Chavez v. Mountain States Constructors

• Citation: 122 N.M. 579,929 P.2d 971,1996 NMSC 70
• Decision Date: 02 December 1996
• Docket Number: No. 22865,22865
• Parties: Richard CHAVEZ, Claimant-Petitioner, v. MOUNTAIN STATES CONSTRUCTORS, employer, and Mountain States Mutual Casualty Company, insurer, Employer-Insurer-Respondents.
• Court: Supreme Court of New Mexico

Page 971

929 P.2d 971

122 N.M. 579

Richard CHAVEZ, Claimant-Petitioner, v. MOUNTAIN STATES CONSTRUCTORS, employer, and Mountain States

Mutual Casualty Company, insurer,

Employer-Insurer-Respondents.

No. 22865.

Supreme Court of New Mexico.

Dec. 2, 1996.

[122 N.M. 580] Elizabeth Gabriel, Albuquerque, for Claimant-Petitioner.

Robert C. Collins and Donald C. Clifford, Albuquerque, for Employer-Insurer-Respondents.

OPINION

FRANCHINI, Justice.

As a consequence of a work-related truck accident, Richard Chavez incurred mental injuries that rendered him totally disabled. He was denied any benefits for his mental injuries because the Workers' Compensation Judge (WCJ) believed that recovery was barred by NMSA 1978, § 52-1-24 (Repl.Pamp.1991),¹ the portion of the Workers' Compensation Act that governs mental impairments. The WCJ and, on Chavez's appeal, the majority opinion of the Court of Appeals, concluded that Section 52-1-24 barred recovery because Chavez suffered both physical and mental injuries, Chavez did not prove his mental injuries resulted from his physical injuries, and the Legislature intended to preclude recovery on such facts.

We conclude that under Section 52-1-24(B) of the Workers' Compensation Act, Chavez's truck accident qualifies as a "traumatic event that is generally outside of a worker's usual experience and would evoke significant symptoms of distress in a worker in similar circumstances." We further hold that, even though Chavez suffered physical as well as mental injuries, he is not barred from receiving benefits by the stipulation in Section 52-1-24(B) that the mental injury involve "no physical injury." We reverse the Court of Appeals and hold that Chavez may receive workers' compensation benefits for his mental injuries.

I. FACTS

Chavez was employed as a truck driver by Mountain States Constructors, Inc. On April 13, 1989, he was driving a loaded dump truck on a downgrade when the brakes apparently failed to work properly. As he attempted to negotiate the speeding truck around a curve, the vehicle rolled and landed on its side.

Chavez incurred several physical injuries from the accident. He received twenty-eight stitches in the emergency room for two severe lacerations to his head. Also, the muscles and tendons surrounding his right shoulder joint--a physiological structure known as the rotator cuff--were torn. See 4 J.E. Schmidt, Attorneys' Dictionary of Medicine and Word Finder at R-192 (1996) (defining rotator cuff).

After reparative surgery and physical therapy, Chavez was found, under American Medical Association guidelines, to have a permanent thirty-percent impairment of the use of his right shoulder. Because of his rotator-cuff injury, he was declared eligible for forty-eight percent of what he would receive if he were totally disabled, as calculated according to the formulae of the Workers' Compensation Act. See NMSA 1978, §§ 52-1-26(C), -41, -42 (Repl.Pamp.1991) (formulae). However, Chavez also displayed symptoms of mental impairment that were not present before the accident. Although these mental injuries rendered him totally disabled, they were not taken into account in computing his award for benefits.

On August 7, 1991, Chavez filed a workers' compensation claim for total disability benefits and medical expenses. He sought to be compensated for the physical injuries that rendered him partially disabled and the mental injuries that rendered him totally disabled. Mountain States contested his claim of total disability. After a mediation conference on September 12, 1991, the Workers' Compensation Mediator found that Chavez's injuries were "solely of a physical nature" and that his "neuropsychological problems have not been established, by anything resembling medical probability, to be causally connected to the accident of April 13, 1989." Chavez v. Mountain States Constructors, N.M. Workers' Compensation Admin., W CA No. 89-03931, p 4(b) (Sept. 18, 1991) (Schoenhaus, Med.) (Mediator's recommended resolution) [Chavez I ].

Chavez rejected this recommendation. Thereafter, he brought his case before a WCJ who conducted a series of formal hearings over the course of a year from August 10, 1992 to August 31, 1993. Several experts in psychology and psychiatry provided evidence regarding Chavez's mental impairment. Based upon the evidence presented by these experts, the WCJ concluded that Chavez suffered from Ganser's Syndrome. See Chavez v. Mountain States Constr., N.M. Workers' Compensation Admin., W CA No. 89-03931, at 1 (Dec. 30, 1993) (Griego, WCJ) (memorandum opinion) [hereinafter Chavez II ].

Ganser's Syndrome is "[a] condition marked by absurd acts on the part of the patient and by seemingly relevant but inaccurate answers to simple questions." 2 Schmidt, supra, at G-17. For example, when asked the colors of the United States flag Chavez responded white, blue, and pink. Letter from John M. Rhodes, Ph.D., Neuropsychology Assocs., to Tom Howell, Mountain States Casualty (March 24, 1990). When asked the number of days in a week he said there were six. Letter from Dr. Gerald S Fredman, psychiatrist, to Thomas E. Howell, Mountain States Mutual (July 15, 1991). Neurologic examinations established that there was no physical injury to Chavez's brain that would account for his mental impairment. The WCJ concluded that the Ganser's Syndrome was causally related to the dump truck accident and that Chavez was rendered unable to engage in any type of work without constant supervision.

Despite the debilitating nature of Chavez's mental impairment, the WCJ denied Chavez's claim for total disability benefits, and concluded that Ganser's Syndrome was not a compensable form of mental impairment as defined in the Workers' Compensation Act. Chavez II at 2 (discussing Section 52-1-24(B), (C)). In a compensation order issued February 11, 1994, the WCJ awarded Chavez forty-eight percent of his maximum weekly benefit for the physical injuries and denied any benefits for the Ganser's Syndrome. Chavez v. Mountain States Constr., N.M. Workers' Compensation Admin., W CA No. 89-03931, Conclusions of Law 7-11, 16 (Feb. 11, 1994) (Griego, WCJ) (compensation order) [hereinafter Chavez III ].

Chavez appealed to the Court of Appeals on March 11, 1994. Chavez disputed the denial of benefits from the Ganser's Syndrome but did not contest the award of benefits attributable to his physical injuries. In an opinion to which Judge Donnelly dissented, the Court of Appeals affirmed the WCJ's ruling. Chavez v. Mountain States Constr., 119 N.M. 792, 793, 895 P.2d 1333, 1334 (Ct.App.1995) [hereinafter Chavez IV ]. Upon Chavez's appeal, we granted certiorari. Chavez v. Mountain States Constr., 119 N.M. 810, 896 P.2d 490 (1995). We now reverse the determinations of the WCJ and the Court of Appeals.

II. STATUTE IN QUESTION

The types of mental impairment that trigger eligibility for workers' compensation are set forth in Section 52-1-24 of the Workers' Compensation Act:

As used in the Workers' Compensation Act [Chapter 52, Article 1 NMSA 1978]:

....

B. "primary mental impairment" means a mental illness arising from an accidental injury arising out of and in the course of employment when the accidental injury involves no physical injury and consists of a psychologically traumatic event that is generally outside of a worker's usual experience and would evoke significant symptoms of distress in a worker in similar circumstances, but is not an event in connection with disciplinary, corrective or job evaluation action or cessation of the worker's employment; and

C. "secondary mental impairment" means a mental illness resulting from a physical impairment caused by an accidental injury arising out of and in the course of employment.

(Emphasis added.)

The WCJ, in discussing Chavez's mental impairment, determined that "based on the evidence presented at trial ... Worker suffers from Ganser's Syndrome. Worker is rendered totally disabled by reason of Ganser's Syndrome. The Ganser's Syndrome is causally related to the work accident of April 13, 1989." Chavez II at 1. Nevertheless, the WCJ concluded, and the Court of Appeals affirmed, that Chavez's Ganser's Syndrome does not fall within the statutory definitions of either primary or secondary mental impairment. Id. at 2; Chavez III at 6.

Chavez's malady was found not to be a primary mental impairment for two reasons. First, the WCJ stated and the Majority of the Court of Appeals agreed, without explaining their reasoning, that the truck accident was not a "psychologically traumatic event that is generally outside of a worker's usual experience". Section 52-1-24(B). Further, they found no evidence showing a similar truck accident "would evoke significant symptoms of distress in a worker." Id. Apparently, the WCJ and the Court found that the rolling of the truck was not a sufficiently traumatic event to explain Chavez's mental impairment. See Chavez IV, 119 N.M. at 793, 795, 895 P.2d at 1334, 1336; Chavez II at 2.

Second, the Court stated that Chavez's Ganser's Syndrome was precluded from being a primary mental impairment by the words "when the accidental injury involves no physical injury." The Court concluded that these words meant that a primary mental impairment occurred only when there is no physical injury whatsoever; the presence of any physical injury removed any accompanying mental impairment from the definition of "primary mental impairment," even if the mental injuries were not causally connected to the physical injuries. Chavez IV, 119 N.M. at 794, 795, 895 P.2d at 1335, 1336. The WCJ made no explicit reference to this portion of Section 52-1-24(B) though he suggested that "The Ganser's Syndrome does not derive from a physical impairment caused by an accidental injury, but is rather directly related to the accident of April 13, 1989." Chavez II at 1-2.

Additionally, the WCJ and the Court of Appeals concluded that Chavez's Ganser's Syndrome was...