WorkCompCentral recently published Public School Employee Can't Get Benefits for Alleged Injuries From Attack by Student. The headline drew me in, suggesting that somehow a violent personal attack is not compensable in Montana. But, this decision rendered in January does not hold that attacks are not compensable. As an aside, Montana workers' compensation was in the news in February also with a decision highlighted by Bob Wilson on his Cluttered Desk.
The public school case is TG v. Montana Schools Group Insurance, 2018 MTWCC 1. Procedurally, the case came to the Workers' Compensation Court on a motion for "summary judgment," that is that the employer filed seeking a decision that it was entitled to win the claim as a matter of law, and without any hearing. If there are material issues of fact (e.g. did the attack happen or not, etc.) then summary judgment is not appropriate. But when the facts are not disputed, this process can lead to expedited resolutions for either party in litigation.
The public school case is TG v. Montana Schools Group Insurance, 2018 MTWCC 1. Procedurally, the case came to the Workers' Compensation Court on a motion for "summary judgment," that is that the employer filed seeking a decision that it was entitled to win the claim as a matter of law, and without any hearing. If there are material issues of fact (e.g. did the attack happen or not, etc.) then summary judgment is not appropriate. But when the facts are not disputed, this process can lead to expedited resolutions for either party in litigation.
This case involved "an aide at high school" who was struck and pinched by "a special needs student." This resulted in bruises, but the aid "did not seek or require medical treatment." TG was already under the care of a doctor for a pre-existing fibromyalgia and later complained to this physician about the student's actions and the resulting bruises. That physician diagnosed post-traumatic stress disorder, and that TG "aggravated her preexisting anxiety, depression, and pseudoseizures, resulting in her inability to work."
As the case proceeded, one physician noted that TG "has taken medical leave off work right now because she feels that she is unable to deal with that environment." Another detailed one of the student attacks and noted that TG "does still have to work in the same classroom with him." This doctor opined that TG was unable to work because of "psychological conditions," diagnosing post-traumatic stress, and relating it to the work events.
The workers' compensation court focused upon the definition of "injury" in Montana, Section 39-71-407(3)(a), MCA, which requires a showing of "injury" by "objective medical findings." Furthermore, "entitlement to benefits" is required to be
established by objective medical findings that contain sufficient factual and historical information concerning the relationship of the worker’s condition to the original injury, Section 39-71-407(10), MCA.
That is not dissimilar to the standard that Florida uses. See Section 440.09, Fla. Stat. In Montana, the objective "medical findings" are defined specifically, however:
including range of motion, atrophy, muscle strength, muscle spasm, or other diagnostic evidence, substantiated by clinical findings. Section 39-71-116(22), MCA.
The court focused on the fact that TG did not seek care "for her bruising" and that she "does not contend . . . any . . . was necessary." It explained that a bruise "can serve as objective medical finding," but noted that none of the physicians with whom she treated "in the months following the attacks" saw or diagnosed such bruising. The only evidence of bruising was apparently TG's own testimony. It reiterated that "minor wounds" that require no medical care, caused no restrictions or caused no residual problems of disability, and which are "not substantiated by objective medical findings, are not compensable injuries" under Montana law.
Furthermore, upon TG's first visit to her treating doctor for the pre-existing fibromyalgia, after the attacks, the doctor noted her condition as "unchanged from her previous visit." Though he opined there was a "recent exacerbation" of pain, the doctor "did not substantiate his diagnosis with any objective medical findings." The court noted that the bruising had resolved, and thus the diagnosis of "exacerbation" was "based entirely on TG's subjective complaints of increased pain in her neck and arm." The court detailed how these facts did not substantiate a compensable exacerbation under Montana's definitions discussed above.
The court next turned to the claims of psychiatric injury. Montana is not a jurisdiction that recognizes mental injury as compensable in the absence of physical injury. That is currently the law in Florida, but a bill to provide psychiatric care to some Florida employees recently passed and will be considered by the Governor. In some part, Florida may soon provide benefits for "mental-mental claims."
In Montana, psychiatric injury or symptoms must relate to a compensable physical injury. The court in TG concluded that "there is no medical evidence" that connects the diagnoses of "anxiety, depression, seizure-like activity, or PTSD" to the bruising or or increased pain that TG described, and "which she attributes to the attacks." Therefore, the court concluded her psychiatric complaints were "mental-mental conditions" and not compensable.
The court's decision reminds us that medical evidence is critical to a workers' compensation claim. The existence of bruising TG alleged was not sufficient but might have been if TG had visited a physician immediately so that those were witnessed by the medical providers.
A second point one might derive from the outcome regards the selection of a physician. Physicians are generally focused on diagnosing issues. They seek to understand symptoms, relate them to anatomy and physiology, and provide treatment with goals of correcting maladies or at least alleviating symptoms. That is what medical school teaches. Without experience or training in workers' compensation, a physician may not understand the legal parameters or importance of statutory requirements such as "objective medical findings." Those are not taught in medical school, and a physician's specific workers' compensation knowledge may be important.
