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 STATE COMPENSATION MUTUAL 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 (State Fund) 

." > 

Submitted on Briefs: October 22, 1992 

Decided: February 19, 1993 
Justice William E. Hunt, Sr., delivered the opinion of the Court. 

Appellant General Insurance Company of ~merica appeals a 

decision of the Workers1 om pens at ion Court finding that respondent 

Pamela J. Houtsl current medical 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 Workersi Compensation Court err in finding that 

General Insurance unconditionally accepted liability for Houts' 

April 4, 1988, claim? 

Pamela 3. Houts worked as a nursefs aide 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 suffered an inguinal hernia while lifting a patient. 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 she received temporary total disability benefits. 

On January 15, 1987, she returned to work without restrictions as 

a nursesv aide. 

On March 22, 1986, Houts sprained her lower back while putting 

a patient to bed. She filed her claim and received temporary total 

disability benefits until April 4, 1986, when she returned to work. 

On April. 22, 1987, Houts injured her lower side abdomen while 

lifting patients. Her condition was diagnosed as nerve 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 injury occurred on December 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 

claim which was accepted by 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. 

John M. 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 tube 
and 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 now had 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 

from the incident. Houts was terminated the following day when her 

supervisor told her that they had no light duty positions available 

for her. 

A petition for hearing 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 the April 11, 1988, 

surgery stemming from her 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 in a workers' compensation case is that 

this Court will not substitute its judgment for that of the 
Workers' Compensation Court where there is substantial evidence to 

support the court's findings of fact. Laber v. Skaggs Alpha Beta 

(1991), 247 Mont. 172, 805 P.2d 1375. Our responsibility is not to 

determine whether 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, which were neither caused nor permanently aggravated by 

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 seek medical assistance. 

It is well established that an employer takes an employee as 

he finds him. Roadarmel, 772 P.2d at 1263. Although an employee 

5 
may 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 course of employment. Roadamel, 772 P. 2d 

We have stated that: 

[Mledical possibility evidence that an industrial 

accident or injury aggravated a pre-existing condition, 

may together with other evidence, establish a compensable 

disability. However, medical possibility evidence, in 

and of itself, does not necessarily extinguish claimant'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 cause tension in the adhesive process and cause some 

discomfort. Dr. Gallus testified that Houtsq pain 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 real possibility that the adhesion tore away from the 

attachments and exacerbated Houtsl condition. 

The medical testimony raised the possibility that Houtsi 

pre-existing condition was aggravated by the April 4, lifting 

injury. The medical possibility must be corroborated by 

independent evidence. Houtsl testimony supports the doctors1 

contention that lifting and ovulation would aggravate the injury. 

At the hearing, she testified to the following: 

Q. Was that higher, as far as more 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. I mean it would be sore down 

there, but when I had my periods, it was worse. 

The fact that Houts experienced pain in the exact location of 

the adhesion prior to, and on April 4, 1988, as well at the 

laparoscopic exam, further corroborates the doctors1 testimony. 

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. A preponderance of the medical evidence establishes 

a causal relationship between Houtsl present pain in her left thigh 

and the April 11 surgery resulting from the lifting injury. We 

hold that there is substantial evidence to support the Workers1 

compensation Court'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 sustained a compensable injury arising 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