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 claimant, a bus driver employed by the City of Albuquerque, sustained injuries in workplace accidents on May 10, 1989; May 9, 1990; July 31, 1991; and December 20, 1991. She initially received treatment through the City’s Employee Health Center (EHC) and its referrals. Subsequently, she sought treatment from her chosen health care providers, including Dr. Racca, Dr. Fredman, and Dr. Pendleton, for injuries and related conditions such as anxiety and depression (paras 2-3).
Procedural History
- Workers' Compensation Administration, Judge Dinelli: Designated Dr. Racca and Dr. Pendleton as the claimant’s health care providers for the July 1991 and December 1991 accidents, respectively. The order did not determine the City’s obligation to pay for their services (paras 2-3, 7, and 13).
Parties' Submissions
- Claimant-Appellant: Argued that the City was obligated to pay for medical treatment provided by her chosen health care providers, as designated by Judge Dinelli. She also contended that Judge Wiltgen erred in applying the Bowles test and in failing to give deference to Judge Dinelli’s prior order (paras 1, 4, and 13).
- Respondent-Appellee (City of Albuquerque): Asserted that the medical services provided by the claimant’s chosen health care providers were not reasonable or necessary under the applicable statutory standard, and therefore, the City was not obligated to pay for them (paras 4, 8, and 11).
Legal Issues
- Whether the employer was obligated to pay for medical treatment provided by health care providers chosen by the claimant under the amended Section 52-1-49 of the New Mexico Workers’ Compensation Act.
- Whether Judge Wiltgen erred in failing to give deference to Judge Dinelli’s prior order designating the claimant’s health care providers (para 1).
Disposition
- The Court of Appeals affirmed the compensation order, holding that the City was not obligated to pay for the medical services provided by the claimant’s chosen health care providers (para 14).
Reasons
Per Black J. (Donnelly and Bivins JJ. concurring):
Judge Wiltgen erred in applying the Bowles test, which was superseded by the 1991 amendment to Section 52-1-49. The amended statute allows the worker to choose a health care provider after 60 days, but the employer’s obligation to pay remains limited to “reasonable and necessary” services (paras 5-6).
The Court found that Judge Dinelli’s order designating Dr. Racca and Dr. Pendleton as health care providers did not determine the City’s obligation to pay for their services. The order only addressed the choice of providers and explicitly preserved the City’s right to contest liability for payment (paras 7-8, 13).
Judge Wiltgen’s findings established that the claimant’s injuries from the July 1991 and December 1991 accidents did not necessitate further medical treatment. Specifically, the claimant had reached maximum medical improvement for the July 1991 accident and returned to work without restrictions. Additionally, the December 1991 accident did not result in a compensable injury. The services provided by Drs. Racca, Fredman, and Pendleton were deemed unrelated, unreasonable, unnecessary, or duplicative, and thus not compensable under Section 52-1-49(A) (paras 9-12).
The Court concluded that, despite the error in applying the Bowles test, the correct result was reached because the services in question were not “reasonable and necessary” under the statute (para 12).