AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

A worker sustained a back injury during the course of his employment on September 18, 2001. He initially selected a health care provider (HCP), who referred him to another doctor. The employer later exercised its statutory right to redirect the worker to a different HCP. The worker sought further medical evaluation after reaching maximum medical improvement, but the employer refused to authorize it (paras 2-5).

Procedural History

• New Mexico Workers' Compensation Administration: The Workers' Compensation Judge (WCJ) granted the worker the right to a six-month periodic examination by a non-HCP, despite the statute limiting this right to employers (paras 1, 5).

Parties' Submissions

• Appellants (Employer/Insurer): Argued that the plain language of NMSA 1978, § 52-1-51(D) unambiguously limits the right to six-month periodic examinations to employers and that the WCJ erred in granting this right to the worker (paras 1, 10).
• Appellee (Worker): Contended that the WCJ's decision was fair and necessary to ensure access to reasonable and necessary medical treatment, despite the statutory language (paras 5, 11).

Legal Issues

• Whether the six-month periodic review right under NMSA 1978, § 52-1-51(D) applies to workers as well as employers.

Disposition

• The Court of Appeals reversed the WCJ's decision, holding that the six-month periodic review right under NMSA 1978, § 52-1-51(D) is limited to employers (para 13).

Reasons

Per Vigil J. (Bustamante and Robinson JJ. concurring):

• The Court applied a de novo standard of review to interpret the statute. It found that the plain language of NMSA 1978, § 52-1-51(D) unambiguously grants the right to six-month periodic examinations exclusively to employers (paras 9-10).
• The Court rejected the WCJ's "fair-is-fair" reasoning, emphasizing that fairness cannot override the clear statutory language. The statute provides mechanisms for workers to seek independent medical examinations if dissatisfied with their care, ensuring their rights are protected (paras 11-12).
• The Court noted that the legislative intent behind the statute was to allow employers some control over medical costs when workers select their own HCPs, consistent with the broader framework of the Workers' Compensation Act (para 12).
• The Court concluded that there was no legislative basis to extend the six-month periodic review right to workers and reversed the WCJ's decision (paras 12-13).