATION, subsidiaries and affiliates,
Respondent and Appellant.
APPEAL FROM: Montana Workers’ Compensation Court, WWC No. 2005-1337
Honorable James J. Shea, Presiding Judge
COUNSEL OF RECORD:
For Appellant:
Michael P. Heringer, Don M. Hayes, Brown Law Firm, P.C.,
Billings, Montana
For Respondent:
Mark M. Kovacich, Lewis, Slovak & Kovacich, P.C.,
Great Falls, Montana
Submitted on Briefs: October 10, 2006
Decided: June 5, 2007
Filed:
__________________________________________
Clerk
Justice Patricia O. Cotter delivered the Opinion of the Court.
¶1 Sears Holdings Corporation appeals from the judgment of the Workers’
Compensation Court rescinding the settlement agreement in Mary Ann Gamble’s injury
claim.
¶2 The Appellant raises the following issues for review:
¶3 (1) Did the court err in rescinding the parties’ settlement agreement?
¶4 (2) Did the court err in concluding that Gamble’s failure to comply with
§ 39-71-1101(2), MCA, did not absolve Sears of liability for the cost of medical
treatment?
¶5 We affirm.
FACTUAL AND PROCEDURAL BACKGROUND
¶6 K-Mart Corporation (“K-Mart”) hired Mary Ann Gamble (“Gamble”) in 1988 to
work at its retail store in Great Falls, Montana. After working in several capacities at the
store during the following years, Gamble was promoted to the position of manager of the
housewares department in 1996. Thereafter, on May 16, 1997, she was injured in an
accident that occurred during the course and scope of her employment.
¶7 As department manager, Gamble was required to lift and move pieces of furniture,
appliances, and other items. Her injury occurred while she was moving a desk, weighing
approximately 150 pounds, which was contained in a box. As she attempted to remove
the box from a shelf, it fell onto the top of her head. She instantly experienced severe
pain in her neck. Her left knee was also injured in this accident, eventually requiring
2
surgery, but only her neck injury is at issue in this appeal. Gamble reported her injuries
to K-Mart’s personnel department and filed an injury claim form that day. 1
¶8 During the period in which K-Mart employed Gamble, it was self-insured for
workers’ compensation purposes. Thus, K-Mart accepted liability for Gamble’s injury
claim and paid benefits accordingly. Sears Holdings Corporation (“Sears”) is the
successor to K-Mart and has assumed liability for K-Mart’s workers’ compensation
claims.
¶9 After the accident, Gamble experienced a number of symptoms including
continuous pain in her neck, particularly at the base of her skull, a limited range of
motion in her neck, severe headaches on a regular basis, as well as numbness and a
burning sensation on the right side of her face. Additionally, the act of leaning forward—
to pick up a piece of merchandise from the floor, for example—caused nausea and
vomiting. The severity of Gamble’s condition caused her to frequently cut short her
work shifts at the store. Ultimately, her symptoms did not subside until September of
2004 after she underwent surgery to fuse a fractured bone in her neck.
¶10 Although Gamble visited a chiropractor shortly after the accident, she did not seek
additional medical treatment for a number of months, as she hoped her neck would heal
on its own. Then, in the fall of 1997, after Gamble missed part of a day of work due to a
particularly severe headache which brought on an extended bout of nausea and vomiting,
her manager expressed concern over her frequent absence from work and directed her to
1
The personnel department lost the original claim form and later directed Gamble to fill out
another one. Consequently, the claim form in the record is dated January 19, 1998.
3
see a physician. Accordingly, in November of 1997, Gamble went to Dr. Jerry Speer, a
board-certified family practitioner in Great Falls. Based on his examination, Dr. Speer
believed Gamble was suffering from “a muscular rotational injury with underlying
osteoarthritic problems.” He prescribed anti-inflammatory medication and referred
Gamble to Dr. Dale Schaefer, a board-certified neurosurgeon.
¶11 After examining Gamble in December of 1997, Dr. Schaefer initially believed that
she was suffering from a soft-tissue injury. Thus, he recommended pain medication and
a course of physical therapy. Gamble completed six weeks of physical therapy and
reported that it did not relieve her symptoms. As an additional diagnostic measure, Dr.
Schaefer then ordered a cervical myelogram and CAT scan. After reviewing the films
from these tests, Dr. Schaefer came to believe that Gamble was suffering from arthritic
degenerative or spondylitic changes in her neck, rather than a soft-tissue injury, and
therefore concluded that he could not offer treatment that would benefit her.
Consequently, he released Gamble from his care, and she continued to see Dr. Speer.
¶12 In March of 1998, Gamble ceased working at K-Mart due to her persisting
symptoms. Then, in September of 1998, she was examined by a panel of doctors at the
request of the firm administering Gamble’s injury claim, Compensation Adjusters, Inc.
In rendering its report, the panel diagnosed Gamble with, among other things,
“multi-level cervical degenerative changes.” While the panel determined that this
condition likely existed before her on-the-job injury, it also determined that “the
occupational injury represents a significant and permanent aggravation” of her
pre-existing degenerative condition. Further, the panel determined that Gamble had
4
reached a maximum medical improvement plateau, but also noted that she could require
further treatment. Finally, the panel assigned her a 5% whole-person impairment rating
and determined that while continued work as the housewares department manager would
be inappropriate, she “may be able to return to a light duty vocational position with
restrictions.”
¶13 In May of 2001, the parties entered into an agreement that settled Gamble’s claims
for disability and rehabilitation benefits under the Workers’ Compensation Act. At that
time, the parties believed that Gamble’s condition had been properly diagnosed and that
she had achieved maximum medical improvement, in accordance with the panel’s
conclusion. However, the settlement agreement expressly reserved further medical
benefits, apparently because the panel had determined that Gamble could require further
treatment. Yet, because Gamble was not diagnosed with a fracture at the time of
settlement, the reservation of medical benefits did not extend to that condition. Shortly
thereafter, the Department of Labor and Industry approved this settlement agreement.
¶14 In the years following the settlement of her claim, Gamble’s symptoms did not
subside. During this time, Dr. Speer periodically prescribed pain medication and muscle
relaxant medication. He also conducted testing which demonstrated that Gamble was not
suffering from rheumatoid arthritis. Gamble treated with Dr. Speer until he ceased his
full-time family practice in 2003. Then, in the summer of 2004, Gamble went to Dr.
James Legan, who ordered new MRI testing. Based on the results, Dr. Legan determined
that she was suffering from a fracture in her odontoid process, which is a part of the
second vertebra of the neck. He then referred Gamble to Dr. Michael Dube, a
5
board-certified orthopedic surgeon. Dr. Dube ordered a CAT scan in August of 2004.
The results of that test clearly showed that Gamble was suffering from an odontoid
fracture that had failed to heal properly. He recommended that Gamble undergo a bone
fusion surgery without delay, and informed her of the serious risks associated with such a
procedure. Gamble agreed to undergo the procedure and Dr. Dube successfully
performed surgery in September of 2004. Consequently, Gamble’s symptoms subsided
dramatically.
¶15 Thereafter, Dr. Dube was presented with the results of an x-ray taken in March of
1998, less than a year after Gamble’s injury occurred. Upon review, he concluded that
Gamble’s odontoid fracture was visible in these x-ray films. Dr. Dube further concluded,
based on the eroded bone margins and callous formation he found at the site of the
fracture, the 1998 x-ray films, and Gamble’s symptoms, that her odontoid fracture was
caused by the 1997 accident at K-Mart.
¶16 In June of 2005, Gamble filed a petition for trial with the Workers’ Compensation
Court (“WCC”). In the petition, Gamble contended that she had not reached maximum
medical improvement when the settlement agreement was executed, contrary to the
parties’ belief, because her odontoid was fractured at that time. Thus, Gamble contended,
both parties’ consent to the settlement agreement was based on a mutual mistake
regarding the nature of her physical condition. Additionally, Gamble asserted that Sears
had acted unreasonably in refusing to recognize the mutual mistake and provide coverage
for the medical expenses she incurred as a result of the fracture. Upon these contentions,
6
Gamble requested that the WCC rescind the settlement agreement and award attorney
fees and a penalty against Sears for its unreasonable conduct. 2
¶17 In response, Sears argued that no mutual mistake of fact had occurred and that the
settlement agreement should not be rescinded. Sears also argued that it was not liable for
the cost of any treatment rendered by Dr. Legan or Dr. Dube, regardless of whether
Gamble’s odontoid fracture was caused by the 1997 accident, because she had failed to
obtain authorization to treat with either of these doctors.
¶18 The WCC held a trial in January of 2006. In rendering its judgment shortly after
trial, the court found that Gamble’s odontoid fracture was caused by the 1997 accident at
K-Mart and that it was present when the parties entered into their settlement agreement in
2001. Thus, because Sears and Gamble believed that she had been properly diagnosed
and had reached maximum medical improvement at the time of settlement, the WCC
found that the parties were mistaken regarding a fact that was material to the agreement.
Accordingly, the WCC rescinded the settlement agreement, thereby reopening Gamble’s
claim. Further, the WCC rejected Sears’ argument that Gamble’s failure to request
authorization to change treating physicians absolved Sears of liability for the cost of
treatment rendered by Dr. Legan and Dr. Dube. In doing so, the court observed that no
one knew Gamble’s odontoid fracture was related to the 1997 accident until after Dr.
Dube performed the bone fusion surgery. Finally, the court denied Gamble’s request for
2
Sections 39-71-611 and 39-71-2907, MCA, respectively provide for an award of attorney fees
and the assessment of a penalty against an insurer that unreasonably denies liability or delays or
refuses to make payments.
7
an award of attorney fees and a penalty, finding that Sears had not acted unreasonably in
opposing her effort to reopen the claim.
¶19 Sears now appeals from the judgment.
STANDARD OF REVIEW
¶20 We conduct de novo review of the WCC’s conclusions of law in order to
determine whether they are correct. Flynn v. Uninsured Employers’ Fund, 2005 MT
269, ¶ 11, 329 Mont. 122, ¶ 11, 122 P.3d 1216, ¶ 11. As for the WCC’s findings of fact,
however, our review is both deferential and limited in scope. We simply review the
WCC’s factual findings to determine whether they are supported by substantial credible
evidence. In re Abfalder, 2003 MT 180, ¶ 10, 316 Mont. 415, ¶ 10, 75 P.3d 1246, ¶ 10.
We have stated that substantial credible evidence is that which a reasonable mind could
accept as adequate to support a conclusion. Simms v. State Compensation Ins. Fund,
2005 MT 175, ¶ 11, 327 Mont. 511, ¶ 11, 116 P.3d 773, ¶ 11. Indicating the high level of
deference this Court accords to the WCC’s factual findings, we have stated that evidence
will be considered substantial even if it is contradicted by other evidence, even if it is
somewhat less than a preponderance, and even if it is inherently weak. EBI/Orion Group
v. State Compensation Mut. Ins. Fund, 249 Mont. 449, 453, 816 P.2d 1070, 1073 (1991);
Simms, ¶ 11; Wolfe v. Webb, 251 Mont. 217, 230, 824 P.2d 240, 248 (1992). However, it
must be more than a mere “scintilla” of evidence and it must rise above the level of
“trifling or frivolous.” Simms, ¶ 11; EBI/Orion Group, 249 Mont. at 453, 816 P.2d at
1073. As for the scope of our review, we do not resolve conflicts in the evidence, and we
do not consider whether evidence supports findings that are different than those made by
8
the WCC; rather, we confine our review to determining whether substantial credible
evidence supports the findings actually made by the WCC. Kloepfer v. Lumbermen’s
Mutual Casualty Co., 276 Mont. 495, 498-99, 916 P.2d 1310, 1312 (1996); Montana
State Fund v. Murray, 2005 MT 97, ¶ 19, 326 Mont. 516, ¶ 19, 111 P.3d 210, ¶ 19; In re
Abfalder, ¶ 10.
¶21 The “substantial credible evidence” standard of review is further defined by rules
regarding our consideration of witness testimony. As for witnesses who testify in person
at trial, we defer to the WCC’s findings concerning credibility and the weight to be
accorded to this testimony. Kuntz v. Nationwide Mutual Fire Ins. Co., 1998 MT 5, ¶ 35,
287 Mont. 142, ¶ 35, 952 P.2d 422, ¶ 35; Wilson v. Liberty Mutual Fire Ins., 273 Mont.
313, 319, 903 P.2d 785, 788 (1995). It is the WCC’s job to resolve any inconsistencies in
a witness’s testimony. Walls v. Travelers Indemnity Co., 281 Mont. 106, 111, 931 P.2d
712, 716 (1997). Ultimately, because an assessment of testimony is best made upon
observation of the witness’s demeanor and consideration of other intangibles that are only
evident during live testimony, we will not substitute our judgment for the WCC’s
judgment regarding credibility and the weight accorded to live testimony. Wilson, 273
Mont. at 319, 903 P.2d at 788.
¶22 Conversely, we are in as good a position as the WCC to assess testimony
presented at trial by way of deposition. McIntyre v. Glen Lake Irrigation District, 249
Mont. 63, 67, 813 P.2d 451, 454 (1991); White v. Ford, Bacon & Davis Texas, Inc., 256
Mont. 9, 13, 843 P.2d 787, 789 (1992). Therefore, we conduct de novo review of
deposition testimony. White, 256 Mont. at 13, 843 P.2d at 789. However, this
9
independent review of deposition testimony is only one component of our task on appeal.
We must then consider the deposition testimony in the context of the other relevant
evidence in order to properly assess the factual findings at issue. McIntyre, 249 Mont. at
67-68, 813 P.2d at 454; White, 256 Mont. at 13, 843 P.2d at 789. As we have stated,
even where we conduct de novo review of deposition testimony, we are ultimately
restricted to determining whether substantial credible evidence supports the WCC’s
findings. Weber v. Public Employees’ Retirement Board, 270 Mont. 239, 245, 890 P.2d
1296, 1299 (1995).
DISCUSSION
¶23 (1) Did the court err in rescinding the parties’ settlement agreement?
¶24 A settlement agreement is a contract; therefore, we apply contract law to
determine whether the agreement is valid and enforceable. Wolfe, 251 Mont. at 223, 824
P.2d at 244.
¶25 The parties must give their consent to enter into a contract. Wolfe, 251 Mont. at
227, 824 P.2d at 246 (citing § 28-2-102(2), MCA). The requisite consent must be given
freely, and consent cannot be given freely when it is based on a mistake. Wolfe, 251
Mont. at 227, 824 P.2d at 246 (citing § 28-2-301(1) and § 28-2-401(1)(e), MCA). Either
a mistake of fact or a mistake of law will preclude freely given consent.3 Wolfe, 251
Mont. at 224, 824 P.2d at 244 (citing § 28-2-408, MCA). A mistake of fact, which
3
We have addressed both scenarios in cases appealed from the WCC. See, e.g., Kienas v.
Peterson, 191 Mont. 325, 330, 624 P.2d 1, 3 (1980) (addressing the parties’ mutual mistake
regarding facts relevant to the claimant’s physical condition) and Brown v. Richard A. Murphy,
Inc., 261 Mont. 275, 282, 862 P.2d 406, 410 (1993) (addressing a mutual mistake regarding the
law of subrogation rights).
10
Gamble alleges in this case, is defined as “a mistake not caused by the neglect of a legal
duty on the part of the person making the mistake,” and consisting of “an unconscious
ignorance or forgetfulness of a fact, past or present, material to the contract” or a belief in
“the present existence of a thing material to the contract which does not exist” or a belief
in “the past existence of such a thing which has not existed.” Wolfe, 251 Mont. at 224,
824 P.2d at 244 (citing § 28-2-409, MCA).
¶26 Pursuant to these rules, it is well established that a settlement agreement must be
rescinded if, when the parties entered into it, they were mutually mistaken regarding a
fact that was material to the agreement.4 Kienas v. Peterson, 191 Mont. 325, 328-30, 624
P.2d 1, 2-3 (1980); Weldele v. Medley Development, 227 Mont. 257, 260, 738 P.2d 1281,
1283 (1987); Kimes v. Charlie’s Family Dining, 233 Mont. 175, 177, 759 P.2d 986, 988
(1988); Wolfe, 251 Mont. at 223-28, 824 P.2d at 244-46; South v. Transportation Ins.
Co., 275 Mont. 397, 401, 913 P.2d 233, 235 (1996).
4
We recognize that it is not strictly accurate to say that the agreement must be “rescinded”
based on a mutual mistake of material fact, because such a mistake technically precludes the
formation of a contract, Weldele, 227 Mont. at 260, 738 P.2d at 1283, and rescission cannot
technically occur unless a contract has first been formed, see Black’s Law Dictionary 1332
(Bryan A. Garner ed., 8th ed., West 2004) (citations omitted). Nonetheless, our cases have often
used the term “rescind” to describe the appropriate remedy where a mutual mistake occurs. See,
e.g., South, 275 Mont. at 401, 913 P.2d at 235; Brown, 261 Mont. at 282, 862 P.2d at 411;
Whitcher v. Winter Hardware Co., 236 Mont. 289, 292, 769 P.2d 1215, 1216 (1989). This
technical inconsistency is similar to that which is present in the commonly used expression “void
contract.” The so-called “void contract” is actually a contradiction in terms because a “contract”
is defined in terms applicable only to a valid agreement; however, the phrase “void contract” is
convenient and therefore used universally. Black’s Law Dictionary at 350 (citations omitted).
Similarly, in our workers’ compensation cases, we continue to use the term “rescind” as a
convenient means of characterizing the remedy that must follow where the parties’ consent to an
agreement was based on a mutual mistake of material fact.
11
¶27 A “material” fact is “a vital fact upon which [the parties] based their bargain.”
South, 275 Mont. at 401, 913 P.2d at 235 (internal quotation marks omitted). Thus, we
have stated that a mutual mistake regarding a material fact is a mistake that is “so
substantial and fundamental as to defeat the object of the parties in making the contract.”
South, 275 Mont. at 401, 913 P.2d at 235 (internal quotation marks omitted). Finally, we
have determined in several cases that the nature and extent of a claimant’s physical
condition is a fact that is material to an agreement settling an injury claim. 5 Kienas, 191
Mont. at 330, 624 P.2d at 3; Weldele, 227 Mont. at 261, 738 P.2d at 1283; Kimes, 233
Mont. at 178, 759 P.2d at 988; Wolfe, 251 Mont. at 231, 824 P.2d at 248.
¶28 Here, Gamble had not been diagnosed with an odontoid fracture when she entered
into the settlement agreement with K-Mart. It is undisputed that if Gamble’s fracture
existed at that time, the parties were mutually mistaken as to a material fact—i.e., the
nature of her physical condition—and the agreement must therefore be rescinded. 6 Thus,
in order to resolve the first issue raised in this appeal, we need only determine whether
5
In addressing the contract law principles relevant to this case, Sears cites our unpublished
decision in Romans v. Liberty Mutual Fire Ins. Co., 2001 MT 64N, despite the fact that we
expressly designated it as a noncite opinion and stated in the very first paragraph of the decision
that it “shall not be cited as precedent.” Thus, we admonish Sears for disregarding our express
instruction regarding the Romans decision.
6
Although Sears does not dispute this application of the law, it nonetheless directs our attention
to a portion of the settlement agreement which provides that Gamble’s claim cannot be reopened
even if the parties are mistaken as to the nature or extent of her physical condition. That
provision states in part: “both the Insurer and Claimant agree to assume the risk that the
condition of the Claimant, as indicated by reasonable investigation to date, may be other than it
appears.” However, this provision is of no consequence. In Wolfe, this Court held that such a
provision is not enforceable because it directly conflicts with Montana law regarding the
formation of a contract—i.e., freely given consent is a prerequisite, and consent cannot be freely
given when it is based on a mistake. Wolfe, 251 Mont. at 227-28, 824 P.2d at 246. In other
words, parties may not agree to enter into a legally invalid contract.
12
substantial credible evidence supports the WCC’s finding that Gamble’s odontoid
fracture was caused by the 1997 accident at K-Mart and was present when the parties
entered into their settlement agreement.
¶29 Before assessing the relevant evidence, however, we address three preliminary
issues related to the standard of review. First, Sears challenges the credibility of
Gamble’s testimony regarding the mechanism of her injury and the onset of certain
symptoms. Particularly, Sears argues that Gamble’s testimony that the desk “fell” on her
is inconsistent with her prior statements describing the incident as a “lifting” accident.
Sears also argues that Gamble was inconsistent in her testimony regarding the burning
sensation and numbness she experienced in her face. At trial, Gamble testified that she
had continually experienced these symptoms since the accident, but also stated that she
could not remember exactly when the symptoms began. Additionally, Sears emphasizes
that Gamble did not report these particular symptoms to Dr. Schaefer even though the
symptoms had allegedly been present since the accident.
¶30 The applicable standard of review in this case does not allow us to render our own
judgment regarding the alleged inconsistencies that Sears identifies. As noted above, it is
the WCC’s job to resolve any inconsistencies in a witness’s testimony, and this Court
defers to the WCC’s findings regarding the credibility of testimony rendered in person at
trial. Walls, 281 Mont. at 111, 931 P.2d at 716; Kuntz, ¶ 35; Wilson, 273 Mont. at 319,
903 P.2d at 788. We have consistently adhered to this rule because an assessment of
testimony is best made upon observation of the witness’s demeanor and consideration of
other intangibles that are only evident during live testimony. See Wilson, 273 Mont. at
13
319, 903 P.2d at 788. Here, because Gamble testified in person at trial, the WCC was
able to observe her demeanor, consider any inconsistencies in her testimony, and
ultimately judge her credibility based on these considerations and in light of the other
evidence presented. The WCC did so and, as expressly stated in the written judgment,
found that Gamble’s testimony was credible. 7 Therefore, we consider Gamble’s trial
testimony to be credible. Further, we note that Gamble’s husband testified in person at
trial. He provided testimony that was consistent with Gamble’s, and the WCC expressly
found his testimony to be credible as well.
¶31 Second, Sears argues that substantial credible evidence supports a finding that
Gamble’s odontoid fracture was caused by a “natural progression of [her] underlying
degenerative disk disease” rather than the 1997 accident. In supporting this argument,
Sears presents a lengthy and detailed description of Gamble’s medical history, which it
characterizes as “overwhelming” evidence, and points to medical testimony which
conflicts with the evidence that the WCC relied on in reaching its findings. In addition,
Sears relentlessly emphasizes the fact that none of the doctors who examined her prior to
settlement ever diagnosed an odontoid fracture. Of course, it goes without saying that
Gamble was not diagnosed as having an odontoid fracture prior to settlement; if she had
been, there would be no basis for this litigation. More importantly, however, our
standard of review renders these arguments irrelevant.
7
We note that even if some portion of a witness’s testimony is shown to be false or unreliable,
the WCC is not required to discount the entirety of that witness’s testimony. Walls, 281 Mont. at
111, 931 P.2d at 716.
14
¶32 It is the WCC’s job to make factual findings, while our limited appellate role is to
merely review those findings. Kloepfer, 276 Mont. at 498-99, 916 P.2d at 1312. In
conducting our review, we do not resolve evidentiary conflicts or consider whether
evidence supports factual findings that the WCC did not make; rather, our inquiry is
restricted to determining whether substantial credible evidence supports the findings
actually made by the WCC. Murray, ¶ 19; In re Abfalder, ¶ 10; Kloepfer, 276 Mont. at
498-99, 916 P.2d at 1312. To that end, we simply review the evidence that the WCC
relied on in making its findings, rather than conducting a far-reaching and comprehensive
evidentiary analysis, as advocated by Sears, which would render our role no different
than that of the WCC. Although we do conduct de novo review of testimony presented
by way of deposition, that independent review function is only one element of our task on
appeal, and it remains subordinate to the ultimate determination of whether substantial
credible evidence supports the findings actually made by the WCC. McIntyre, 249 Mont.
at 67-68, 813 P.2d at 454; White, 256 Mont. at 13, 843 P.2d at 789; Weber, 270 Mont. at
245, 890 P.2d at 1299. Therefore, we will not consider the merits of Sears’ argument.
¶33 Third, Sears argues that we should make our own finding, entirely independent of
the WCC’s finding, as to whether Gamble’s odontoid fracture existed at the time of
settlement. In support of this argument, Sears argues that Gamble’s physical condition at
the time of settlement is simply a “medical question” which we can resolve de novo
because all the medical testimony in this case was received in the form of transcribed
depositions—evidence that we can review just as well as the WCC.
15
¶34 We have stated that “our review of medical evidence presented through
depositions must be considered in the context of the other evidence presented at trial
which was relevant to the medical issue.” Wilson, 273 Mont. at 317, 903 P.2d at 787.
Here, in addition to the medical testimony presented through depositions, Gamble’s
testimony given in person at trial was relevant to the issue of her physical condition at the
time of settlement. Indeed, as explained below, her testimony was integral to the WCC’s
factual findings. Thus, because Gamble rendered pertinent testimony at trial regarding
her physical condition, and because we do not conduct de novo review of testimony
presented in person at trial, Kuntz, ¶ 35, we cannot make an independent factual finding
as to whether Gamble’s odontoid fracture existed at the time of settlement. Rather, we
simply review the WCC’s finding on this issue to determine whether it is supported by
substantial credible evidence. In re Abfalder, ¶ 10.
¶35 We now turn to the evidence that the WCC relied on in making the critical finding
of fact in this case—i.e., the finding that Gamble’s odontoid fracture resulted from the
1997 accident at K-Mart and was present when the parties entered into their settlement
agreement.
¶36 Dr. Dube testified that the 2004 CAT scan reveals Gamble was suffering from an
“old fracture” which he characterized as a “nonunion” fracture because it had failed to
heal properly. In support of this conclusion, Dr. Dube explained that the human body
naturally produces new bone matter in attempting to heal a fracture. He further stated
that the 2004 CAT scan results show evidence of “old attempts at healing where the bone
margins were very eroded,” as well as “callous formation” at the site of the fracture. This
16
analysis was confirmed by a set of x-ray films taken in March of 1998, less than one year
after Gamble’s injury occurred. Upon reviewing these films, Dr. Dube testified that they
show a lucency in Gamble’s odontoid which demonstrates the presence of a fracture in
the same location as shown in the 2004 CAT scan.
¶37 While defense counsel emphasized that the 1998 x-ray films were not interpreted
as showing an odontoid fracture at the time they were taken, Dr. Dube testified that such
fractures often go undetected in the reasonable interpretation of radiology studies. While
defense counsel also emphasized that a 1998 CAT scan of Gamble’s neck was not
interpreted at that time as showing an odontoid fracture, Dr. Dube testified that the CAT
scan technology of 1998 was substantially inferior to present-day technology, and it did
not allow for easy detection of an odontoid fracture. Further, while defense counsel
deemed it significant that Gamble continued to work for some time after her 1997
accident, Dr. Dube testified that a fractured odontoid often does not prevent a person
from engaging in normal activity for some time.
¶38 Dr. Dube also testified that odontoid fractures do not occur in the absence of
trauma, and that the kind of trauma Gamble experienced in her 1997 accident at K-Mart
is consistent with her fracture. Further, Dr. Dube testified that the symptoms Gamble
experienced after her accident, particularly the pain at the base of her skull, are consistent
with the presence of an odontoid fracture. Ultimately, Dr. Dube opined that Gamble’s
odontoid fracture was caused by her accident at K-Mart in 1997.
¶39 The testimony of Dr. George Ro, a board-certified radiologist, was consistent with
that of Dr. Dube. Dr. Ro reviewed the 2004 CAT scan results and testified that they
17
show a “chronic” (i.e., aged or long term) fracture that had occurred “in the past
remotely.” Additionally, he reviewed the 1998 x-ray films and testified that they show a
nonunion fracture as demonstrated by a lucency in Gamble’s odontoid. Further, Dr. Ro
testified that the lucency present in the 1998 x-ray films was consistent with the fracture
that was evident in the 2004 CAT scan results. Finally, Dr. Ro testified that fractures
may be overlooked in the reasonable interpretation of imaging studies.
¶40 Sears claims that the testimony of Dr. Dube and Dr. Ro is not credible and argues
that we should therefore reverse the WCC because it “relied exclusively upon the
deposition testimony of Drs. Ro and Dube” in rendering its findings. First, we note that
the WCC did not rely exclusively on the testimony of these two doctors. In fact, the
court also relied extensively on Gamble’s testimony. Specifically, the WCC relied on
Gamble’s description of how the accident occurred, which was evidence of substantial
trauma consistent with an odontoid fracture. The court also relied on Gamble’s
description of the symptoms she experienced after the accident—symptoms that are
consistent with an odontoid fracture. Further, the court relied on Gamble’s testimony that
she had been tested for rheumatoid arthritis and the test showed that she does not have
that condition. The actual test results were not available in this litigation. Thus, the
court’s reliance on Gamble’s testimony was significant because the absence of
rheumatoid arthritis ruled out the possibility, advocated by Sears, that her odontoid
fracture was caused by that disease after the parties entered into their settlement
agreement. Finally, the WCC relied on Gamble’s testimony that she had not experienced
any trauma to her neck since the accident, such as falling or being struck in the head,
18
which ruled out the possibility that a traumatic force could have caused her odontoid
fracture after the settlement.
¶41 Sears argues that the testimony of Dr. Dube and Dr. Ro should be disregarded
because it is based in part on the 1998 x-ray films which are inferior to MRI and CAT
scan studies of Gamble’s neck which were completed prior to settlement and were not
interpreted by other physicians as showing an odontoid fracture. However, except for the
1998 x-ray films, the results of all pre-2004 radiographic studies of Gamble’s neck were
destroyed before this litigation ensued, for reasons not made clear in the record, and were
therefore not available for review. Thus, we cannot fault Dr. Dube and Dr. Ro for relying
in part on the 1998 x-ray films, despite the fact that these films are inferior to the MRI
and CAT scan studies.
¶42 Sears also argues that Dr. Dube’s testimony should be disregarded because it is
based in part on Gamble’s testimony which Sears claims is not credible. We reject this
argument because, as noted above, the WCC expressly found Gamble’s testimony to be
credible and we must defer to the court’s judgment in that regard.
¶43 As noted above, while our overall review of the WCC’s factual findings is
deferential and limited in scope, we conduct de novo review of deposition testimony
because we are in as good a position as the WCC to evaluate such evidence. White, 256
Mont. at 13, 843 P.2d at 789. Here, Dr. Dube’s testimony and Dr. Ro’s testimony were
received at trial in the form of transcribed depositions. Their testimony regarding
Gamble’s condition prior to settlement, and particularly their assessment of the 1998
x-ray films, conflicted with medical testimony offered by Sears. However, the WCC
19
found the testimony of Dr. Dube and Dr. Ro to be credible and therefore accorded it
substantial weight. Having conducted de novo review of these two depositions, and
having paid particular attention to defense counsel’s extensive questioning of these
physicians, we agree with the WCC’s assessment.
¶44 Viewed in light of our highly deferential standard of review, the evidence relied on
by the WCC is clearly sufficient to support the critical finding of fact in this case. The
evidence establishes that Gamble’s injury was consistent with her on-the-job accident,
and that her symptoms were in turn consistent with the injury. Additionally, the evidence
provides a basis for ruling out other potential causes of injury, which we have previously
indicated is an important factor in determining whether the evidence is sufficient to
support a WCC decision to rescind a settlement agreement for a mutual mistake of
material fact. Wolfe, 251 Mont. at 231, 824 P.2d at 248 (where the WCC rescinded the
settlement agreement based on the claimant’s shoulder injury that was not diagnosed at
the time of settlement, we identified claimant’s testimony that he had sustained no trauma
to his shoulder after the industrial accident as an important element of the evidence
deemed sufficient to support the WCC’s decision). Further, the evidence provides an
explanation as to why Gamble’s injury was not diagnosed until 2004, which we have
indicated is another important factor. Weldele, 227 Mont. at 261, 738 P.2d at 1283
(where the WCC rescinded a settlement agreement because the claimant’s thoracic outlet
syndrome was undiagnosed at the time of settlement, our decision to affirm the WCC was
based in part on medical testimony that this condition is difficult to diagnose).
20
¶45 The evidence relied on by the WCC certainly rises above the level of “trifling or
frivolous,” it constitutes far more than a mere “scintilla” of evidence, and we conclude
that a reasonable mind could accept it as adequate to support the finding that Gamble’s
odontoid was fractured in the 1997 accident at K-Mart. See Simms, ¶ 11; EBI/Orion
Group, 249 Mont. at 453, 816 P.2d at 1073. It is irrelevant that contradictory evidence
presented by Sears may adequately support a different finding—it is not our role to
resolve conflicts in the evidence or to determine whether the evidence would support
findings contrary to those made by the WCC. Murray, ¶ 19; Kloepfer, 276 Mont. at
498-99, 916 P.2d at 1312. Thus, we hold that substantial credible evidence supports the
WCC’s finding that Gamble’s odontoid fracture was caused by the 1997 accident at
K-Mart and was present when the parties entered into their settlement agreement.
¶46 Because Sears does not dispute the WCC’s application of the law, the remainder
of our analysis is straightforward. It is undisputed that the parties mutually believed
Gamble had reached maximum medical improvement at the time of settlement, and that
this belief was “a vital fact upon which they based their bargain.” South, 275 Mont. at
401, 913 P.2d at 235 (internal quotation marks omitted). It is also undisputed that if
Gamble’s odontoid fracture existed at the time of settlement, she had not reached
maximum medical improvement, and the parties’ mistaken belief regarding her physical
condition was “so substantial and fundamental as to defeat the object of the parties in
making the contract.” South, 275 Mont. at 401, 913 P.2d at 235 (internal quotation marks
omitted). Consequently, it is undisputed that if Gamble’s odontoid fracture existed at the
21
time of settlement, the parties were mutually mistaken regarding a material fact, and the
settlement agreement must therefore be rescinded.
¶47 Accordingly, because we have affirmed the WCC’s finding that Gamble’s
odontoid fracture existed when the parties reached their settlement, we hold that the
WCC did not err in rescinding the settlement agreement.
¶48 (2) Did the court err in concluding that Gamble’s failure to comply with
§ 39-71-1101(2), MCA, did not absolve Sears of liability for the cost of
medical treatment?
¶49 Section 39-71-1101(1), MCA, provides that a worker may choose his or her initial
treating physician. Section 39-71-1101(2), MCA, provides:
Authorization by the insurer is required to change treating physicians. If
authorization is not granted, the insurer shall direct the worker to a
managed care organization, if any, or to a medical service provider who
qualifies as a treating physician, who shall then serve as the worker’s
treating physician.
Here, Gamble initially chose Dr. Speer as her treating physician. While he referred
Gamble to Dr. Schaefer for treatment of her neck at one point, Dr. Speer remained
Gamble’s treating physician even after the parties entered into their settlement agreement
which expressly reserved medical benefits. However, Dr. Speer ceased his medical
practice in 2003. Gamble then went to Dr. Legan who conducted an examination and,
based upon his findings, referred her to Dr. Dube who subsequently performed the bone
fusion surgery.
¶50 Sears attempts to avoid liability for the extant costs of treating Gamble’s odontoid
fracture even if that injury is properly found to have been caused by her accident at
K-Mart. Specifically, Sears argues that it was automatically absolved of all liability for
22
the cost of treatment rendered by Dr. Legan and Dr. Dube because Gamble obtained this
treatment without first securing Sears’ authorization to change treating physicians,
thereby failing to comply with § 39-71-1101(2), MCA. In its judgment, the WCC ruled
that Sears was not absolved of liability based on Gamble’s failure to comply with the
authorization rule of § 39-71-1101(2), MCA. This ruling is a conclusion of law which
we review de novo. Flynn, ¶ 11.
¶51 While § 39-71-1101(2), MCA, states that “[a]uthorization by the insurer is
required to change treating physicians,” it does not contain a penalty provision, nor does
Sears point to any statutorily established penalty that would be applicable where a
claimant fails to comply with this statute. Further, § 39-71-1101(2), MCA, was enacted
in 1993 and we have not had occasion to interpret it. However, we did interpret the
authorization rule now set forth in this statute when it was previously contained in
Montana’s administrative rules. Sears relies on two such cases.
¶52 First, Sears relies on Garland v. Anaconda Co., 177 Mont. 240, 581 P.2d 431
(1978). The claimant in that case, Douglas Garland, suffered a back injury in the course
and scope of his employment, and it rendered him unable to continue working for a
period of time. Garland, 177 Mont. at 241, 581 P.2d at 431-32. In the subsequent
weeks, Garland was treated several times by a chiropractor who eventually determined,
seventeen days after his injury occurred, that Garland could return to work at that time.
Garland, 177 Mont. at 241, 581 P.2d at 432. Shortly after the chiropractor made this
determination, Garland went to an orthopedist who provided treatment and advised him
not to return to work for several more weeks. Garland, 177 Mont. at 242, 581 P.2d at
23
432. At that time, § 24-3.18 (22)-S18080 of the Montana Administrative Code required,
as is required presently by § 39-71-1101(2), MCA, that a claimant must obtain
authorization to choose a new treating physician over the one initially selected. Garland,
177 Mont. at 242-43, 581 P.2d at 432.
¶53 Garland’s employer paid benefits for the seventeen-day period between his injury
and the date on which the chiropractor determined that Garland could return to work.
Garland, 177 Mont. at 241-42, 581 P.2d at 432. However, because Garland had not
obtained authorization to treat with the orthopedist, his employer refused to pay benefits
for the subsequent time period in which the orthopedist had advised Garland not to work.
Garland, 177 Mont. at 242, 581 P.2d at 432. Consequently, Garland filed a petition in
the WCC to obtain benefits. Garland, 177 Mont. at 242, 581 P.2d at 432. The WCC
ruled that the employer had properly denied benefits based simply on Garland’s failure to
comply with the administrative rule requiring authorization to treat with the second
doctor. Garland, 177 Mont. at 244, 581 P.2d at 433. On appeal, we recognized that a
failure to comply with the authorization rule could result in a loss of coverage for
treatment rendered by the unauthorized doctor, but we nonetheless held that the WCC
had erred. Garland, 177 Mont. at 244, 581 P.2d at 433. Specifically, we held that the
WCC should have considered the medical reports and diagnosis rendered by the second
doctor rather than simply treating Garland’s failure to comply with the authorization rule
as a categorical bar to coverage. Garland, 177 Mont. at 244, 581 P.2d at 433.
Accordingly, we vacated the WCC’s judgment and remanded for consideration of the
orthopedist’s findings. Garland, 177 Mont. at 244, 581 P.2d at 433.
24
¶54 Second, Sears relies on Carroll v. Wells Fargo Armored Service Corp., 240 Mont.
151, 783 P.2d 387 (1989). The claimant in that case, Laine Carroll, suffered a back
injury in the course and scope of his employment, for which the insurer accepted liability.
Carroll, 240 Mont. at 153, 783 P.2d at 389. After treating for more than a year with the
physician he had initially chosen, Carroll requested the insurer’s authorization to go to
another doctor; however, the insurer specifically refused to grant the authorization.
Carroll, 240 Mont. at 156, 783 P.2d at 390; Appellant’s Brief at 19-20. Nonetheless,
Carroll went to the very doctor which the insurer had refused to authorize. Carroll, 240
Mont. at 156, 783 P.2d at 390; Appellant’s Brief at 19-20. The insurer refused to pay the
costs of treatment rendered by the second doctor because it had denied Carroll the
authorization to change treating physicians, and because Carroll’s initial treating
physician had not referred him to this second doctor. Carroll, 240 Mont. at 156, 783
P.2d at 390. The WCC concluded that the insurer was not liable for the costs of
treatment rendered by the second doctor based on Carroll’s violation of the authorization
rule. Carroll, 240 Mont. at 156, 783 P.2d at 390; Appellant’s Brief at 19. In affirming,
this Court cited Garland which, as noted above, recognized that a failure to obtain
authorization to change treating physicians could in some cases result in a loss of
coverage for treatment rendered by the unauthorized doctor. Carroll, 240 Mont. at 156,
783 P.2d at 390.
¶55 Here, in seeking to avoid liability for the cost of treatment provided by Dr. Legan
and Dr. Dube, Sears argues that Garland and Carroll establish an unqualified rule that a
claimant’s failure to obtain authorization to change treating physicians absolves the
25
insurer of all liability for the cost of treatment rendered by the unauthorized physician.
However, Garland rejects the categorical imposition of such a severe penalty for failure
to comply with the authorization rule. Indeed, we concluded that the WCC erred in
Garland by treating a violation of the authorization rule as an absolute bar to coverage
for treatment rendered by an unauthorized physician. Garland, 177 Mont. at 244, 581
P.2d at 433.
¶56 This Court also refused to treat a violation of the authorization rule as a categorical
bar to coverage in Hutchison v. General Host Corp., 178 Mont. 81, 582 P.2d 1203
(1978). The injured worker in that case, Betty Hutchison, received treatment from a
number of doctors without obtaining the insurer’s authorization to change treating
physicians. Hutchison, 178 Mont. at 91-92, 582 P.2d at 1209. Consequently, the insurer
argued that it was absolved of liability based on Hutchison’s failure to comply with the
authorization rule. Hutchison, 178 Mont. at 91-92, 582 P.2d at 1209. As we had done in
Garland, we again rejected the categorical imposition of such a severe penalty for failure
to comply with the authorization rule, noting that the rule must not be applied so as to
defeat the general purpose of the Workers’ Compensation Act. Hutchison, 178 Mont. at
92-93, 582 P.2d at 1209. Ultimately, because the insurer had refused to pay any benefits
from the outset, we held the WCC correctly determined that Hutchison’s failure to
comply with the authorization rule did not absolve the insurer of liability for treatment
rendered by unauthorized physicians. Hutchison, 178 Mont. at 92-93, 582 P.2d at 1209.
¶57 Consistent with Garland and Hutchison, we again refused to hold that a violation
of the authorization rule categorically bars coverage in Linton v. City of Great Falls, 230
26
Mont. 122, 749 P.2d 55 (1988). The claimant in that case, Richard Linton, suffered an
injury in the course and scope of his employment, for which the insurer accepted liability.
Linton, 230 Mont. at 125, 749 P.2d at 57. After Linton received treatment from one
physician initially, he obtained the insurer’s authorization to treat with another physician.
Linton, 230 Mont. at 125, 749 P.2d at 57. Subsequently, Linton went to yet another
physician, Dr. Bill Tacke, without obtaining the insurer’s authorization to do so. Linton,
230 Mont. at 126, 131, 749 P.2d at 58, 61. Dr. Tacke recommended that Linton undergo
a course of physical rehabilitation treatment intended to manage chronic pain. Linton,
230 Mont. at 126, 749 P.2d at 58. Despite Linton’s failure to obtain authorization to treat
with another physician, the WCC ruled that the insurer was liable for the cost of the
rehabilitation treatment Dr. Tacke had recommended. Linton, 230 Mont. at 126, 749
P.2d at 58. On appeal, the insurer did not dispute that the rehabilitation treatment was
appropriate for Linton’s condition, but argued that it could not be held liable for the cost
of this treatment because Linton had not obtained authorization to treat with Dr. Tacke.
Linton, 230 Mont. at 131, 749 P.2d at 61. In rejecting this argument and affirming the
WCC’s decision, we noted that the court had, in accordance with Garland, considered the
actual diagnosis of Linton’s condition in considering his failure to comply with the
authorization rule. Linton, 230 Mont. at 132, 749 P.2d at 61. Ultimately, because the
WCC had determined that the treatment recommended by Dr. Tacke was appropriate in
light of Linton’s condition, we held that the WCC had not erred in concluding that the
insurer could not avoid liability based on Linton’s failure to comply with the
authorization rule. Linton, 230 Mont. at 132, 749 P.2d at 61-62.
27
¶58 As Garland, Hutchison, and Linton demonstrate, a claimant’s failure to comply
with the authorization rule does not necessarily absolve the insurer of liability for the cost
of treatment rendered by an unauthorized physician. Although we held that the claimant
in Carroll was properly denied coverage for the cost of treatment from an unauthorized
doctor, our decision in that case did not establish that the same penalty must be imposed
whenever a claimant fails to comply with the authorization rule. As noted above, the
insurer in Carroll specifically refused the claimant’s request for authorization to treat
with a particular physician, but the claimant nonetheless obtained treatment from that
very physician. This circumstance distinguishes the Carroll case from Garland,
Hutchison, Linton, and the instant case.
¶59 Moreover, to categorically impose the penalty advocated by Sears, without regard
to the facts of each case, would directly conflict with Montana’s public policy underlying
the Workers’ Compensation Act. Viewing the statutory authorization rule in isolation,
one might perhaps conclude that the failure to obtain authorization to change treating
physicians should necessarily result in a loss of coverage for the treatment provided by
the unauthorized physician. However, we cannot view § 39-71-1101(2), MCA, in
isolation. As we have often held, in interpreting a statute we must view it as a part of a
whole statutory scheme and construe it so as to forward the purpose of that scheme. Orr
v. State, 2004 MT 354, ¶ 25, 324 Mont. 391, ¶ 25, 106 P.3d 100, ¶ 25. Further, we have
held that statutes must be construed in a way that avoids absurd results. Orr, ¶ 25.
Consistent with these longstanding principles, we stated in Hutchison that the
authorization rule must not be applied in a way that would defeat the general purpose of
28
the Workers’ Compensation Act. Hutchison, 178 Mont. at 92, 582 P.2d at 1209. Section
39-71-105(1), MCA, which the Legislature has entitled the “[d]eclaration of public
policy” underlying the Workers’ Compensation Act, states: “An objective of the
Montana workers’ compensation system is to provide, without regard to fault, wage-loss
and medical benefits to a worker suffering from a work-related injury or disease.” Given
this underlying policy, we must reject Sears’ contention that any failure to comply with
the authorization rule necessarily eliminates medical benefits that are mandated under the
Workers’ Compensation Act. Categorical imposition of the penalty advocated by Sears,
based solely on a mere failure to obtain authorization, could lead to absurd outcomes
wherein an injured worker is deprived of all coverage for the cost of medical treatment
that is undisputedly necessary to address an injury which was plainly sustained in the
course and scope of employment. Such a draconian consequence is not only unjust on its
face, it also directly conflicts with the Workers’ Compensation Act’s underlying purpose
of ensuring medical benefits for work-related injuries without regard to fault. Simply
put, the procedural authorization rule of § 39-71-1101(2), MCA, allows the insurer an
opportunity to choose a treating physician if the claimant no longer prefers the doctor he
or she initially chose; it does not operate as an escape mechanism by which the insurer
can avoid all liability for the cost of undisputedly necessary treatment arising from a
work-related injury.
¶60 As for Gamble’s failure to obtain authorization of Dr. Legan as her treating
physician, we note Sears does not dispute that the services rendered by Dr. Legan were
appropriate for the treatment of Gamble’s condition. Nor does Sears identify any specific
29
factual aspects of this case, other than Gamble’s failure to obtain authorization of Dr.
Legan, that would justify eliminating her coverage for medical treatment that was
undisputedly appropriate. Rather, Sears simply argues that it was automatically absolved
of all liability for the cost of Dr. Legan’s treatment solely because Gamble failed to
comply with § 39-71-1101(2), MCA. As demonstrated by Garland, Hutchison, and
Linton, which accurately reflect the Workers’ Compensation Act’s underlying purpose,
the law does not categorically deprive an injured worker of medical benefits based simply
on a failure to comply with the procedural authorization rule. 8 Thus, because Sears
simply argues for the categorical approach which this Court has repeatedly refused to
employ, we hold that the WCC correctly concluded Sears was not absolved of liability
for the cost of Dr. Legan’s treatment.
¶61 As for Gamble’s failure to obtain authorization of Dr. Dube as her treating
physician, additional facts are relevant, but the outcome is the same. Sears does not
dispute that the services rendered by Dr. Dube were appropriate for the treatment of
8
We note that § 39-71-1101(2), MCA, appears to address the scenario where a claimant seeks to
stop treating with his or her initially-chosen physician in order to obtain care from another
physician. On its face, this statute does not require a claimant to obtain authorization to choose a
treating physician where the claimant’s initially-chosen physician has ceased practicing or
otherwise become inaccessible. Here, when Dr. Speer ended his full-time practice, Gamble was
left without her initially-chosen physician. As a result, she was not in a position to “change
treating physicians” by choosing another physician over Dr. Speer; rather, Gamble had to select a
doctor in the same way that she had done at the outset when she similarly had no treating
physician. Thus, it would appear that Gamble did not attempt to “change treating physicians” as
contemplated by § 39-71-1101(2), MCA. Indeed, the WCC assumed that Dr. Legan became
Gamble’s treating physician when she chose to treat with him after Dr. Speer ended his practice.
Judgment, ¶ 22. However, because the parties have not squarely raised the issue on appeal, our
Opinion here is not a comment on the issue of whether a claimant is actually bound to obtain the
authorization required by § 39-71-1101(2), MCA, where the claimant’s initially-chosen treating
physician ceases to treat patients or otherwise becomes inaccessible.
30
Gamble’s condition. Rather, Sears again simply argues that it was automatically
absolved of all liability for the cost of Dr. Dube’s treatment solely because Gamble failed
to comply with the procedural authorization requirement of § 39-71-1101(2), MCA. We
disagree.
¶62 At the time of settlement, neither of the parties believed Gamble was suffering
from an odontoid fracture. Thus, although the settlement agreement expressly reserved
medical benefits, it did not contemplate continuing medical benefits for the treatment of a
fracture. Subsequently, after Dr. Legan detected Gamble’s odontoid fracture, she went to
Dr. Dube specifically for treatment of that newly discovered condition. Then, after Dr.
Dube performed the bone fusion surgery, he reviewed the 1998 x-ray films and
consequently determined that Gamble’s odontoid fracture was caused by her on-the-job
accident in 1997. In light of these circumstances, the proper resolution of this issue
becomes abundantly clear.
¶63 If Gamble had sought authorization to treat with Dr. Dube, she would have been
asking Sears to pay for treatment of a condition that was not yet determined to be
causally connected to her on-the-job accident. While Sears faults Gamble for not doing
so, it is undisputed, as the WCC noted, that if she had sought authorization, Sears itself
would not have followed the mandates of § 39-71-1101(2), MCA—i.e., the insurer’s
obligation to either authorize the claimant’s preferred physician or direct the claimant to
another care provider for treatment of a work-related injury—precisely because her injury
was not yet causally connected to the 1997 accident at K-Mart. Moreover, it is
undisputed that even if Dr. Dube had opined prior to Gamble’s surgery that her fracture
31
was caused by the 1997 accident, Sears would have refused authorization and disputed
Dr. Dube’s opinion, just as it has done throughout this litigation.
¶64 Because Gamble went to Dr. Dube for treatment of a condition that was unknown
to the parties at settlement and therefore not contemplated by the settlement agreement’s
reservation of medical benefits, and because that condition was not causally connected to
Gamble’s on-the-job accident until after her surgery, we conclude that her failure to
comply with § 39-71-1101(2), MCA, must be excused as a matter of law. To eliminate
her benefits in these circumstances would directly conflict with the underlying purpose of
the Workers’ Compensation Act, and we have stated that the authorization rule must not
be applied in such a way. Hutchison, 178 Mont. at 92, 582 P.2d at 1209. Thus, we hold
that the WCC correctly concluded Sears was not absolved of liability for the cost of Dr.
Dube’s treatment.
CONCLUSION
¶65 We have held that the WCC did not err in rescinding the settlement agreement or
in holding Sears liable for the cost of Gamble’s medical treatment.
¶66 Accordingly, we affirm.
/S/ PATRICIA COTTER
We Concur:
/S/ KARLA M. GRAY
/S/ JAMES C. NELSON
/S/ JIM RICE
/S/ BRIAN MORRIS
32