96-594
No. 96-594
IN THE SUPREME COURT OF THE STATE OF MONTANA
1997
LINDIA GROOMS,
Petitioner and Appellant,
v.
PONDEROSA INN,
Employer,
STATE COMPENSATION MUTUAL
INSURANCE FUND
and
DEPARTMENT OF LABOR AND INDUSTRY,
Respondents.
APPEAL FROM: Workers' Compensation Court, State of Montana
The Honorable Mike McCarter, Judge presiding.
COUNSEL OF RECORD:
For Appellant:
Don Edgar Burris, Attorney at Law, Billings, Montana
For Respondents:
Ann E. Clark, State Compensation Insurance Fund, Helena, Montana
Robert J. Campbell, Department of Labor & Industry, Helena, Montana
Submitted on Briefs: March 13, 1997
Decided: July 15, 1997
Filed:
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__________________________________________
Clerk
Justice Karla M. Gray delivered the Opinion of the Court.
Lindia Grooms (Grooms) appeals from the order and judgment entered by the
Workers' Compensation Court which rejected her constitutional challenges to certain
Occupational Disease Act statutes and dismissed her petition. We affirm.
We address the following issues on appeal:
1. Did the Workers' Compensation Court err in concluding that Grooms' right to
due process was not violated when the State Compensation Mutual Insurance Fund
determined that her claim should be processed under the Occupational Disease Act of
Montana?
2. Did the Workers' Compensation Court err in concluding that Grooms' right to
choose her treating physician was not violated by the statute permitting the
Department
of Labor and Industry to select an occupational disease medical panel physician to
examine her for the purpose of determining whether she was suffering from an
occupational disease?
3. Did the Workers' Compensation Court err in concluding that Grooms' right to
equal protection of the laws was not violated by the statutory requirement that a
claimant
requesting a second examination by a panel physician pay for the examination?
4. Did the Workers' Compensation Court err in concluding that Grooms was not
deprived of the right to legal redress?
BACKGROUND
Grooms filed a workers' compensation claim with the State Compensation Mutual
Insurance Fund (State Fund), her employer's workers' compensation insurer. She
alleged
she was suffering from dermatitis, a skin allergy condition. The State Fund denied
liability under the Workers' Compensation Act (WCA) and, pursuant to the Occupational
Disease Act of Montana (ODA), requested the Department of Labor and Industry (the
Department) to schedule an examination of Grooms by a member of the occupational
disease medical panel. Grooms objected to the first physician designated and the
Department subsequently designated Dr. Stephen Behlmer (Behlmer), a Helena
dermatologist, as the examining physician. Grooms did not pursue the workers'
compensation claim after the State Fund denied it.
Behlmer diagnosed Grooms as suffering from "atopic dermatitis," a condition
which is largely hereditary but which also has environmental components. He stated
that
household products, such as soap and ammonia, may trigger the condition and that he
could not determine whether Grooms' condition was aggravated by her work. Based on
Behlmer's report, the Department issued an "Order Referring Copy of Medical Reports
To Parties" (Order) which informed Grooms and the State Fund of its preliminary
determination that Grooms' claim would be denied and she would not be entitled to
occupational disease benefits. The Order also notified the parties that either of
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them
could request a second examination by a medical panel physician, at their own
expense,
and that either party could request a hearing. Grooms requested a second examination
and the Department scheduled it. Grooms then submitted an affidavit to proceed in
forma
pauperis and requested the Department to pay for the second examination. The
Department denied Grooms' request and the second examination did not take place.
Grooms subsequently petitioned for a hearing with the Department's hearings
unit,
advancing various constitutional challenges. She then moved to dismiss her petition
on
the basis that the Department did not have jurisdiction to determine her
constitutional
issues. The Department agreed that it was without jurisdiction and dismissed the
petition.
Grooms appealed the Department's dismissal order to the Workers' Compensation Court.
The Workers' Compensation Court deemed Grooms' action a petition for
declaratory judgment, rather than an appeal. Following consideration of the parties'
briefs, the court concluded that (1) the statutes permitting the State Fund to
determine that
a claim should be processed under the ODA did not violate Grooms' due process rights;
(2) the Department's designation of an examining physician from the occupational
disease
panel for the purpose of determining whether a claimant is suffering from an
occupational
disease did not violate Grooms' right to choose her own treating physician; (3) the
requirement that a claimant requesting a second examination by a panel physician pay
for
the examination did not violate Grooms' right to equal protection; and (4) Grooms was
not deprived of the right to legal redress. The Workers' Compensation Court entered
its
order and judgment dismissing Grooms' petition and Grooms appeals.
STANDARD OF REVIEW
Grooms asserts error with regard to the Workers' Compensation Court's legal
conclusions. We review the court's conclusions of law to determine whether they are
correct. Turjan v. Valley View Estates (1995), 272 Mont. 386, 390, 901 P.2d 76, 79
(citing Caekaert v. State Compensation Mutual Ins. Fund (1994), 268 Mont. 105, 111,
885 P.2d 495, 498). DISCUSSION
1. Did the Workers' Compensation Court err in concluding that Grooms' right to
due process was not violated when the State Fund determined that her claim should be
processed under the Occupational Disease Act of Montana?
Grooms argued in the Workers' Compensation Court--and argues on appeal--that
her right to due process was denied by the State Fund's unilateral determinations
that she
had not suffered an "injury" as defined in the WCA and that her claim should be
processed pursuant to the ODA. According to Grooms, the State Fund's decisions
deprived her of the notice and opportunity to be heard on her workers' compensation
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claim which due process requires.
The Workers' Compensation Court concluded that, when the State Fund denied
Grooms' workers' compensation claim, she retained statutory rights to request
mediation
of the dispute before a Department mediator and to petition the Workers' Compensation
Court to determine that she had suffered a compensable injury. On that basis, it
rejected
Grooms' assertion that the State Fund had effectively deprived her of a claim under
the
WCA without affording her notice and an opportunity to be heard and concluded that
Grooms had not been deprived of her right to due process.
Grooms argues that the court erred as a matter of law. The only authorities she
advances, however, reiterate general due process concepts too well-established to
need
repeating. Grooms cites to no authority under which the State Fund itself would be
required to hold a hearing in advance of denying her workers' compensation claim.
Nor
does she address the Montana statutes which clearly provide procedures under which
workers' compensation claimants can have their claims determined after denial by the
insurer.
Section 39-71-2401(1), MCA, provides that, when a dispute arises concerning
benefits under the WCA, the parties involved in the dispute must bring the matter
before
a Department mediator. In the event mediation does not resolve the dispute, either
party
may petition the Workers' Compensation Court for a resolution. Section 39-71-2401
(1),
MCA. Section 39-71-2905, MCA, mirrors 39-71-2401(1), MCA, by providing that,
after satisfying the statutory dispute resolution requirements, either a claimant or
an
insurer may petition the Workers' Compensation Court for a determination of a dispute
concerning benefits under the WCA.
Grooms did not avail herself of the available statutory procedures for
resolution
of her dispute with the State Fund over her asserted entitlement to workers'
compensation
benefits; indeed, she took no further action on her workers' compensation claim
after the
State Fund denied it. Nonetheless, those statutory procedures were available to her
and
the State Fund's decisions to deny her workers' compensation claim and to process it
pursuant to the ODA did not deprive her of the opportunity to be heard on that
claim.
Grooms simply failed to take advantage of the due process afforded her under the
WCA.
We hold, therefore, that the Workers' Compensation Court correctly concluded that
Grooms' right to due process was not denied.
2. Did the Workers' Compensation Court err in concluding that Grooms' right to
choose her treating physician was not violated by the statute permitting the
Department
to select an occupational disease medical panel physician to examine her for the
purpose
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of determining whether she was suffering from an occupational disease?
When the State Fund denied Grooms' workers' compensation claim, it requested
the Department to schedule, pursuant to 39-72-602, MCA, an examination of Grooms
by a medical panel physician. The Department did so and Grooms was examined by
Behlmer. Grooms contended that the statutory procedures for an examination by a
panel
physician deprived her of her right under 33-22-111, MCA, to select her own
treating
physician.
The Workers' Compensation Court determined that the 33-22-111, MCA, right
to select a physician is limited to selection of a treating physician and that
examinations
by panel physicians are in the nature of independent medical examinations used only
for
the purpose of assessing whether the claimant suffers from an occupational disease.
The
court further determined that an ODA claimant is not required to undergo treatment by
the panel physician who conducts the examination. On that basis, the Workers'
Compensation Court concluded that the examination required by 39-72-602(2)(a),
MCA, did not infringe on Grooms' right to choose her treating physician. We agree.
Section 33-22-111, MCA, provides, in pertinent part, that
[a]ll policies of disability insurance . . . must provide that the insured has
full freedom of choice in the selection of any licensed physician . . . for
treatment of any illness or injury within the scope and limitations of the
person's practice.
This statute clearly provides an insured the freedom to choose a treating physician;
it does
not require, however, that an insured be allowed to choose any and all physicians who
may be utilized during the determination of an ODA claim. Section 39-72-602, MCA,
on the other hand, authorizes the Department to select a panel physician to
independently
examine the claimant to assist in determining whether the claimant suffers from an
occupational disease. This examination is separate from, and in addition to, any
examination and treatment a claimant may choose to pursue. There is no requirement
in
39-72-602, MCA, that the claimant proceed with treatment from the panel physician
selected to conduct the examination.
Grooms also argues that her right to choose a treating physician is violated by
the
operation of 39-72-602(2)(b), MCA, which provides that either the insurer or the
claimant may request an additional examination by a second panel physician. She
contends that, inherent in her right to choose her treating physician, is the right
to have
her chosen physician suggest or designate a qualified expert to conduct the second
examination and that it is impermissible to limit her selection to those physicians
who are
members of the occupational disease medical panel. Grooms cites to Stordalen v.
Ricci's
Food Farm (1993), 261 Mont. 256, 862 P.2d 393, for the proposition that the State
Fund
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cannot unreasonably deny a claimant's request to be examined by a physician of her
choice and argues that, as a result, the Department also should not be able to deny
her
the choice of a physician for her second examination.
In Stordalen, the Workers' Compensation Court determined that the State Fund
unreasonably denied Stordalen's request pursuant to Rule 24.29.1403(3), ARM, for a
neurological consultation with a physician of her choice; the issue on appeal was
whether
the State Fund's denial of the request was unreasonable for purposes of imposing a
penalty and attorney fees. Stordalen, 862 P.2d at 394-95. Stordalen involved
neither
39-72-602(2)(b), MCA, nor an ODA examination by a medical panel physician at the
Department's request. Thus, it has no application to the case presently before us.
We hold that the Workers' Compensation Court correctly concluded that Grooms'
right to choose her treating physician was not violated by the statute permitting the
Department to select a medical panel physician to examine her for the purpose of
determining if she was suffering from an occupational disease.
3. Did the Workers' Compensation Court err in concluding that Grooms' right
to equal protection of the laws was not violated by the statutory requirement that a
claimant requesting a second examination by a panel physician pay for the
examination?
The Workers' Compensation Court determined that Grooms' ability to seek or
receive benefits under the ODA was not impeded by the requirement that she pay for a
second examination if she requested one. The court noted that Grooms was entitled to
one examination under the ODA for which she was not required to pay and that she was
also entitled to a hearing on her claim before the Department at which she could
present
her own evidence to support her claim. The Workers' Compensation Court concluded
that a second examination, at Grooms' expense, was not a prerequisite to pursuit of
Grooms' claim and, therefore, the requirement that she pay for a second examination
if
she requested one did not violate equal protection.
Grooms' argument in this regard appears to be twofold. First, she contends that
requiring her to pay for the second examination she requested under the ODA violates
equal protection because she would not have been required to pay for such an
examination had her claim remained under the WCA. Second, Grooms contends that
39-72-602, MCA, violates equal protection because it requires a mandatory physical
examination without providing for a waiver of the costs of the examination for an
indigent
claimant.
Legislative enactments are presumed to be constitutional. Heisler v. Hines
Motor
Co. (Mont. 1997), 937 P.2d 45, 50, 54 St.Rep. 345, 348 (citations omitted). The
party
challenging a statute bears the burden of proving its unconstitutionality beyond a
reasonable doubt and, if any doubt exists, it must be resolved in favor of the
statute.
Heisler, 937 P.2d at 50.
The equal protection clauses of the Fourteenth Amendment to the United States
Constitution and Article II, Section 4 of the Montana Constitution require that all
persons
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be treated alike under like circumstances. Heisler, 937 P.2d at 50 (citations
omitted).
We apply the rational relationship test to equal protection challenges to workers'
compensation statutes. Heisler, 937 P.2d at 50 (quoting Stratemeyer v. Lincoln
County
(1993), 259 Mont. 147, 151, 855 P.2d 506, 509 (citation omitted)). In order to pass
the
"rational relationship" or "rational basis" test, a challenged legislative enactment
" 'must
implicate legitimate goals, and the means chosen by the legislature must bear a
rational
relationship to those goals.' " Heisler, 937 P.2d at 50 (quoting Lyng v. Automobile
Workers (1988), 485 U.S. 360, 375, 108 S.Ct. 1184, 1194, 99 L.Ed.2d 380, 394
(Marshall, J., dissenting)). Grooms' equal protection challenges to certain ODA
statutes
and procedures are premised on the rational basis test.
Grooms first argues that her equal protection guarantees are infringed by the
requirement that, if she requests a second examination pursuant to 39-72-602(2)(b),
MCA, she must pay the costs of that examination, whereas if her claim had proceeded
under the WCA, 39-71-605, MCA, would require the insurer or the Department to pay
those costs. Grooms misreads 39-71-605, MCA.
Section 39-71-605(1)(a), MCA, provides that an insurer or the Department may
require a workers' compensation claimant submit to physical examinations from time to
time at the insurer's or Department's cost. It does not authorize a workers'
compensation
claimant to request and obtain an examination and require the insurer to pay for it.
Similarly, the Department may require an independent examination of a workers'
compensation claimant on the request of either the claimant or the insurer. Section
39-
71-605(2), MCA. In such a case, the party requesting the examination must pay the
cost
of the examination. Section 39-71-605(2), MCA. Thus, 39-71-605, MCA, does not
allow a workers' compensation claimant to request and obtain an examination at the
insurer's expense. As a result, no disparate treatment of claimants exists between
the
WCA and the ODA in this regard and the premise underlying this portion of Grooms'
equal protection argument fails.
Grooms also argues that the ODA violates equal protection by requiring a
mandatory physical examination without providing for a waiver of costs for those
examinations for indigent claimants. On this basis, she contends that indigent
claimants,
as a class, are discriminated against under the ODA. Again, however, Grooms
mischaracterizes the controlling statute and, as a result, the premise underlying
this
portion of her equal protection argument also fails.
When an insurer has not accepted liability for an ODA claim, the Department must
designate a medical panel physician to examine the claimant and determine whether she
is suffering from an occupational disease. Section 39-72-602(2)(a), MCA. The
expense
of this examination is borne by the insurer. Section 39-72-608, MCA. Thus, while it
is mandatory that an ODA claimant submit to an examination for the purpose of
assessing
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the compensability of the claim, the claimant is not required to pay for the
examination.
In the event either the claimant or the insurer is dissatisfied with the result of
the first
examination, that party may request a second examination. Section 39-72-602(2),
MCA.
The party requesting the second examination must pay for it. Section 39-72-608, MCA.
Sections 39-72-602 and 39-72-608, MCA, simply do not mandate an examination
at the claimant's expense under any circumstance. While a claimant may be required
to
submit to two physical examinations thereunder, the claimant never pays for the
first and
pays for the second only when she initiates the request for it. When a claimant
requests
the examination, that examination cannot be characterized as a mandatory
examination.
As a result, the ODA does not require an examination at the claimant's cost which
could
violate equal protection.
We hold that the Workers' Compensation Court correctly concluded that Grooms'
right to equal protection of the laws was not violated by the statutory requirement
that the
party requesting a second examination by an occupational disease panel physician pay
for
the examination.
4. Did the Workers' Compensation Court err in concluding that Grooms was not
deprived of the right to legal redress?
The Workers' Compensation Court rejected Grooms' argument that her asserted
inability to pay for a second examination by a medical panel physician denied her
access
to a forum for resolving her ODA claim in violation of Article II, Section 16 of the
Montana Constitution. Observing that Grooms could have requested, and obtained, a
hearing before the Department pursuant to 39-72-611, MCA, at which she would have
been entitled to present evidence, the Workers' Compensation Court concluded that
Grooms had not been precluded from litigating her ODA claim on the basis of her
asserted inability to pay for a second examination, or on any other basis.
The Department's Order stated that, on the basis of the examining physician's
report, the Department's determination would be to deny Grooms' ODA claim. The
Order also outlined the parties' rights to request a second examination pursuant
to 39-
72-602, MCA, and to request a hearing pursuant to 39-72-611, MCA, before the
Department issued its final determination on Grooms' entitlement to occupational
disease
benefits.
Grooms contends on appeal that she could not afford to pay for a second
examination to rebut the findings of the physician who conducted the first
examination.
As a result, she asserts that she was effectively denied the ability to pursue her
claim.
Grooms mischaracterizes the purpose of the second examination available under 39-
72-
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602(2), MCA, and ignores her statutory rights under the ODA.
Under 39-72-602(2), MCA, the Department selects a medical panel physician to
conduct an independent examination of an ODA claimant; the physician is not
affiliated
with either the insurer or the claimant. A second examination under 39-72-602(2),
MCA, is an additional independent examination by a physician not affiliated with
either
party. It is not conducted to provide the party requesting the examination with
evidence
to "rebut" the findings of the first examining physician, but rather to provide a
second
objective report regarding a claimant's physical condition vis-a-vis entitlement to
occupational disease benefits.
Moreover, 39-72-611, MCA, permits an ODA claimant to request a hearing on
her claim before the Department issues its final decision; if a hearing is
requested, it must
be held. Sections 39-72-611 and 39-72-612, MCA. Entitlement to a hearing is
unqualified; that is, a second examination, at the expense of the requesting party,
is not
a prerequisite to entitlement to a hearing. Thus, even assuming Grooms could not
afford
a second examination pursuant to 39-72-602(2)(b), MCA, she could have requested a
hearing and presented evidence such as the testimony and records of her treating
physician in support of her asserted entitlement to occupational disease benefits.
That
Grooms did not request a hearing does not negate the availability of the hearing and
the
opportunity to establish the compensability of her occupational disease claim.
In essence, Grooms' argument here is that her right to legal redress requires
the
State Fund--and, indirectly, her employer--or the Department--and, indirectly,
Montana
taxpayers--to finance her efforts to establish her occupational disease claim. She
cites to
no authority for such a proposition and we know of none.
We hold that the Workers' Compensation Court did not err in concluding that
Grooms was not deprived of her right to full legal redress by the application of
39-72-
608, MCA.
Affirmed.
/S/ KARLA M. GRAY
We concur:
/S/ J. A. TURNAGE
/S/ JAMES C. NELSON
/S/ WILLIAM E. HUNT, SR.
/S/ JIM REGNIER
/S/ TERRY N. TRIEWEILER
/S/ W. WILLIAM LEAPHART
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Grooms v. Ponderosa Inn
Court: Montana Supreme Court
Date filed: 1997-07-15
Citations: 942 P.2d 699, 283 Mont. 459, 54 State Rptr. 725
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