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 suffered a compensable injury to his shoulder and was medically restricted to light duty work after reaching maximum medical improvement. The employer offered the worker a return to work position that exceeded the worker's physical limitations, which the worker did not accept. Subsequently, the employer unilaterally reduced the worker's Permanent Partial Disability (PPD) benefits, leading the worker to file an application for a finding of bad faith and/or unfair claims processing practices (paras 2, 4-5).

Procedural History

• Serrano v. Los Alamos National Laboratories, No. A-1-CA-33922, mem op. (N.M. Ct. App. Aug. 5, 2015) (non-precedential): The Court of Appeals held that certain medical opinions were improperly admitted and reversed and remanded for further proceedings regarding the worker's impairment rating (para 3).
• Workers’ Compensation Judge (WCJ) filed a Compensation Order and later a Supplemental Compensation Order granting the worker's application for finding of bad faith and/or unfair claims processing practices. The employer's motion for reconsideration was partially denied by the WCJ (paras 2, 8, 11).

Parties' Submissions

• Worker-Appellee: Argued that the employer unilaterally reduced PPD benefits without a court order, violating the Compensation Order. The worker requested reinstatement of benefits at the 68% rate, a penalty of 25% of the underlying indemnity benefits due, attorney’s fees, and post-judgment interest (para 6).
• Employer/Insurer-Appellants: Contended that their return to work offer was within the worker's permanent physical restrictions at pre-injury wages, and by refusing the offer, the worker's entitlement to modifier benefits expired. They argued the worker's bad faith/unfair claims processing claim was without merit (para 7).

Legal Issues

• Whether the employer engaged in unfair claims processing practice by unilaterally reducing the worker's PPD benefits upon the worker's non-acceptance of a return to work offer that exceeded his physical limitations (para 1).
• Whether the WCJ erred in using the worker's physical capacity of "Light" to determine the reasonableness of the worker's rejection of the return to work offer, instead of the actual restrictions placed by the healthcare provider (para 9).

Disposition

• The Court of Appeals affirmed the WCJ's order partially denying the employer's motion for reconsideration (para 19).

Reasons

• The Court of Appeals, per Judge Michael E. Vigil, with Judges M. Monica Zamora and Henry M. Bohnhoff concurring, found that the employer waived its right to challenge the WCJ's award of modifier-based PPD to the worker by abandoning its appeal of the Compensation Order. The court held that the employer was required to continue paying modifier-based PPD benefits until a specified condition occurred. The WCJ did not abuse its discretion in finding the employer engaged in unfair claims processing practices by suspending payments without a court order and in reducing the penalty awarded to the worker based on the evidence presented. The court concluded that the employer's actions resulted in an unreasonable delay in the payment of benefits to the worker (paras 13-18).