Hall v. Carlsbad Supermarket/Iga

• Decision Date: 06 December 2007
• Docket Number: No. 26,538.,26,538.
• Citation: 177 P.3d 530,2008 NMCA 026
• Parties: Esther HALL, Worker-Appellee, v. CARLSBAD SUPERMARKET/IGA, and Food Industry Self Insurance Fund of New Mexico, Employer/Insurer-Appellants.
• Court: Court of Appeals of New Mexico

177 P.3d 530

2008 NMCA 026

Esther HALL, Worker-Appellee, v. CARLSBAD SUPERMARKET/IGA, and Food Industry Self Insurance Fund of New Mexico, Employer/Insurer-Appellants.

No. 26,538.

Court of Appeals of New Mexico.

December 6, 2007.

Jeff Diamond Law Firm, Jeffrey B. Diamond, Greta Fischer, Carlsbad, NM, for Appellee.

Modrall, Sperling, Roehl, Harris & Sisk, P.A., Max J. Madrid, Emil J. Kiehne, Albuquerque, NM, for Appellants.

OPINION

VIGIL, Judge.

{1} This case presents an issue of first impression under the Workers' Compensation Act (the Act), NMSA 1978, §§ 52-1-1 to -70 (1929, as amended through 2007): Does a doctor who performs an independent medical examination (IME) under Section 52-1-51, pursuant to the parties' agreement, exceed the scope of his authority when he diagnoses injuries not specifically identified in the agreement and concludes they were caused by the on-the-job accident? We hold that the doctor did not exceed the scope of the IME and that the worker's compensation judge (WCJ) did not err by considering the information in awarding benefits. We also consider whether the parties' agreement precluded Worker from raising the newly diagnosed injuries in an amended workers' compensation claim, and hold that Worker was not precluded from seeking compensation for her newly diagnosed work injuries. We therefore affirm the WCJ's compensation order.

I. BACKGROUND

{2} Worker is an elderly woman who worked at Carlsbad Supermarket (Employer) in the deli section of the store. She injured her knee and back when she fell while carrying supplies to the deli. Worker was diagnosed with a fracture to her patella and lower back lumbar strain, and Employer paid the costs of her medical care and provided disability benefits with respect to these injuries. Worker also complained of middle back thoracic back pain to Dr. Baca, her authorized healthcare provider. Dr. Baca diagnosed Worker's back pain as resulting from a compression fracture of Worker's T12 vertebra, and attributed the subtle wedging of Worker's T12 vertebra to Worker's on-the-job accident. Dr. Baca also determined that, as of February 4, 2004, Worker had reached maximum medical improvement.

{8} Employer denied Worker's request for benefits for the T12 compression fracture, disputing that the injury was causally related to the workplace accident. Worker filed a workers' compensation complaint and then a first amended complaint. After the first amended complaint was filed, the parties attended mediation and a recommended resolution was issued by the mediator and agreed to by the parties in pertinent part the recommended resolution states, "Wile primary issue in this case is whether Worker's T12 compression fracture is related to the on-the-job accidental injury(,]." and "as a compromise, interim resolution" provides (1) that the parties agreed that Worker had reached maximum medical improvement as of February 4, 2004, and (2) that Worker will receive an IME to be performed by Dr. Nieves "to obtain an independent opinion of whether the T12 compression fracture is related to the on-the-job accidental injury." The recommended resolution also contains a provision providing that "[b]oth parties reserve and retain all rights and defenses regarding the claim for additional permanent partial disability benefits."

{4} On February 7, 2005, Dr. Nieves performed the IME of Worker and concluded that, while Worker had a T12 compression fracture, it was not causally related to her workplace accident because it predated the accident. However, in the course of his examination, Dr. Nieves identified injuries to Worker's sacrum, and diagnosed Worker with sacroiliac joint dysfunction and radiculitis as a result of her on-the-job injury. Dr. Nieves further concluded that Worker had not reached maximum medical improvement from her injuries.

{5} Worker then filed a second amended complaint based on the IME, seeking temporary total disability and permanent partial disability benefits, in addition to medical benefits and attorney fees. Another recommended resolution was proposed, which Worker rejected, and the case proceeded to a compensation hearing before the WCJ.

{6} At the compensation hearing, Employer objected to Dr. Nieves's opinions as exceeding the scope of the IME agreed to in the recommended resolution. Employer also contended that Worker was precluded from raising new injuries by the recommended resolution which, according to Employer, limited the issues in dispute to the causal relation of the T12 compression fracture to Worker's workplace accident. The WCJ determined that, based on the language contained in the recommended resolution, Worker was not limited to the issue of the T12 fracture. Accordingly, the WCJ considered Dr. Nieves's opinions about the newly diagnosed injuries in determining his compensation award to Worker. This appeal followed.

II. DISCUSSION

{7} The issues Employer raises on appeal require us to interpret several provisions of the Act. In interpreting a statute, our review is de novo. Smith v. Ariz. Pub Sera Co., 2003-NMCA-097, ¶ 5, 134 N.M. 202, 75 P.3d 418. "Our main goal in statutory construction is to give effect to the intent of the legislature." Archer v. Roadrunner Trucking, Inc., 1997-NMSC-003, ¶ 7, 122 N.M. 703, 930 P.2d 1155. "We look first to the plain meaning of the statute's words, and we construe the provisions of the Act together to produce a harmonious whole." Smith, 2003-NMCA-097, ¶ 5, 134 N.M. 202, 75 P.3d 418. After we determine the meaning of the statutes, "we review the whole record to determine whether the WCJ's findings and award are supported by substantial evidence." Id.

A. Testimony of Independent Medical Examiner

{8} Employer argues on appeal that the WCJ erred by considering Dr. Nieves's testimony to the extent it went beyond the causal relationship between Worker's T12 compression fracture and the on-the-job accident. Employer also challenges the WCJ's determination, based on Dr. Nieves's testimony, that Worker was suffering from a sacral fracture, aggravation of bulging discs, and sacroiliac joint dysfunction, as a result of her on-the-job injury.

{9} To determine whether or not the WCJ erred by considering Dr. Nieves's testimony regarding injuries other than the T12 compression fracture, we must determine if Dr. Nieves was authorized to provide the testimony pursuant to the Act. We conclude that Dr. Nieves was authorized to provide the challenged testimony and therefore hold that the WCJ did not err by considering Dr. Nieves's opinions on issues other than Worker's T12 compression fracture.

{10} The Act limits the testimony that can be provided by medical experts at a workers' compensation hearing to testimony by "a treating physician or a health care provider who has provided an independent medical examination pursuant to the Act." Banks v. IMC Kalium Carlsbad Potash Co., 2003-NMSC-026, ¶ 28, 134 N.M. 421, 77 P.3d 1014; see also § 52-1-51(C). The provision of the Act dealing with IMEs provides that, "[i]n the event of a dispute between the parties concerning any medical issue, if the parties cannot agree upon the use of a specific independent medical examiner, either party may petition a workers' compensation judge for permission to have the worker undergo an independent medical examination." § 52-1-51(A).¹ This provision provides two means by which an IME may be obtained: (1) by the agreement of the parties or (2) by order of the WCJ. Id.

{¶} In this case, the parties agreed as part of the recommended resolution for an IME to be performed by Dr. Nieves in order to "obtain an independent opinion of whether the T12 compression fracture [was] related to the on-the-job accidental injury." Employer argues that, although the parties agreed that Dr. Nieves would conduct an IME of Worker, Dr. Nieves exceeded the scope of the authority conveyed to him by not limiting his examination or opinions to the T12 compression fracture. According to Employer, the above-quoted language of the recommended resolution operated to limit the scope of the IME solely to the causal relationship between the T12 compression fracture and Worker's accidental on-the-job injury, and Dr. Nieves's opinions regarding other back-related injuries caused by Worker's accident were outside the scope of the parties' agreement.

{12} Neither this Court nor our Supreme Court have had the occasion to consider whether and how the parties may limit the authority of an independent medical examiner when an IME is conducted pursuant to the agreement of the parties. Although Section 52-1-51 appears to contemplate circumstances in which parties may enter into agreements to have an IME conducted, the Act provides no provisions specifically addressing what must be contained in the agreement. Nor does Rule 1-035 NMRA, governing IMEs in civil proceedings before the district courts, provide us with guidance for resolving the matter before us, as Rule 1-035 only applies in circumstances where a court has ordered an IME be conducted. See State ex rel. Miller v. Tackett, 68 N.M. 318, 321, 361 P.2d 724, 726 (1961).

{13} Employer argues that we should rely on principles of contractual interpretation to determine the extent of the authority the parties bestowed on Dr. Nieves through the agreed upon recommended resolution. Worker disagrees, arguing that a recommended resolution is not a contract but an informal order that becomes binding if not contested, and thus principles of contractual interpretation are inapplicable. We previously held in Norman v. Lockheed Engineering & Science Co., 112 N.M. 618, 620-21, 817 P.2d 1260, 1262-63 (Ct.App.1991), that a conclusively binding recommended resolution was tantamount to a compensation order. We also recently stated in Benavidez v. Benavidez, 2006-NMCA-138, ¶ 8, 140 N.M. 637, 145 P.3d 117 (quoting Lone Star Cement Corp. v. Fair, 467 S.W.2d 402, 404-05 (Tex. 1971)), that "[t]he `same rules of interpretation...