Wright v. Ace American Insurance
249 P.3d 485
Mont.2011Background
- Wright was injured in Oct 2004 while removing pallets; left shoulder injury led to Jan 12, 2005 surgery and ongoing pain.
- Over years, Wright underwent evaluations by multiple physicians, including IMEs by Singer (2006) and surgical opinions by Hansen (2006–2009) noting shoulder and cervical spine issues.
- Hansen recommended two shoulder procedures (biceps tenodesis and rotator cuff repair) and identified cervical degenerative disease potentially exacerbated by the injury.
- Shabacker, a pain-management physician, treated Wright; he assessed MMI in 2008 and testified Wright’s return to work would be a matter of commitment to work despite pain.
- In Jan 2010 the WCC held trial, found Ace liable for Hansen’s shoulder surgery and for cervical treatment planning via a spine surgeon; concluded Wright had not reached MMI and reinstated temporary total disability benefits.
- Ace appealed, arguing Hansen was not a Montana-licensed treating physician and that WCC improperly weighed opinions; court affirmed the WCC finding and its reliance on Hansen’s opinion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the WCC erred in ordering additional medical benefits. | Ace contends Hansen is not a Montana-licensed treating physician and his opinions are not primary medical services. | Wright's condition and Hansen's evaluations justify treatment recommendations under the treating-physician statute. | WCC correctly applied the statute; Hansen qualifies as treating physician for purposes of liability. |
| Whether the WCC's decision is supported by substantial credible evidence. | Ace asserts Hansen’s opinion should not control, as Shabacker and others offered competing views (less weight to Hansen). | WCC properly weighed expert opinions; Hansen's orthopedic expertise provides the most persuasive basis for treatment. | WCC's decision is supported by substantial credible evidence; its weighing of opinions was appropriate. |
Key Cases Cited
- Gamble v. Sears, 337 Mont. 354, 160 P.3d 537 (2007 MT 131) (authorization issues do not bar insurer liability for treating physicians)
- Garland v. Anaconda Co., 177 Mont. 240, 581 P.2d 433 (1978) (consider diagnosis of unauthorized doctors; not a categorical bar to coverage)
- Snyder v. S.F. Feed & Grain, 230 Mont. 16, 748 P.2d 924 (1987) (treating physician not always controlling; persuasiveness varies)
- White v. Ford, Bacon, & Davis Tex., Inc., 256 Mont. 9, 843 P.2d 787 (1992) (weight of treating physician’s testimony not dispositive)