Opinion ID: 879520
Heading Depth: 1
Heading Rank: 1

Heading: Unfair Claims Settlement Practices

Text: Plaintiff and appellant Spadaro alleges that respondents acted in bad faith when they suspended or denied Spadaro's workers' compensation benefits. Spadaro claims respondents violated § 33-18-201, MCA, which prohibits unfair claim settlement practices by an insurer. Appellant cites no facts to support her allegation that § 33-18-201, MCA, was violated. The moving party has the initial burden of establishing the absence of any genuine issue of material fact. Mustang Beverage Company, Inc. v. Jos. Schlitz Brewing Company (1973), 162 Mont. 243, 246, 511 P.2d 1, 3. However, once the moving parties' burden has been met, as found by the District Court, the burden of establishing a genuine issue of material fact shifts to appellant Spadaro. In order to prevent summary judgment, Spadaro must produce evidence sufficient to raise a genuine issue of fact. Kaiser v. Town of Whitehall (Mont. 1986), 718 P.2d 1341, 1342, 43 St. Rep. 176. On appeal, Spadaro has failed to cite any disputed facts. Instead, Spadaro has relied on general allegations of disputed facts. A party opposing summary judgment [m]ust set forth specific facts showing that there is a genuine issue for trial. Rule 56(e), M.R.Civ.P.. National Gypsum v. Johnson, (1979), 182 Mont. 209, 212, 595 P.2d 1188, 1189. Additionally, Spadaro's allegations that various sections of XX-XX-XXX, MCA, were violated by respondents is not supported by the record. Respondents began paying benefits to Spadaro when they issued Check # 1 on August 22, 1983. Respondents accepted Spadaro's claim even though they had evidence that her claim might not be genuine. On September 2, 1983, respondents issued Check # 2. After receiving the checks, Spadaro fraudulently told her first attorney, Robert Skaggs, that she had not received the checks. North Star, following Skaggs's request, stopped payment on the checks. North Star became suspicious upon learning that the checks had already been cashed. In response to the confusing situation created by Spadaro, North Star began its investigation. Respondents were aware that Spadaro was initially advised by Dr. Robert Kerr on August 2, 1983, to take a week off for bed rest. Respondents were also aware that Kerr then advised her to return to work. However, Spadaro was examined by Dr. Lewallen apparently without a referral from Dr. Kerr. On August 19, 1983, Dr. Lewallen placed Spadaro in traction in a Billings hospital. Given this information, respondents sought Spadaro's complete medical records. On September 8, 1983, respondents requested Robert Skaggs, Spadaro's first attorney, to forward appellant's medical records. Respondent's request was not honored following Skaggs' withdrawal on September 20, 1983. Subsequent to Skaggs's withdrawal, Spadaro did not contact respondents until October 4, 1983. Her new attorney, Lewis Brueggemann, failed to complete a client authorization until October 11, 1983. On October 14, 1983, respondents requested Brueggemann to provide them with Spadaro's medical records. On October 28, 1983, Brueggemann sent Dr. Richard Lewallen's report, which specifically stated that claimant Spadaro had injured her back in a work-related accident on August 1, 1983. The record reveals that Spadaro was the primary cause for the delay in receiving her compensation benefits. Spadaro's (1) fraudulent conduct, (2) change of attorneys and (3) failure to provide respondents with her medical records delayed receipt of her benefits until October 28, 1983. Spadaro complains that she did not receive benefits for four months. However, the record clearly reveals that she is responsible for a delay of approximately three months. The record also reveals that Spadaro and her new attorney Lewis Brueggemann were aware that § 39-71-610, MCA, enabled Spadaro by petitioning the division, to receive benefits for forty-nine days pending a hearing on the matter. Brueggemann and Spadaro elected not to utilize § 39-71-610, MCA. Spadaro is not required to utilize the benefits of this section. However, her failure to do so is a proper consideration.