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

• In March 2011, a physical therapist assistant was injured when a patient fell on her, resulting in a fracture. She received temporary total disability benefits and returned to work with a 3 percent whole person impairment rating. After moving to Michigan and experiencing ongoing pain, she was diagnosed with chronic active sacroiliitis and a labral tear in her left hip. She filed a complaint seeking benefits for her conditions, which she attributed to her 2011 work accident (paras 2-4).

Procedural History

• Workers’ Compensation Administration, Terry Kramer, WCJ, April 17, 2012: Approved a lump sum settlement agreement for the worker (para 2).
• Workers’ Compensation Administration, November 23, 2016: Issued a compensation order finding the worker was not at maximum medical improvement (MMI) for injuries caused by the work accident and entitled to ongoing medical care, but did not include a labral tear and cyst as part of the injuries (para 7).
• Workers’ Compensation Administration, Rachel A. Bayless, WCJ, 2018: Issued a compensation order concluding that the medical providers treating the worker for her labral tear were not authorized health care providers (HCPs) and denied coverage for the hip surgery (para 11).

Parties' Submissions

• Worker-Appellant: Argued that the Workers’ Compensation Judge (WCJ) erred in denying coverage for hip surgery, improperly weighed treating physicians' testimony, and made errors in resetting the trial for an independent medical evaluation (IME). Also contended that the whole record review does not support the WCJ’s decision to deny coverage for the hip surgery (paras 12-13).
• Employer/Insurer-Appellees: Objected to the worker receiving treatment from an out-of-state doctor not licensed in New Mexico and argued that the medical providers treating the worker for her labral tear were not authorized HCPs, leading to the denial of coverage for the hip surgery (paras 5, 9, 22).

Legal Issues

• Whether the WCJ erred in denying coverage for the worker’s hip surgery.
• Whether the WCJ improperly weighed the testimony of the worker’s treating physicians against the IME panel’s opinions.
• Whether the medical providers treating the worker for her labral tear were authorized HCPs under the Workers’ Compensation Act.
• Whether the 2016 compensation order was a final, appealable order (paras 12, 14, 22, 30, 34, 38, 40).

Disposition

• The Workers’ Compensation Judge’s decision to deny coverage for the worker’s hip surgery and related treatment was affirmed (para 53).

Reasons

• The Court of Appeals held that the WCJ did not err in weighing the medical opinions offered in the case, finding that the IME panel had a more complete picture of the worker’s treatment and complaints. It was concluded that Dr. Silas was not an authorized HCP, and the worker did not seek approval for out-of-state HCPs as required. The Court also found that the 2016 compensation order was a final, appealable order, and the worker’s arguments regarding issues determined in the 2016 compensation order were untimely. The Court affirmed the WCJ’s findings and conclusions in the 2018 compensation order, supporting the decision to deny coverage for the hip surgery (paras 14-20, 22-28, 30-33, 34-37, 38-39, 40-51).