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

• The Worker suffered a work-related injury to his wrists and elbows, qualifying for medical cannabis under the Lynn and Erin Compassionate Use Act. The Worker purchased medical cannabis for $453.05 and sought reimbursement from the Employer/Insurer, who reimbursed $108.18 based on the Workers’ Compensation Administration's fee schedule. The Worker requested the difference between the cost and the reimbursement amount (para 2).

Procedural History

• [Not applicable or not found]

Parties' Submissions

• Worker-Appellant: Argued that under NMSA 1978, Section 52-1-49(A) of the Workers’ Compensation Act, he is entitled to full reimbursement for out-of-pocket medical cannabis expenses. Contended that the fee schedule limiting reimbursement conflicts with the Act's requirement to provide necessary health care services (paras 4, 6).
• Employer/Insurer-Appellees: Argued that the Act does not specify full coverage of health care services costs by the employer. Highlighted the Act's intent for efficient delivery of benefits at a reasonable cost to employers and noted that the fee schedule and administrative rules establish caps on reimbursements, including for medical cannabis (paras 7-8).

Legal Issues

• Whether the Workers’ Compensation Act requires full reimbursement of the Worker's out-of-pocket medical cannabis costs.
• Whether the administrative rule establishing a fee schedule for medical cannabis reimbursement applies to the Worker's case.

Disposition

• The Court of Appeals affirmed the Workers’ Compensation Judge’s denial of the Worker's request for full reimbursement of out-of-pocket costs for medical cannabis (para 1).

Reasons

• The Court found the Worker's argument that the Workers’ Compensation Act requires full reimbursement for medical cannabis costs unpersuasive. It held that the Act, when read in conjunction with Section 52-4-5, does not obligate the employer to cover costs beyond the maximum allowable payment established in the fee schedule. The Court also found the Worker's argument that the administrative rule does not apply to his case unpreserved for review, as it was not raised before the Workers’ Compensation Judge (paras 5-11).