This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.
Facts
The Worker sustained an injury in February 2005 and initially received treatment from the Employer's selected health care providers. In April 2006, the Worker chose her own provider, Dr. Garza, who later passed away in 2007. Subsequently, the Worker began treatment with Dr. Sloan, which was agreed upon by the parties. In November 2008, the Worker sought to change her provider to Dr. Esparza, citing dissatisfaction with Dr. Sloan's care. The Employer objected to this change, leading to a dispute over the Worker’s right to select a new provider (paras 2-5).
Procedural History
- Workers’ Compensation Administration, November 21, 2008: The Workers’ Compensation Judge (WCJ) allowed the Worker to select Dr. Esparza as her new provider, finding that the Worker was entitled to relief due to Dr. Garza’s death and the impasse between the parties regarding medical care (paras 4-5, 13).
Parties' Submissions
- Employer: Argued that the Worker had already exercised her right to a second selection by choosing Dr. Garza and subsequently Dr. Sloan. Contended that the Worker was required to prove that Dr. Sloan’s care was unreasonable to justify a further change in provider, which she failed to do (paras 6, 10-12).
- Worker: Claimed that Dr. Sloan’s care was inadequate and disorganized, and that she continued to experience debilitating pain. Asserted that she should be allowed to select a new provider due to Dr. Garza’s death and the impasse in reaching an agreement on her care (paras 4-5, 8-9).
Legal Issues
- Was the Worker entitled to select a new health care provider under Section 52-1-49 of the Workers’ Compensation Act without proving that the current provider’s care was unreasonable?
Disposition
- The Court of Appeals reversed the decision of the Workers’ Compensation Judge, holding that the Worker was required to prove that Dr. Sloan’s care was unreasonable before selecting a new provider (para 19).
Reasons
Per Sutin J. (Fry C.J. and Vanzi J. concurring):
The Court held that under Section 52-1-49 of the Workers’ Compensation Act, a Worker is entitled to a second selection of a health care provider without needing to prove unreasonableness in the care provided by the first provider. However, any subsequent changes in providers require the Worker to demonstrate that the current provider’s care is unreasonable (paras 7-12).
The Court found that the Worker’s selection of Dr. Garza constituted her second selection, and the subsequent agreement to have Dr. Sloan as her provider did not reset her rights under the statute. The Worker failed to present evidence proving that Dr. Sloan’s care was unreasonable, and her offer of proof was insufficient to meet this burden (paras 13-14).
The Court rejected the Worker’s argument that the Workers’ Compensation Judge should have broad discretion in resolving provider disputes, emphasizing that statutory requirements must be followed. The Court also noted that the Worker had the opportunity to request an evidentiary hearing to present evidence but chose not to do so (paras 15-18).
Accordingly, the Court reversed the decision of the Workers’ Compensation Judge, holding that the Worker was not entitled to select Dr. Esparza as her new provider without meeting the statutory burden of proof (para 19).