No. 92-140 IN THE SUPREME COURT OF THE STATE OF MONTANA

PAMELA

### J. HOUTS, Claimant/Petitioner/Respondent,
v. KARE-MOR, INC., d/b/a BUTTE PARK ROYAL CONVALESCENT CENTER, and HORIZON HEALTHCARE CORP., d/b/a BUTTE PARK ROYAL CONVALESCENT CENTER, and STATECOMPENSATIONMUTUAL INSURANCE FUND,

and HORIZON HEALTHCARE CORP., d/b/a BUTTE PARK ROYAL CONVALESCENT CENTER, and GENERAL INSURANCE COMPANY OF AMERICA,

APPEAL FROM: The Workers' Compensation Court The Honorable Timothy W. Reardon, Judge presiding.

COUNSEL OF RECORD: For Appellant: Geoffrey R. Keller, Matovich, Addy & Keller, Billings, Montana (General Insurance) For Respondent: R. Lewis Brown, Attorney at Law, Butte, Montana

(Houts);Michael McCarter, Hughes, Kellner, Sullivan & Alke, Helena, Montana (StateFund) ." > Submitted on Briefs: October 22, 1992 Decided: February 19, 1993Justice William E. Hunt, Sr., delivered the opinion of the Court. Appellant General Insurance Company of ~mericaappeals 

### a decisionof theWorkers1

### om pens at ion Court findingthatrespondent Pamela J. Houtsl

### currentmedical condition,resulting from surgery on April 11, 1988, stemmed from her April 4, 1988, industrial injury. We affirm. General Insurance presents two issues for review. Houts believes that the two issues can be combined into one. We will review the following issues: 1. Is there substantial evidence to support the Workers1 Compensation Court's Findings of Fact and Conclusions of Law? 2. Did the WorkersiCompensation Court err in finding that General Insurance unconditionally accepted liability 

### for Houts' April 4, 1988, claim? 

### Pamela 3. Houts worked as 

### a nursefsaide at Butte 

### Park Royal Convalescent Center from September 4, 1984, until her employment


### was terminated 

### on October 27, 1988. During that period, she reported six workersf compensation injuries. The insurer, the State Fund, accepted claims for four injuries occurring from 1985 through 1987. General Insurance was the insurer for two injuries that occurred in 1988. Houtsf first industrial injury occurred on October 7, 1985. She sufferedan 

### inguinalherniawhile lifting apatient. She filed
a claim and received temporary total disability benefits from the State Fund. The hernia was repaired by surgery on November 11,1986,after which shereceived temporary total disability benefits. On January 15, 1987, she returned to work without restrictions as a nursesvaide. OnMarch 22, 1986,Houts sprainedher lowerbackwhileputting
apatient to bed. She filedher claimand received temporarytotal disability benefits untilApril 4,1986,when she returned towork. OnApril. 22, 1987,Houts injuredher lower side abdomen while liftingpatients. 

### Her conditionwas diagnosed asnerve entrapment for which she had surgery on May 12, 1987. At the time of trial, the State Fund was still paying her temporary total disability benefits attributable to this injury. Houts fourth industrial injuryoccurred onDecember 24, 1987, when she was lifting a patient into a wheelchair and she felt a pain on her left side, Nouts reported the accident and filed a claimwhichwas acceptedby the State Fund,but no medical expenses
or wage loss was reported. On April 4, 1988, Houts was injured when she was lifting a patient and felt a sharp pain in her left side. The insurer at this point was General Insurance. Houts was examined by Dr. JohnM. Gallus, her treating physician, who concluded that the problem was 

### a continuation of her previous medical problems on her left side. 

### Houts continued 

### to experience discomfort and on April 7,1988, Dr. Gallus referred her to Dr. R. E. Nehls in Butte who was board certified 

### in obstetrics and gynecology. On April 11, 1988, Dr. Nehls performed a laparoscopic examination of her abdomen which revealed for the first time that her left tubeand ovary were attached to her abdominal wall by dense adhesions. Dr. Nehls decided to perform general surgery and remove the abnormal condition of the tube and left ovary. Following the surgery, Houts' abdominal pain was gone,however, she nowhad pain in the front area of her left thigh. She was then referred to Dr. W. T. Escober, a neurologist, for a neurological exam. Houts received temporary total disability benefits from April 18, 1988, through mid-August 1988, when she returned to work. The last industrial injury Houts suffered occurred on October 26, 1988, when she was attempting to place a shirt on a patient and was punched in the stomach. No disability was alleged fromthe incident. Houtswas terminated the followingdaywhenher supervisortoldher that theyhad no light dutypositions available for her. A petition forhearing was filed on January 16, 1991, and was heard before the hearing examiner on September 4, 1991. On February 28, 1992, the Workers' Compensation Court adopted the hearing examiner's findings of fact and conclusions of law which stated that Houts' current symptoms arose from theApril 11, 1988, surgery stemming fromher April 4, 1988, claim. General Insurance appeals the decision of the Workers' Compensation Court. I. Is there substantial evidence to support the Workers' Compensation Court's Findings of Fact and Conclusions of Law? Our standard of review inaworkers' compensation case is that this Court will not substitute its judgment for that of theWorkers' Compensation Court where there is substantial evidence to support the court's findings of fact. Laber v. Skaggs Alpha Beta (1991),247Mont. 172,805 P.2d 1375. Our responsibilityis not to determinewhether sufficient evidence supports

### a contrary finding. Hall v. Atlantic Richfield Co. (lggl), 248 Mont. 484, 812 P.2d 1262. The claimant is required to prove by the preponderance of the evidence that her current disability was caused by an injury sustained on the job. 

# w,812 P.2d at 1264. Therefore, we will not overturn the Workers' Compensation Court unless its findings
are not supported by substantial evidence. In its conclusions of law, the Workers' Compensation Court determined that during the laparoscopic examination Dr. Nehls discovered that Houts' left ovary was attached to the abdominal wall and covered with dense adhesions. This abnormal condition would be aggravated by lifting and ovulation. General Insurance contends that with these conclusions it is impossible to reconcile the Workers' Compensation Court's conclusion that the April 11, 1988, surgery to remove the adhesions,whichwere neither caused nor permanently aggravatedby the April 4, 1988, lifting incident, was not a result of that injury. Houts counters that the cause of the adhesions is not the critical factor,but whether the lifting incident exacerbated the intermittently painful ovarian adhesions by producing the severe pain that caused her to seekmedical assistance. It iswell established that an employer takes an employee as he finds him. Roadarmel, 772 P.2d at 1263. Although an employee 5may be suffering from a pre-existing disease or disability, the condition does not preclude compensation 

### if the disease or disability is aggravated 

### or accelerated by an industrial injury arising out of or in the courseof employment. Roadamel, 772 P.2d

We have stated that:

[Mledical possibility evidence that an industrial accident or injury aggravated a pre-existing condition, may togetherwithother evidence,establisha compensable disability. However, medical possibility evidence, in and of itself, doesnotnecessarily extinguishclaimant's burden to prove her case by a preponderance of the evidence. Laber, 805 P.2d at 1378. Tn this case, Dr. Nehls testified that any strain, including lifting,could causetension in the adhesive process and cause some discomfort. Dr. Gallus testified that Houtsqpain was exacerbated by her lifting 

### at work. 

### Dr. Gallus also stated that the adhesions
can 

### tear away with heavy lifting or exertion. He further stated that 

### it

### was a realpossibility that theadhesion toreaway from the attachments and exacerbated Houtslcondition. The medical testimony raised the possibility that Houtsi pre-existing condition was aggravatedby theApril 4, lifting injury. The medical possibility must be corroborated by independent evidence. Houtsl testimony supports the doctors1 contention that lifting and ovulationwould aggravate the injury. At the hearing, she testified to 

### the following: Q. Was that higher, as far asmore towards your navel than the pain that 

### you experienced in your groin area?A. It was above the incision from the hernia, it was like up, 

### moving up. Q. So it was higher,more toward your navel? A. Yes. Q. Do you recall, if anything, what brought on that pain? A. No, just from lifting and working, I'd be very painful down there. 

### Imean it would be sore down there,but when 

### Ihad 

### my periods, it was worse. 

### The fact that Houts experienced pain in the exact locationof the adhesion prior to, and 

### on April 4, 1988, as well at the laparoscopic exam, further corroborates the doctors1testimony. Dr. Nehls performed surgery to remove the ovary which caused Houts' pain. The surgery was successful but resulted 

### in intermittent pain from Houts' left thigh to her knee. Doctors Charles 33. Beuler, an orthopedic surgeon, and neurologist Gary Cooney, testified that her leg pain resulted from the April 11, 1988,surgery. 

### Apreponderance of themedical evidenceestablishes

a causal relationship betweenHoutslpresentpain inher left thigh and the April 11 surgery resulting from the lifting injury. We hold that there is substantial evidence to support the Workers1 compensationCourt's findings of fact and conclusions of law.11. Did the Workers' Compensation Court err in finding that General Insurance unconditionally accepted liability for Houts' April 4, 1988,claim? As previously stated,Houts has met her burden of proof that she sustaineda compensable injuryarising out of and in the course of her employment for which her employer and insurer are liable. Whether General Insurance accepted liability is immaterial because liability attaches as a matter of law. We hold that the Workers' Compensation Court did not err in finding that General Insurance accepted liability for Houts' injury. We affirm. /
Justice We concur:

Chief Justice