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 registered nurse working at the University of New Mexico Hospital injured her back while lifting and turning a patient in October 1994. Disputes arose regarding compensable injuries, changes in treating physicians, refusal of payment for necessary medical services, and improper curtailment of benefits and medical services. Following a trial and subsequent hearings, a Workers' Compensation Judge (WCJ) appointed an independent nurse case manager to coordinate the worker's future medical treatments (paras 2-6).

Procedural History

• Workers’ Compensation Administration, June 3, 1996: WCJ Wiltgen concluded the worker suffered permanent injuries from the October 1994 accident and had a continuing need for medical care (para 3).
• Workers’ Compensation Administration, October 27, 1999: WCJ Wiltgen appointed Ms. St. Martin as an independent nurse case manager (para 4).
• Workers’ Compensation Administration, February 22, 2006: A final compensation order was filed, determining the worker suffered multiple injuries from the 1994 accident and required future medical treatment, with Ms. St. Martin to continue as the nurse case manager (para 6).

Parties' Submissions

• Employer/Insurer-Appellant: Argued that the appointment of Ms. St. Martin as a nurse case manager violated the Procurement Code because her employer’s contract with the WCA had expired. They contended that a WCJ cannot order case management that circumvents the system and exceeds the WCJ’s authority (paras 7, 8).
• Worker-Appellee: Contended that the issues were not preserved for appeal, arguing that the employer had complied with Ms. St. Martin's appointment for fifteen years without incident. The worker also argued that the WCJ’s order falls within the Procurement Code’s litigation exemption (para 9).

Legal Issues

• Whether the appointment of a case manager for ongoing coordination of health care services by a WCJ constitutes a “litigation expense” exempt from the Procurement Code (para 1).
• Whether the WCJ’s order appointing Ms. St. Martin as a nurse case manager violated the Procurement Code due to the absence of a contract (para 18).

Disposition

• The order of the WCJ appointing Ms. St. Martin to continue as Worker’s case manager was reversed (para 22).

Reasons

• The Court of Appeals, per Chief Judge Michael E. Vigil, with Judges Michael D. Bustamante and J. Miles Hanisee concurring, found that the services provided by a case manager under the Workers’ Compensation Act do not constitute a “litigation expense” as they are not incurred directly in connection with litigation but are a consequence of litigation for ongoing coordination of healthcare services. The court concluded that a WCJ cannot exceed statutory authority by ordering the continuation of a case manager's services in the absence of a contract under the Procurement Code, despite the practical benefits of such an appointment (paras 14-21).