The Montana Workers’ Compensation Court Tuesday ruled against an insurer that terminated an injured employee’s comp benefits over a refusal to attend an appointment with a designated occupational medicine physician.
The court said Victory Insurance Co. improperly stopped benefits for Phyllis Russell, who claimed that the insurer didn’t have the right to designate a new treating physician because at the time it hadn’t yet accepted liability for her claim.
Ms. Russell, who in February 2022 hurt her back, shoulder and hip at work, argued that the occupational medicine physician wasn’t her treating physician at the time and that she wasn’t legally obligated to attend an appointment scheduled by Victory.
According to the court record, Victory adjuster Ashley Burch agreed to pay benefits under a “reservation of rights,” allowing the coverage while she would “continue my investigation without accepting liability or waiving my right of defending this case in the future should there be a need to do so.”
Victory paid Ms. Russell’s benefits without accepting liability for more than seven months. The employer was not named in the ruling.
The court, in granting partial summary judgment to Ms. Russell, ruled Victory had no grounds by which to terminate the woman’s benefits for refusing to attend the November 2022 doctor’s appointment.
The court also said it would schedule a trial where Ms. Russell could raise her additional claims, including a petition to have Victory retroactively issue her benefits dating to the time of termination.