Thompson v. Cigna

2000 MT 306, 14 P.3d 1222, 302 Mont. 399, 57 State Rptr. 1292, 2000 Mont. LEXIS 318
CourtMontana Supreme Court
DecidedDecember 6, 2000
Docket99-582
StatusPublished
Cited by5 cases

This text of 2000 MT 306 (Thompson v. Cigna) 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
Thompson v. Cigna, 2000 MT 306, 14 P.3d 1222, 302 Mont. 399, 57 State Rptr. 1292, 2000 Mont. LEXIS 318 (Mo. 2000).

Opinions

JUSTICE NELSON

delivered the Opinion of the Court.

¶1 Gregg Thompson appeals a decision of the Workers’ Compensation Court declining to assess a 20% penalty against CIGNA for unreasonably delaying payment to Thompson pursuant to § 39-71-2907, MCA (1981). We affirm.

¶2 Thompson raises the following issue on appeal:

¶3 Whether the Workers’ Compensation Court erred in refusing to award the 20% penalty pursuant to § 39-71-2907, MCA (1981).

Factual and Procedural Background

¶4 Thompson suffered an injury to his knee on October 22,1981, while working for Deaconess Hospital. The hospital was insured by CIGNA who accepted liability for the claim and paid medical and disability benefits. Since Thompson’s injuries occurred in the fall of 1981, the 1981 version of the Workers’ Compensation Act applies to all facets of Thompson’s claim. Buckman v. Montana Deaconess Hosp. (1986), 224 Mont. 318, 321, 730 P.2d 380, 382 (citing Trusty v. Consolidated Freightways (1984), 210 Mont. 148, 151, 681 P.2d 1085, 1087; Iverson v. Argonaut Ins. Co. (1982), 198 Mont. 340, 342, 645 P.2d 1366, 1367).

¶5 As a result of his injury, Thompson underwent 13 knee surgeries which left him permanently totally disabled. Thompson received permanent total disability benefits on a bi-weekly basis. However, Thompson’s benefits, amounting to $162.21 per week, were frozen at the 1981 wage and benefit level.

¶6 In March 1997, Thompson retained attorney Patrick Sheehy to settle Thompson’s workers’ compensation claim asserting that after 15 years of inflation, the $162.21 per week benefit was not enough to sustain Thompson and his family. Consequently, on June 2, 1997, Sheehy wrote to CIGNA requesting information regarding Thompson’s claim. However, CIGNA did not provide the requested information until September 9,1997.

¶7 On September 23,1997, Sheehy sent CIGNA a letter wherein he calculated CIGNA’s exposure for lifetime permanent-total and permanent-partial disability benefits at $226,675.77. In his letter, [401]*401Sheehy did not make a settlement demand. Instead, he requested that CIGNA make an offer of settlement.

¶8 On February 11,1998, almost five months after sending the first letter, Sheehy, having received no reply from CIGNA, sent another letter explaining Thompson’s financial needs and requesting discussions on settlement or a partial lump sum advance. When CIGNA again failed to respond, Sheehy sent a third letter on April 2, 1998, setting forth a present value calculation of Thompson’s benefits of $106,879.88. Noting in this letter that present value reductions are not allowed on 1981 claims, Sheehy offered to settle the claim for a $150,000 lump-sum payment. CIGNA finally responded in June 1998, and settlement negotiations began.

¶9 By July 1998, Thompson had agreed to settle for an annuity in the amount of $121,132. However, CIGNA’s in-state adjuster, Michele Fairclough, did not have settlement authority for the proposed amount. Fairclough indicated that she would need to request authority from a CIGNA claims committee. In early November, Fairclough contacted Sheehy and suggested that he send a signed settlement petition for the $121,132 that they had discussed. Although she did not yet have settlement authority, Fairclough indicated that she was confident the proposal would be approved.

¶10 Sheehy later testified that Fairclough called him in late November or early December to tell him that she had settlement authority for the $121,132. However, contrary to Sheehy’s assertions, Fairclough testified that she did not have settlement authority at the time and would not have told Sheehy that she did.

¶11 In January 1999, Fairclough’s supervisor directed her to get a new annuity quote, to take a $7,500 overpayment into account, and to explore possible settlement of medical benefits. To that end, Fairclough obtained a new annuity quote in the amount of $117,100. Fairclough subsequently discussed the new annuity quote with Sheehy along with the need to offset the prior $7,500 advance and a Social Security overpayment. In addition, Fairclough indicated that CIGNA would add $10,000 to the settlement amount if they were able to close the medical benefits as well.

¶12 Sheehy objected to this change in the settlement terms. On February 9,1999, Sheehy filed a Petition for Hearing requesting that the Workers’ Compensation Court enforce the settlement agreement reached between the parties in the amount of $121,132 and award [402]*402Thompson a 20% increase for unreasonable delay pursuant to § 39-71-2907, MCA (1981), as well as attorney’s fees and costs.

¶13 At the end of February 1999, Fairclough received final corporate authority to settle the claim for $121,132. She then forwarded the original settlement petition, which she had received from Sheehy in November, to the Department of Labor and Industry for approval. The department approved the settlement on March 29, 1999, and CIGNA issued the settlement checks on April 26,1999.

¶ 14 That same date, a hearing was held regarding Thompson’s petition. The only issues presented were whether Thompson was entitled to an award of a 20% penalty and whether he was entitled to attorney’s fees and costs. On August 17,1999, the Workers’ Compensation Court issued its Findings of Fact, Conclusions of Law and Judgment wherein the court determined that the delay in this case was unreasonable and was the result of CIGNA’s violation of 24.29.804, ARM, requiring workers’ compensation insurers to designate an in-state adjuster with authority to settle claims. Although the court determined that CIGNA acted unreasonably, it declined to award a 20% penalty. Nevertheless, the court did award Thompson his attorney’s fees and costs.

¶15 Thompson appeals the Workers’ Compensation Court’s refusal to award the 20% penalty.

Discussion

¶16 Whether the Workers’ Compensation Court erred in refusing to award the 20% penalty pursuant to § 39-71-2907, MCA (1981).

¶17 We review findings of fact of the Workers’ Compensation Court to determine whether they are supported by substantial credible evidence. Matthews v. State Compensation Ins. Fund, 1999 MT 225, ¶ 5, 296 Mont. 76, ¶ 5, 985 P.2d 741, ¶ 5 (citing EBI/ Orion Group v. Blythe, 1998 MT 90, ¶ 17, 288 Mont. 356, ¶ 17, 957 P.2d 1134, ¶ 17). Our review of the Workers’ Compensation Court’s conclusions of law is plenary; we determine whether its conclusions of law are correct. Matthews, ¶ 5 (citing Liberty v. State Fund, 1998 MT 169, ¶ 7, 289 Mont. 475, ¶ 7, 962 P.2d 1167, ¶ 7).

¶18 The Workers’ Compensation Court determined that although CIGNA’s failure to designate an in-state adjuster with authority to settle claims caused an unreasonable delay in this case, the court was precluded from awarding Thompson a penalty because of the express provisions of§ 39-71-741, MCA (1981), and §39-71-2907, MCA (1981). [403]*403¶19 Section 39-71-741, MCA (1981), provides for the conversion of bi-weekly payments into a lump sum:

Compromise settlements and lump-sum payments — division1 approval required.

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Related

In Re Abfalder
2003 MT 180 (Montana Supreme Court, 2003)
Abfalder v. Nationwide Mutual Fire Insurance
2003 MT 180 (Montana Supreme Court, 2003)
Wild v. Fregein Construction
2003 MT 115 (Montana Supreme Court, 2003)
Thompson v. Cigna
2000 MT 306 (Montana Supreme Court, 2000)

Cite This Page — Counsel Stack

Bluebook (online)
2000 MT 306, 14 P.3d 1222, 302 Mont. 399, 57 State Rptr. 1292, 2000 Mont. LEXIS 318, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thompson-v-cigna-mont-2000.