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 case involves a worker, Rachel Bris, who suffered work-related injuries affecting her back, hips, and knee. Initially, she sought care from Dr. Legate for her back and hips and from Dr. Racca for her knee. Dr. Legate instructed the worker to continue all her injury care with Dr. Racca, who, according to the worker, was informed of her back and hip injuries but did not provide care or referrals for those injuries. The worker's insurance later denied coverage for all injuries except the knee, after an Independent Medical Exam by Dr. Wascher, which did not thoroughly assess the worker's bilateral hip and low back pain but concluded her right knee had reached maximum medical improvement (MMI) as of October 25, 2016. The worker then sought care for her hip and back from Dr. Franco and Dr. Patton, leading to a dispute over the authorization of Dr. Franco as a health care provider under the New Mexico Worker’s Compensation Act (WCA).

Procedural History

• [Not applicable or not found]

Parties' Submissions

• Employer: Argued that Dr. Franco was not an authorized health care provider (HCP) under the WCA because he was not the worker's initial choice nor a referral from an authorized HCP. They also contended that the worker did not meet her burden of proof as required by the WCA.
• Worker: Responded that Dr. Franco was granted status as an authorized HCP before trial under a procedure authorized by the WCA and its implementing regulations, which allow for a change in HCP if the authorized HCP is not providing the worker with reasonable and necessary medical care.

Legal Issues

• Whether Dr. Franco qualifies as an authorized health care provider under the New Mexico Worker’s Compensation Act.
• Whether the worker met her burden of proof as required by the WCA.

Disposition

• The Court of Appeals affirmed the compensation order finding that the worker's left hip condition was compensable under the New Mexico Worker’s Compensation Act and that Dr. Franco was an authorized health care provider.

Reasons

• Per Henderson, J. (Duffy, J., and Baca, J., concurring): The Court of Appeals conducted a whole record review and found substantial evidence supporting the Workers' Compensation Judge's (WCJ) decision. The court noted that the WCJ had conducted a hearing and issued an order granting Dr. Franco status as an authorized HCP based on the procedure outlined in the WCA and its implementing regulations. This procedure allows for a change in HCP if the authorized HCP is not providing reasonable and necessary medical care, which was proven in this case. The court found no error in the WCJ’s decision to grant Dr. Franco authorized HCP status, as there was substantial evidence in the record to support the conclusion that Dr. Racca was not providing reasonable and necessary care for all of the worker's injuries stemming from her work-related accident. The court also found no error in admitting Dr. Franco's deposition testimony and affirmed the WCJ’s order based on substantial evidence supporting Dr. Franco's authorization as an HCP (paras 2-9).