Provider Bulletin

Floyd vs Zurich American Insurance CO. of Illinois (Aug 2017)

2017 MTWCC 4;  WCC No. 2016-3748

DANIAL FLOYD, Petitioner vs. ZURICH AMERICAN INSURANCE CO. OF ILLINOIS, Respondent/Insurer.

FINDINGS OF FACT, CONCLUSIONS OF LAW, AND JUDGMENT

Summary: Petitioner claims that he is not at MMI from his December 2014 injury, and that he is entitled TTD and medical benefits from the time Respondent terminated them. Petitioner further claims that he is entitled to reasonable costs, attorney fees, and a penalty. Although Respondent accepted liability for Petitioner’s injury, Respondent argues that Petitioner’s current complaints are not a result of the incident at work, Petitioner has achieved MMI, and Respondent is no longer liable for benefits.Respondent also contends that its conduct has been reasonable because Petitioner’s presentation has been unique.

Held: Petitioner proved by a preponderance of the evidence that he suffered a compensable injury and that he has not reached MMI. Petitioner is entitled to TTD and medical benefits from the time Respondent terminated them, and, as the prevailing party, Petitioner is entitled to reasonable costs. Respondent’s actions in terminating Petitioner’s benefits were unreasonable because it disregarded the treating physician’s opinions and seized upon the IME physician’s opinions despite their obvious faults. Respondent’s actions in failing to reinstate Petitioner’s benefits after the IME physician’s deposition were unreasonable because the IME physician testified on a more-probable-than-not basis that Petitioner’s injury was compensable. Therefore, Petitioner is entitled to attorney fees and a penalty.

Floyd_2017MTWCC4

Bill Status – 1-877-591-8028

Main Phone Number 406-495-5000 or 800-332-6102

Main Fax  406-495-5020

Medical Team – 406-495-5011

Submit your Claims and/or Correspondence To
Montana State Fund
PO Box 4759
Helena, MT  59604

ACS (Bill Status)
Phone  888-208-2116
Email  MSFBillReviewInquiries@Conduent.com

For questions regarding
: Information in this bulletin, call 800-332-6102 and ask for a member of the Medical Team. Advanced Nurse Review, Kym Vonada at 406-495-5389.


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Judy Morgan
Nurse Manager
406-495-5277

Justin Kennedy
Medical Management Specialist
406-495-5417

Shannon Hadley
Provider Relations Specialist
406-495-5245

Kym Vonada
Medical Auditor
406-495-5389

Annalyn Stewart
Medical Payment Auditor
406-495-5367

Susan Bomar
Medical Payment Auditor
406-495-5271

Cindy Gallus
Medical Customer Service Liaison
406-495-5189

Sherri Sprenger
Medical Customer Service Liaison
406-495-5420

Shannon Mergenthaler
Medical Customer Service Liaison
406-495-5185

Maggie Pentecost
Medical Customer Service Liaison
406-495-5322

Jamie Statton
Medical Customer Service Liaison
406-495-5386

Website Information

Montana State Fund montanastatefund.com

Department of LaborDepartment of Labor and Industry (DLI) website.
The website includes the Facility and Non-Facility Fee Schedule information as well as the Administrative Rules of Montana (ARM) and the instruction set for the Non-Facility Fee Schedule. Historical fee schedule information can also be found on this website.

If you have questions regarding the fee schedules call 406-444-6530 and someone will direct you to a DLI representative. For NPI information click here National Plan and Provider Enumeration System (NPPES)