No. 86-295 

IN THE SUPREME COURT OF THE STATE OF MONTANA 

1987 

GLORIA RIGHTNOUR, 

Claimant and Respondent, 

-vsKARE-MOR , INC . , 

Employer, 

and 

INTERMOUNTAIN INSURANCE COMPANY, 

Defendant and Appellant. 

APPEAL FROM: The Workers' Compensation Court, The Honorable 

Timothy Reardon, Judge presiding. 

COUNSEL OF RECORD: 

For Appellant: 

Garlington, Lohn & Robinson; Larry W. Jones, Missoula, 

Montana 

For Respondent: 

David L. Holland, Butte, Montana 

Submitted on Briefs: Dec. 11, 1986 

Decided: January 20, 1987 

Filed: " IAN 2 0 1987 
Mr. Justice John Conway Harrison delivered the Opinion of the 

Court. 

This is an appeal from an order of the Montana Workers' 

Compensation Court granting summary judgment to 

plaintiff/claimant and denying defendant/appellantls motion 

for summary judgment. Claimant sustained a compensable 

injury in January, 1982. The settlement agreement included 

reservation of medical benefits. Following surgery performed 

in March, 1985, claimant was awarded medical benefits as 

benefits reserved. We affirm. 

The claimant suffered a low back injury arising out of 

and in the course of her employment, January 19, 1982. Her 

employer, Kare-Mor, Inc., of Butte, Montana, was enrolled 

under compensation plan number I1 of the Workers' 

Compensation Act. Insurer was Intermountain Insurance 

Company (appellant). The employer and appellant accepted 

liability for the claimant's injury and paid weekly temporary 

total disability benefits pursuant to 5 39-71-701, MCA. 

A lumbar laminectomy on a herniated disk at the L4-L5 

level was performed September 30, 1982, by Dr. James P. 

Murphy. Dr. Murphy performed a second surgery in the same 

area March 30, 1983, to relieve nerve root compression and to 

remove loose fragments. Dr. Murphy testified in a deposition 

that claimant's healing period had ended and she had reached 

maximum healing November 22, 1983. A final settlement was 

negotiated and approved January 20, 1984, with the claimant 

reserving medical benefits. 

In March, 1984, the claimant was caring for children in 

her home when she went outside to retrieve a child because of 

the cold. Her dog moved in front of the steps and she 

tripped on his chain and fell. Dr. Paul Giacomini made a 
house call to examine the claimant. She could not move her 

left leg because of severe pain and had muscle spasm in the 

lumbar region. He prescribed a muscle relaxant. The 

doctor's examination notes of September, 1984, indicate he 

believed her tripping and falling caused the pain in her leg, 

which was becoming progressively more severe. 

The claimant was examined by Dr. Murphy in March, 1985. 

A lumbar myelogram indicated subluxation, the movement of one 

vertebrae over another. He performed surgery to fuse the L-4 

to the sacrum because of the subluxation. This third surgery 

was not to repair a defect in the prior surgery. The 

appellant denied liability for payment to claimant of 

disability and medical benefits under the Workers' 

Compensation Act. 

Both parties deposed Drs. Murphy and Giacomini. 

Appellant then moved the court for summary judgment on the 

ground the injury for which claimant was seeking medical and 

disability benefits did not arise out of and in the course of 

her employment. In turn, claimant filed a motion for summary 

judgment, arguing the injury did arise out of and in the 

course of her employment. The Workers' Compensation Court 

adopted the hearing examiner's findings of fact, conclusions 

of law and proposed judgment ordering appellant to pay 

claimant's medical benefits as the medical benefits reserved 

by the claimant relating to her compensable injury of 

January, 1982. Appellant filed a motion for a new trial, or 

in the alternative asked the court to amend its order to 

conform to the findings. The motion was denied and this 

appeal was filed. 
The facts are not in dispute, leaving only a question 

of law to be resolved by this Court. Solich v. Hale (1967), 

150 Mont. 358, 361, 435 P.2d 883, 885; S 25-7-102, MCA. 

If [the question on appeal] is a question 

of law, . . . our scope of review is not 

so limited [as when reviewing a question 

of fact]. In such a case, the 

appropriate standard of review is simply 

whether the lower court's interpretation 

of the law is correct. We are not bound 

by the lower court's conclusion and 

remain free to reach our own. 

Wassberg v. Anaconda Copper Co. (Mont. 1985), 697 P.2d 909, 

912, 42 St.Rep. 388, 391. 

Liabilty is limited statutorily to those injuries 

sustained arising out of and in the course of the claimant's 

employment. 

Every insurer is liable for the payment 

of compensation, in the manner and to the 

extent hereinafter provided, to an 

employee of an employer it insures who 

receives an injury arising out of and in 

the course of his employment. . . 

Section 39-71-407, MCA. 

The essential element to be proved by a claimant is a 

direct relationship between the claimant's employment and the 

injury. Schwartzkopf v. Industrial Accident Board (1967) , 

149 Mont. 488, 493, 428 P.2d 468, 470. That is, a subsequent 

injury is compensable if it is the direct and natural result 

of a compensable primary injury, and not the result of an 

independent intervening cause attributable to the claimant's 

own intentional conduct. See Breen v. ~ndustrial ~ccident 

Board (1968), 150 Mont. 463, 436 P.2d 701. When a subsequent 

injury is compensable, the claimant is entitled to receive 
those benefits which are payable because of medical treatment 

necessitated by the original injury pursuant to $ 39-71-407, 

MCA, and $ 39-71-704, MCA, including any medical benefits 

reserved. 

Dr. Giacomini testified the fall aggravated her 

preexisting weakened back condition. When asked if the 

subluxation that precipitated the third surgery was a result 

of the fall in 1984, Dr. Giacomini answered ". . . the fall 

of 1984 could have caused the subluxation because the 

previous operation[s] had weakened her spine." He testified: 

[Flrom the time she lifted the patient in 

the nursing home and injured herself to 

the time she had surgery this last time 

is just one continuous line that might 

have direct ties or indirect ties. But 

it is the same injury. 

Dr. Murphy testified it was "probable the first incident 

requiring not one, but two surgeries, can be extrapolated 

back to her original injury." He said the fall could have 

aggravated the original injury. 

The need for two surgeries as a result of the original 

injury is undisputed. Nor is there dispute the claimant now 

has a weakened lower back. The Workers' Compensation Court 

concluded 

[tlhe claimant has proven to a reasonable 

degree of medical certainty that the 

original compensable injury of January 

19, 1982 and the two subsequent surgeries 

weakened her back, and combined with the 

fall in her home in March, 1984, resulted 

in a third surgery being required. Such 

surgery and other medical bills related 

to that fall are the natural consequence 

of the original injury. 
The claimant has shown by medical testimony a causal 

connection between her injury of January, 1982, and the 

surgery performed in March, 1985. Thus we affirm the order 

of the Workers' Compensation Court. 

We concur: