Larson v. Cigna Insurance Company

894 P.2d 327, 271 Mont. 98, 52 State Rptr. 369, 1995 Mont. LEXIS 81
CourtMontana Supreme Court
DecidedMay 4, 1995
Docket94-523
StatusPublished
Cited by2 cases

This text of 894 P.2d 327 (Larson v. Cigna Insurance Company) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Larson v. Cigna Insurance Company, 894 P.2d 327, 271 Mont. 98, 52 State Rptr. 369, 1995 Mont. LEXIS 81 (Mo. 1995).

Opinions

JUSTICE LEAPHART

delivered the Opinion of the Court.

This is an appeal from the judgment of the Workers’ Compensation Court holding that appellant Carl Larson could not receive permanent total disability benefits for his work-related hernia condition due to the fact that he first became totally disabled by a pre-existing, non work-related and independent heart condition. We reverse the decision of the Workers’ Compensation Court and remand for further proceedings.

Factual Background

Until December 15, 1981, the last day of his employment, Larson worked in the truck parts business for approximately thirty years. From 1978 through December 15, 1981, Larson was parts manager for Yellowstone Ford Truck Sales in Billings, Montana.

On August 20, 1980, Larson suffered a heart attack and was off work for several months. On October 13,1980, he underwent a heart catheterization. On October 16, 1980, he underwent open heart surgery which involved a resection of a left ventricular aneurism. In April, 1981, he had a second heart catheterization. Larson was unsure as to precisely when he returned to work, but he agreed that he probably went back to work full time sometime during the spring of 1981. When he returned to work, Larson assigned the heavier tasks to the other employees. Then, on July 15,1981, Larson suffered a left inguinal hernia when he lifted a 150-pound truck spring. This injury [100]*100occurred in the course and scope of Larson’s employment with Yellowstone Ford Truck Sales. At the time of the hernia injury, Yellowstone Ford was insured by Cigna.

Cigna accepted liability for Larson’s hernia injury and paid medical benefits and temporary total disability benefits. On September 14, 1981, Larson had hernia repair surgery. He returned to work in October, 1981, at which time his doctor considered his hernia one hundred percent healed.

Following his heart attack in August of 1980 and his hernia in July of 1981, Larson had difficulty performing his normal job duties of heavy lifting and running up and down stairs. On December 15,1981, Larson was laid off work due to his inability to perform his job. As of December 15, 1981, Larson considered himself unable to work and, therefore, retired.

Larson was awarded Social Security Disability benefits as a result of his heart condition. Those benefits became effective in February, 1981 and continued through March 16,1988, when Larson turned 65 and became eligible for Social Security retirement benefits.

Despite his physician’s determination that the hernia was one hundred percent healed, in May, 1982, Larson’s left inguinal hernia symptoms flared up. On June 17, 1982, a recurrence of the left inguinal hernia was medically diagnosed. However, Larson received no further treatment for his hernia symptoms until December, 1984. The left inguinal hernia was surgically repaired in 1985, 1986, and finally in 1987. There has been no recurrence of his left inguinal hernia since 1987. Larson, however, continues to experience localized pain in his left groin. Medical bills for Larson’s hernia repairs were submitted to Cigna and were paid. In September, 1992, Larson submitted a claim for additional compensation benefits respecting his hernia.

Dr. Shaw gave Larson an impairment rating of twenty-five percent of the whole person based on the inguinal hernia. The Workers’ Compensation Court found that, based on Dr. Shaw’s testimony, Cigna had paid Larson eight months of temporary total disability benefits. At the time of trial, Cigna’s counsel indicated that Cigna had agreed to pay an additional six months of temporary total disability benefits for purposes of retraining and 500 weeks of permanent partial disability benefits, including amounts due for the impairment rating. Larson’s post-trial briefs indicate that payment was made shortly after trial.

[101]*101The Workers’ Compensation Court denied Larson’s application for permanent total disability benefits under § 39-71-116(13), MCA (1979).

The Workers’ Compensation Court held that Larson was ineligible to receive permanent total disability benefits for his work-related hernia, due to the fact that he first became totally disabled by a preexisting, non work-related and independent heart condition. The Workers’ Compensation Court held, in its conclusion of law No. 4, as follows:

4. Claimant has failed to carry his burden of proof. A preponderance of credible evidence establishes that as of December 15,1981, claimant was permanently totally disabled by a preexisting heart condition that was not work-related. The heart condition preceded claimant’s industrial injury and the permanent disability was the result of a natural progression of that condition. It does not appear that claimant ever returned to full duties after his August 1980 heart attack. During the short periods he did return to work he had difficulty performing his job. Ultimately, he could not perform his job at all, even though he had successfully recovered from his hernia operation. While claimant’s left inguinal hernia subsequently occurred, he was already permanently disabled.
The Court is also not persuaded that the hernia would have recurred absent the totally disabling heart condition. The heart condition, and the inactivity it caused, increased claimant’s risk of recurrence.
As a result of his heart attack claimant sustained a “total loss of wages” and had no “reasonable prospect of employment of any kind in the normal market.” Thus, claimant had nothing else to lose on account of his industrial accident. He does not meet the criteria for permanent total disability and is therefore not entitled to permanent total disability benefits.

Discussion

This case presents an issue of first impression in the State of Montana. This Court has not had occasion to address a situation involving independent, disabling conditions, one work-related and the other not. Although this Court has not been presented with this particular fact situation before, courts from other jurisdictions have dealt with the issue presented.

In 1974, the Court of Appeals of Washington decided Shea v. Department of Labor and Industry (Wash. Ct. App. 1974), 529 P.2d [102]*1021131. The Shea case involved facts very similar to those presently before this Court. As early as 1961, Mr. Shea first began to suffer the effects of a non work-related degenerative vascular disease and resultant hypertension, which were treated with medication permitting him to continue his work. Mr. Shea then injured his right shoulder in a work-related accident in 1964. However, by November of 1965, Mr. Shea could not have worked at any occupation on a reasonably continuous basis since he was totally disabled due to the progressively degenerative, non work-related vascular condition. Mr. Shea did not work subsequent to November, 1965. His shoulder condition continued to worsen and, in 1971, after the shoulder claim was reopened and brought to hearing, Mr. Shea argued that he was permanently totally disabled by the 1964 shoulder injury.

The Washington court characterized the situation as follows: Thus, viewing the evidence in a light most favorable to the workman (which we must), we visualize him as suffering from two totally independent conditions, each of which is progressively causing increasingly serious disabilities.

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Related

Larson v. Cigna Insurance
915 P.2d 863 (Montana Supreme Court, 1996)

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Bluebook (online)
894 P.2d 327, 271 Mont. 98, 52 State Rptr. 369, 1995 Mont. LEXIS 81, Counsel Stack Legal Research, https://law.counselstack.com/opinion/larson-v-cigna-insurance-company-mont-1995.