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Carrier incurs penalty for overly frugal assessment of caregiver services
In Montana, a workers' compensation judge can increase the amount of a claimant's compensation benefits by 20 percent when the carrier unreasonably delays or refuses to make payments.
Case name: Quick v. Montana State Fund, No. DA 08-0285 (Mont. 05/13/09). Ruling: The Montana Supreme Court upheld the Workers' Compensation Commission's imposition of a 20 percent penalty fee on the carrier.
Summary: An employee suffered a brain injury in a work-related motor vehicle accident. His injuries eventually forced him to need full-time domiciliary care, which his wife provided. The carrier accepted the claim and the request for domiciliary care, but only agreed to pay his wife, a registered nurse, $7.50 per hour for her services. Multiple doctors testified that the employee a level of care that only an RN could provide, and two RNs testified that the salary for a home health nurse ranged from $25 to $65 per hour. The Montana Supreme Court affirmed the workers' compensation judge's determination that the wife should get a reduced amount of $20, due to her "greater level of discretion and freedom" than a privately retained nurse. The court found the carrier acted unreasonably in questioning the monetary value of the wife's services. It pointed out that, as far back as 1987 and 1989, the going rate for domiciliary care provided by an employee's spouse, not even a registered nurse, was between $7 and $7.50 per hour. Noting the rise in medical care costs since the 1980s, the court held the carrier unreasonably determined the rate of pay, and therefore the 20 percent penalty increase was appropriately assessed. July 2, 2009 Copyright 2009© LRP Publications |
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