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

• Worker, Ashley Vigil, experienced a compensable workplace accident on December 6, 2010, and subsequently received non-emergency medical care. The dispute arose when the Worker attempted to change her healthcare provider (HCP), leading to an objection by the Employer, General Parts, and its insurer, New Hampshire Insurance Co., c/o Gallagher Bassett (collectively, Employer), against the Worker's notice of change of HCP (para 1).

Procedural History

• [Not applicable or not found]

Parties' Submissions

• Worker-Appellant: Argued that the Employer failed to properly notify her of the HCP selection process, which should allow her to change her healthcare provider.
• Employer/Insurer-Appellees: Initially contended that they had satisfied the requirement to notify the Worker of the HCP selection process through a letter, but later conceded that this letter likely did not meet the necessary written notice requirements (paras 3-4).

Legal Issues

• Whether the Employer satisfied the requirement to notify the Worker of the HCP selection process as per 11.4.4.11(C)(2)(a) NMAC.
• Whether the Employer presented sufficient "other evidence" to overcome the presumption that it had selected the initial HCP, in light of its failure to provide proper notice (para 4).

Disposition

• The Court of Appeals reversed the Workers’ Compensation Judge's (WCJ) order sustaining the Employer's objection to the Worker's notice of change of HCP and remanded the case for further proceedings (para 7).

Reasons

• Per Timothy L. Garcia, J. (Cynthia A. Fry, J., and J. Miles Hanisee, J., concurring):
  The court found that the Employer's letter to the Worker did not satisfy the written notice requirement for informing the Worker of the HCP selection process as mandated by 11.4.4.11(C)(2)(a) NMAC. The Employer conceded this point, acknowledging that the letter served more as a confirmatory notice, which was insufficient (paras 1-3).
  Despite the Employer's concession, it argued that it had presented sufficient "other evidence" to rebut the presumption that it had selected the initial HCP, specifically pointing to a telephone conversation between one of the Worker's healthcare providers and the Worker. The court did not find this argument persuasive, noting that the issue of whether such evidence could overcome the presumption had not been properly preserved for review and was not sufficiently developed in the record for consideration (paras 4-6).
  The court reversed the WCJ's order and remanded the case for the WCJ to consider whether the Employer had previously presented sufficient "other evidence" to overcome the presumption that it had selected the initial HCP. The court emphasized that the WCJ's determination must be based on evidence presented at the previous hearing and also instructed the WCJ to consider the Worker's claim for attorney fees and costs (para 7).